Linking Nonrestorative Sleep and Activity Interference Through Pain Catastrophizing and Pain Severity: An Intraday Process Model Among Individuals With Fibromyalgia

Abstract Objective To compare pain and psychological outcomes in veterans with chronic musculoskeletal pain and comorbid post-traumatic stress disorder (PTSD) or pain alone and to determine if veterans with comorbidity respond differently to a stepped-care intervention than those with pain alone. Design Secondary analysis of data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial. Setting Six Veterans Health Affairs clinics. Subjects Iraq and Afghanistan veterans (N = 222) with chronic musculoskeletal pain. Methods Longitudinal analysis of veterans with chronic musculoskeletal pain and PTSD or pain alone and available baseline and nine-month trial data. Participants randomized to either usual care or a stepped-care intervention were analyzed. The pain–PTSD comorbidity group screened positive for PTSD and had a PTSD Checklist–Civilian score ≥41 at baseline. Results T tests demonstrated statistically significant differences and worse outcomes on pain severity, pain cognitions, and psychological outcomes in veterans with comorbid pain and PTSD compared with those with pain alone. Analysis of covariance (ANCOVA) modeling change scores from baseline to nine months indicated no statistically significant differences, controlling for PTSD, on pain severity, pain centrality, or pain self-efficacy. Significant differences emerged for pain catastrophizing (t = 3.10, P < 0.01), depression (t = 3.39, P < 0.001), and anxiety (t = 3.80, P < 0.001). The interaction between PTSD and the stepped-care intervention was not significant. Conclusions Veterans with the pain–PTSD comorbidity demonstrated worse pain and psychological outcomes than those with chronic pain alone. These findings indicate a more intense chronic pain experience for veterans when PTSD co-occurs with pain. PTSD did not lead to a differential response to a stepped-care intervention.

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Are mindfulness skills associated with reducing kinesiophobia, pain severity, pain catastrophizing and physical disability? Results of Iranian patients with chronic musculoskeletal pain

Health Psychology Report ◽

10.5114/hpr.2019.84747 ◽

2019 ◽

Author(s):

Sajjad Rezaei ◽

Sedigheh Hassanzadeh

Keyword(s):

Musculoskeletal Pain ◽

Physical Disability ◽

Pain Catastrophizing ◽

Chronic Musculoskeletal Pain ◽

Pain Severity ◽

Mindfulness Skills ◽

Iranian Patients

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Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

Journal of Behavioral Medicine ◽

10.1007/s10865-007-9138-z ◽

2007 ◽

Vol 31 (2) ◽

pp. 105-114 ◽

Cited By ~ 18

Author(s):

Brandy Wolff ◽

John W. Burns ◽

Phillip J. Quartana ◽

Kenneth Lofland ◽

Stephen Bruehl ◽

...

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Pain Severity ◽

Physiological Indexes ◽

Mediation And Moderation

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Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101476 ◽

2020 ◽

Vol 45 (10) ◽

pp. 774-782

Author(s):

Brigitte Brouwer ◽

Sophie Waardenburg ◽

Christian Jacobs ◽

Marjori Overdijk ◽

Carsten Leue ◽

...

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Daily Practice ◽

Integrated Treatment ◽

Pain Severity ◽

Numerical Rating ◽

Treatment Plans ◽

Pain Center ◽

Pain Patients

Background and objectivesChronic pain affects many adults. To improve our daily practice, we need to understand multidisciplinary approaches, integrated treatment plans and the biopsychosocial context of these patients. To date, almost 15 000 chronic pain patients have been referred to the Maastricht University Pain Center in the Netherlands.MethodsThis study describes 11 214 of these patients suffering from chronic pain. Chronic pain was analyzed using relevant Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials instruments.ResultsMost patients were female (59.3%). The prevalence of low education was 59%, and unemployment/disability was 35.9%. The mean age was 55.6 years. Severe pain (Numerical Rating Sale score 7–10) was reported by 71.9% of the patients; psychological and quality of life values deteriorated when pain severity increased. Approximately 36% of patients showed severe signs of depression or anxiety, and 39% displayed high pain catastrophizing. Of all patients, 17.8% reported high values for pain severity, catastrophizing and anxiety or depression.ConclusionsBased on baseline biopsychosocial values, this study shows the complexity of patients referred to pain centers. Pain management with a biopsychosocial approach in an integrated multidisciplinary setting is indispensable. Above all, adjusted education on chronic pain and attention to its biopsychosocial aspects are deemed necessary.

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Psychometric Evaluation and Refinement of the Pain Response Preference Questionnaire

Pain Research and Management ◽

10.1155/2014/532678 ◽

2014 ◽

Vol 19 (1) ◽

pp. 42-48 ◽

Cited By ~ 3

Author(s):

Lachlan A McWilliams ◽

John Kowal ◽

Donald Sharpe ◽

Bruce D Dick

Keyword(s):

Factor Analysis ◽

Pain Catastrophizing ◽

Psychometric Evaluation ◽

Pain Severity ◽

Pain Response ◽

Response Preference ◽

Empirically Supported ◽

Single Scale ◽

Assessment Measure ◽

Potential Clinical Utility

BACKGROUND: The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytical study of the PRPQ produced four empirically supported scales labelled Solicitude, Management, Encouragement and Suppression. A second study produced similar findings, but suggested that the Management and Encouragement scales be combined into a single scale labelled Activity Direction.OBJECTIVES: To use factor analytical methods to evaluate these competing configurations of the PRPQ (ie, three versus four scales) and to further refine the measure. The ability of the PRPQ scales to account for pain severity and disability ratings was also evaluated.METHODS: Chronic pain patients (n=201) completed the PRPQ along with the Pain Catastrophizing Scale (PCS) and self-reports of pain severity and disability.RESULTS: Confirmatory factor analysis indicated that both models tested provided a poor fit to the data. A follow-up exploratory factor analysis was used to further refine the PRPQ scales and resulted in scales labelled Solicitude, Encouragement and Suppression. Supportive of the potential clinical utility of the PRPQ, Suppression was positively associated with pain severity and Solicitude was positively associated with disability. These two scales were also positively associated with the PCS. Supportive of the incremental validity of the PRPQ, a multiple regression analysis indicated that the Solicitude scale accounted for unique variance in disability ratings beyond that accounted for by demographic/clinical variables and the PCS.CONCLUSIONS: The PRPQ has promise as a clinical assessment measure and for advancing research examining the interpersonal context of pain.

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The Effects of Pain Severity, Pain Catastrophizing, Depression, and Exercise on Perceived Disability in Acute Low Back Pain Patients

Research and Theory for Nursing Practice ◽

10.1891/1541-6577.32.4.436 ◽

2018 ◽

Vol 32 (4) ◽

pp. 436-448 ◽

Cited By ~ 2

Author(s):

Elizabeth Salt ◽

Amanda T. Wiggins ◽

Quenten Hooker ◽

Leslie Crofford ◽

Mary Kay Rayens ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Catastrophizing ◽

Behavioral Model ◽

Pain Severity ◽

Cognitive Behavioral ◽

Low Back ◽

Perceived Disability ◽

Acute Low Back Pain ◽

Cognitive Behavioral Model

Background/Purpose: The effectiveness of cognitive treatments for low back pain, a prevalent and costly condition, are commonly based on the principles of the Cognitive Behavioral Model of Fear of Movement/(Re)injury. In this model, persons with a painful injury/experience who also engage in pain catastrophizing are most likely to avoid activity leading to disability. The validation of this model in patients with acute low back is limited. The purpose of this project was to examine the relationship of perceived disability with variables identified in the Cognitive Behavioral Model of Fear of Movement/(Re)injury such as, pain severity, pain catastrophizing, depression, and exercise in persons with acute low back pain. Methods: A multiple linear regression model was used to assess the association of perceived disability with pain severity, pain catastrophizing, depression, and exercise at baseline among subjects with acute low back pain (N = 44) participating in a randomized clinical trial to prevent transition to chronic low back pain. Results: Controlling for age, the overall model was significant for perceived disability (F[5, 35] = 14.2; p < .001). Higher scores of pain catastrophizing (p = .003) and pain severity (p < .001) were associated with higher perceived disability levels. Exercise and depression were not significantly associated with perceived disability. Implications: The use of the Cognitive Behavioral Model of Fear of Movement/(Re)injury in acute LBP patients is appropriate; because this model is commonly used as rationale for the effectiveness of cognitive treatments, these findings have clinical relevance in the treatment of this condition.

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Perceived Injustice Moderates the Relationship between Pain and Depressive Symptoms among Individuals with Persistent Musculoskeletal Pain

Pain Research and Management ◽

10.1155/2012/501260 ◽

2012 ◽

Vol 17 (5) ◽

pp. 335-340 ◽

Cited By ~ 45

Author(s):

Whitney Scott ◽

Michael Sullivan

Keyword(s):

Depressive Symptoms ◽

Musculoskeletal Pain ◽

Pain Catastrophizing ◽

Self Report ◽

Pain Severity ◽

Hierarchical Regression ◽

Perceived Injustice ◽

Symptoms Of Depression ◽

Post Hoc ◽

The Relationship

BACKGROUND: Numerous investigations report that depressive symptoms frequently coexist with persistent pain. However, evidence suggests that symptoms of depression are not an inevitable consequence of pain. Diathesis-stress formulations suggest that psychological factors interact with the stress of pain to heighten the risk of depressive symptoms. Perceptions of injustice have recently emerged as a factor that may interact with the stress of pain to increase depressive symptoms.OBJECTIVES: The purpose of the present study was to examine whether perceived injustice moderates the relationship between pain and depressive symptoms.METHODS: A total of 107 individuals with persistent musculoskeletal pain completed self-report measures of pain severity, depressive symptoms, perceived injustice and catastrophizing.RESULTS: A hierarchical regression analysis revealed that the interaction between pain severity and perceived injustice uniquely contributed an additional 6% of the variance to the prediction of depressive symptoms, beyond the main effects of these variables. Post hoc probing indicated that pain was significantly related to depressive symptoms at high, but not low levels of perceived injustice. This finding remained statistically significant even when controlling for pain catastrophizing.CONCLUSIONS: The results suggest that perceived injustice augments the relationship between pain severity and depressive symptoms. The inclusion of techniques specifically targeting perceptions of injustice may enhance the effectiveness of interventions aimed at reducing symptoms of depression for individuals presenting with strong perceptions of injustice.

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