Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.

Changes in maladaptive cognitions may constitute therapeutic processes of multidisciplinary pain programs. A cross-lagged panel design was used to determine whether (a) early-treatment cognitive change predicted late-treatment outcome index change, but not vice versa; and (b) these effects remained significant with depression change controlled. Ninety chronic pain patients, in a 4-week multidisciplinary program, completed measures of catastrophizing, pain helplessness, depression, pain, interference, and activity level at pre-, mid-, and posttreatment. With depression changes controlled, early-treatment catastrophizing and pain helplessness changes predicted late-treatment outcome index changes, but not vice versa; early-treatment depression changes predicted late-treatment activity changes, but not vice versa. Findings advance understanding of pain treatment process and suggest that negative cognition changes may indeed affect improvements in treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing a Model of Pain Appraisal and Coping in Children With Chronic Abdominal Pain.

This prospective study of children with recurrent abdominal pain (N=133; ages 8-15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-specific passive coping and long-term symptoms and disability. Accommodative coping (acceptance and self-encouragement) was associated with reduced episode-specific distress, which itself predicted reduced depressive symptoms 3 months later. Results suggest that coping-skill interventions for children with chronic pain should target reductions in passive coping and consider the potential benefits of accommodative coping strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain Catastrophizing Is Associated With Health Indices in Musculoskeletal Pain: A Cross-Sectional Study in the Dutch Community.

Cross-sectional associations were examined between pain catastrophizing and several health indices in 1,164 people with musculoskeletal pain from a Dutch community sample. Health indices included in the present study were specialist consultation, use of medication, and absenteeism or work disability. The results demonstrate that for people with a current episode of musculoskeletal pain, pain catastrophizing, pain intensity, and the presence of multiple pain locations were significantly associated with specialist consultation, use of pain medication, and absenteeism or work disability. The authors conclude that the role of pain itself has perhaps been underestimated in recent models of chronic pain-related disability. Some clinical implications and suggestions for further research are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients (aged 21–64 yrs) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 mo after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of disability claimants' coping styles on judgments of pain, disability, and compensation: A vignette study.

Because insurance adjusters' decisions about whether to grant compensation to disability claimants are often based on subjective criteria, such decisions may be susceptible to the influence of factors irrelevant to the claimant's disabling condition. This study examined whether judgments about compensation claimants are affected by the claimants' way of coping with pain and by claimant sex. Ss were 200 undergraduates. Ss made judgments about vignettes describing fictitious compensation claimants with differing strategies of coping with pain. The main analytic approach involved a multivariate ANOVA with 5 within-subject factors (i.e., coping style described in each of 5 vignettes) and 2 between-subject factors (i.e., sex of claimant described in the vignettes). Coping style was significantly related to perceptions of pain severity and disability and to beliefs about whether compensation should be awarded. Claimants who were described as engaging in catastrophizing or in praying and hoping were more likely than other claimants to be perceived as disabled and as deserving compensation for their injuries. Decisions about disability compensation could be influenced by claimant coping styles… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vitro isolation and characterization of a calicivirus causing a vesicular disease of the hands and feet

Cognitive-behavioral and physical therapies are incorporated into multidisciplinary chronic pain programs because changes in pain cognitions and physical capacity may represent therapeutic processes that facilitate favorable outcome. Decreases in depression, however, may explain treatment responses more parsimoniously. Measures of pain helplessness, lifting capacity, walking endurance, depression, pain severity, and activity level were collected from 94 chronic pain patients at pre- and posttreatment and at 3- to 6-month follow-up evaluations. Decreases in pain helplessness were linked to pain severity reduction, whereas walking endurance increases were related to improvements in activity levels and downtime even after controlling for effects of depression decreases. Thus, cognitive and physical capacity changes that occur through pain treatment may make unique contributions to long-term outcome.     

Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain.

Cognitive–behavioral and physical therapies are incorporated into multidisciplinary chronic pain programs because changes in pain cognitions and physical capacity may represent therapeutic processes that facilitate favorable outcome. Decreases in depression, however, may explain treatment responses more parsimoniously. Measures of pain helplessness, lifting capacity, walking endurance, depression, pain severity, and activity level were collected from 94 chronic pain patients at pre- and posttreatment and at 3- to 6-month follow-up evaluations. Decreases in pain helplessness were linked to pain severity reduction, whereas walking endurance increases were related to improvements in activity levels and downtime even after controlling for effects of depression decreases. Thus, cognitive and physical capacity changes that occur through pain treatment may make unique contributions to long-term outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute and chronic low back pain: Cognitive, affective, and behavioral dimensions.

Despite strong suppositions concerning differences between patients suffering acute and chronic low back pain, relatively few data-based comparisons have been made. In this study, affective, cognitive, behavioral, and demographic contrasts were conducted. Chronic patients were divided into those who demonstrated signs and symptoms that were either congruent or incongruent with underlying anatomical and physiological principles. Low SES, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more characteristic of both acute and chronic incongruent patients than chronic congruent patients. A relatively stereotyped, spontaneous facial expression of pain was observed in all groups when responding to painful movements during a physical examination. The similarities between acute and chronic incongruent patients have implications for the assessment and treatment of low back pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based management of chronic pelvic pain

Diagnosis and management of chronic pelvic pain are greatly facilitated by a multidisciplinary approach integrating medical intervention with identification and management of socioenvironmental problems, cognitive-behavioral pain strategies, and treatment of concurrent psychological morbidity. Available evidence suggests that outcomes, including pain severity, general health and functional status, and disability are more significantly improved after this approach than after isolated medical or surgical interventions. Because of the chronic nature of many of the underlying psychological and social factors predisposing to chronic symptom formation and maintenance, care of the patient with chronic pelvic pain must be continuous and longitudinal if recurrent adverse sequelae, including disability, inappropriate healthcare utilization, and recurrent depression, are to be prevented.     

Catastrophizing, acceptance, and interference: Laboratory findings, subjective report, and pain willingness as a moderator.

Objective: The present study investigated the effects of both catastrophizing and the pain willingness component of acceptance on interference in daily activities and task performance during experimentally induced ischemic pain. In addition, the potential moderating role of pain willingness on the relationship between catastrophizing and degree of pain interference was also examined. Design: Sixty-seven persons with chronic low back pain completed measures of catastrophizing, acceptance, and daily pain interference. Participants underwent an ischemic pain induction procedure during which a Stroop-like task was administered. Main Outcome Measures: Self-reported pain interference and observed performance on a Stroop-like task during induced pain. Results: The pain willingness component of acceptance and catastrophizing both contributed significantly to self-reports of pain interference. However, levels of pain willingness had an effect much stronger than the negative effects associated with catastrophizing with respect to observed pain interference during induced pain. Results also indicated that pain willingness serves as a moderator in the relationship between catastrophizing and task performance during induced pain. Conclusion: The pain willingness factor of acceptance and catastrophizing both appear to be strong predictors for self-reported pain interference. During an objective assessment of pain interference, however, pain willingness shows a stronger effect and attenuates the negative impact of catastrophizing on task functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological resilience predicts decreases in pain catastrophizing through positive emotions.

The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that independent of level of neuroticism, negative emotions, pain intensity, income, and age, high-resilient individuals reported greater positive emotions and exhibited lower day-to-day pain catastrophizing compared with low-resilient individuals. Mediation analyses revealed that psychologically resilient individuals rebound from daily pain catastrophizing through experiences of positive emotion. Implications for research on psychological resilience, pain catastrophizing, and positive emotions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors affecting depression among people with chronic musculoskeletal pain: A structural equation model.

Objective: To adapt and test P. M. Lewinsohn, H. M. Hoberman, L. Teri, and M. Hautzinger's (1985) integrative model of depression for individuals with chronic musculoskeletal pain. Design: Structural equation modeling. Participants: Individuals with chronic pain (N = 171), recruited from 6 outpatient rehabilitation facilities in Canada. Outcome Measures: Two measures of the latent variable, depression (the Center for Epidemiologic Studies-Depression Scale and the Zung Self-Rating Depression Scale), along with multiple measures of each of 5 latent predictors (pain, interferences, stress, coping, and social and family support) and 2 measured predictors (preinjury psychopathology and catastrophizing). Results: The normed fit index, comparative fit index, and parsimony ratio indicated an adequate fit for the model, suggesting that stress, perceived severity of pain, activity interferences, and catastrophizing contributed to increased depression (vulnerabilities), whereas pain coping skills and social and family support contributed to decreased depression (immunities). Conclusions: Empirical support was found for the proposed model of depression for people with chronic musculoskeletal pain, and the model appears to provide useful information for clinical rehabilitation interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in coping style and treatment outcome following motor vehicle accident.

Background: Motor vehicle accidents (MVAs) are highly prevalent and can result in a complex interplay of physical injury, disability, and emotional distress. It has been suggested that the manner in which individuals cope with pain experienced after injury may determine how much recovery of function can be achieved. Only a limited number of studies have examined this process in the context of a rehabilitation program, and to date few studies have examined both functional and quality of life outcomes in MVA recovery in a tertiary level program as a function of coping style. Methods: A sample of 96 consecutive referrals to a tertiary-level multidisciplinary functional restoration program completed physical performance measures pre- and post-treatment, as well as a standardized self-report measure of quality of life (QOL) at the same time points and 6-month follow-up. Results: Findings suggested that improvements from pre- to post-treatment were evident on the 6-minute walk test, left and right grip strength, and most QOL measures. Increases in active coping during treatment were associated with pre- to post-treatment increases in QOL across most domains, and improvements in performance on the 6-minute walk test. Likewise, decreases in passive coping during the course of treatment were associated with improved performance on the 6-minute walk test, right-handed standing reach test, and most QOL indicators. Conclusion: Findings suggest that those who adopt an active approach (and avoid taking a passive approach) to rehabilitation following complex musculoskeletal injury benefit along both QOL and functional dimensions relative to those who do not. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Protective and exacerbating factors in children and adolescents with fibromyalgia.

Objective: To investigate protective and exacerbating factors in the adjustment of youth with juvenile primary fibromyalgia syndrome (JPFS), we examined the relationship of stress, coping strategies, social support, and self-efficacy to quality of life, pain, and depression. Method: Participants were 57 youths (ages 10 to 18 years) and their parents from rheumatology clinics at 2 children's hospitals. The youths self-reported daily hassles, coping strategies, social support, self-efficacy, quality of life, pain, and depression. Parents reported on the youths' major life events and quality of life. Results: In regression analyses, daily hassles, catastrophizing (a coping strategies scale), and self-efficacy predicted child-rated quality of life; self-efficacy predicted pain; and daily hassles predicted depression. Self-efficacy and familial social support moderated the relationship between daily hassles and depression. Conclusions: Daily hassles may be associated with health outcomes for youth with JPFS more than major life events are, and catastrophic thinking and self-efficacy beliefs could be appropriate intervention targets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression history and coping with chronic pain: A daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological factors in chronic pain: Evolution and revolution.

Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on research implicating the importance of people's appraisals of their symptoms, their ability to self-manage pain and related problems, and their fears about pain and injury that motivate efforts to avoid exacerbation of symptoms and further injury or reinjury. They provide a selected review to illustrate treatment outcome research, methodological issues, practical, and clinical issues to identify promising directions. Although there remain obstacles, there are also opportunities for psychologists to contribute to improved understanding of pain and treatment of people who suffer from chronic pain. The authors conclude by noting that pain has received a tremendous amount of attention culminating in the passage of a law by the U.S. Congress designating the period 2001-2011 as the "The Decade of Pain Control and Research." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chronology and sequence of eruption of human permanent teeth in Northern Ireland

OBJECTIVE: To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. METHODS: A group of 157 people with pain "in the last month" was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method. RESULTS: People with chronic pain used relatively more "resting," and "reducing demands" as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found. CONCLUSION: We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of "resting" and a physically active lifestyle are independently associated with less physical disability.     

Feasibility of a Cognitive Restructuring Intervention for Treatment of Chronic Pain in Persons With Disabilities.

Objective: To determine the feasibility of a cognitive restructuring intervention relative to an education intervention for treatment of pain in persons with chronic pain secondary to disability. Study Design: Quasi-experimental. Participants: 18 adults with chronic pain and disability. Interventions: Cognitive restructuring (n = 13) or education (n = 5) group intervention. Main Outcome Measure: Average pain intensity. Results: Participants in the cognitive group reported greater pre- to posttreatment decreases in pain than those in the education group. Participants rated both interventions positively and expressed enthusiasm for psychosocial interventions for pain. Conclusions: Preliminary findings suggest that decreases in pain can occur as a result of a cognitive restructuring intervention and support the feasibility of conducting intervention trials in persons with disability-related chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Categorizing pain in patients seen in a veterans health administration hospital: Pain as the fifth vital sign.

Previous research has supported the concept of classifying pain intensity into distinct categories (of mild, moderate, and severe) based on the effects of pain on functioning. Such categories, however, have not been studied in samples of veterans. The current study sought to validate the concept of pain intensity classification in a sample of veterans with mixed types of chronic pain. There were 632 veterans referred to a pain program and asked to complete a packet of questionnaires that included a 0 to 10 measure of pain intensity and measures of pain-related interference, depressive symptomatology, and disability. The results indicated that the veterans' ratings of pain at its worst could be classified into the categories of mild, moderate, and severe, with cutpoints of a maximum rating of 3 for mild and 7 for moderate pain. The findings suggest that pain treatment studies of veterans with diverse types of chronic pain should include ratings of pain intensity at its worst that can be reliably classified as mild, moderate, or severe and related to other important outcomes such as daily function and mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)