Social Anxiety, Pain Catastrophizing and Return-To-Work Self-Efficacy in chronic pain: a cross-sectional study

AbstractBackground and aimsReturning to work after periods of sick-leave due to chronic pain problems, involve a number of situations of interpersonal nature (e.g. meeting supervisors/insurance companies to adapt work setting to present functional level, receive help from colleagues, express pain, etc.). Since chronic pain has shown co-morbidity with social anxiety, it is of interest to investigate restraining factors in return to work among chronic pain sufferers from a social perspective. Catastrophizing is identified in both pain and social anxiety as a mechanism that might fuel a continuous bias in how situations are perceived (threat) and by hindering the development of functional behavior strategies. The presence of social anxiety in chronic pain patients might be seen as a stressor that limits the individuals’ ability to effectively communicate pain-related needs to colleagues, and/or employers and therefore act as a hindering factor in return-to-work. Hence, the overall aim of this study was to examine the relationship between social anxiety, pain catastrophizing, and perceived ability to communicate pain-related needs to the work environment in a clinical pain population.MethodsThe study employed a cross-sectional design and involved 247 individuals with chronic pain (82.3% women; Mage = 44 years). Measures included the Pain catastrophizing Scale, the Social Phobia Screening Questionnaire and the communication of pain-related needs-subscale of the Return-To-Work Self-efficacy Questionnaire. Analyzes were run to examine whether social anxiety moderated the relation between pain catastrophizing, and perceived ability to communicate pain-related needs while controlling for pain severity/interference and sick leave.ResultsSocial anxiety and pain catastrophizing correlated positively with each other and negatively with perceived ability to communicate pain-related needs. No support was obtained for a moderating effect of social anxiety. However, social anxiety and pain interference were each significant predictors of the individual’s confidence in being able to communicate pain-related needs to the work environment.ConclusionsIn the context of pain and work-related communication, symptoms of social anxiety was identified as being of similar importance to the outcome as pain interference, while pain severity was not associated with the individual’s confidence in communicating one’s pain-related needs.ImplicationsThe results implicate that fears relating to pain-related social situations at work might be central in the process of return-to-work and rehabilitation in chronic pain.

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The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression

Pain Medicine ◽

10.1093/pm/pnz363 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2200-2211

Author(s):

Elisabet Sánchez-Rodríguez ◽

Enric Aragonès ◽

Mark P Jensen ◽

Catarina Tomé-Pires ◽

Concepció Rambla ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Pain Catastrophizing ◽

Positive Association ◽

Pain Severity ◽

Pain Interference ◽

Regression Analyses ◽

Depression Severity ◽

Cross Sectional ◽

The Relationship

Abstract Objective The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. Design Cross-sectional design. Methods Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. Results The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. Conclusions These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.

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REPRINTED WITH PERMISSION OF IASP – PAIN 162 (2021): 619–629: Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic

Ból ◽

10.5604/01.3001.0014.8194 ◽

2021 ◽

Vol 21 (4) ◽

pp. 25-40

Author(s):

Valerie Hruschak ◽

K. Mikayla Flowers ◽

Desiree R. Azizoddin ◽

Robert N. Jamison ◽

Robert R. Edwards ◽

...

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Cross Sectional Study ◽

Pain Severity ◽

Pain Interference ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Social Distancing ◽

Female Sex

The COVID-19 pandemic has had a tremendous impact, including on individuals with chronic pain. The social distancing policies necessary to slow the spread of SARS-CoV-2 have involved increased levels of social isolation. This cross-sectional survey study examined pain severity and interference among individuals with chronic pain during an early phase of social distancing mandates and identified characteristics of individuals who were most impacted. Approximately 4 to 8 weeks after social distancing mandates commenced in the state ofMassachusetts, 150 patients with fibromyalgia, chronic spine, and postsurgical pain completed demographic, pain, social distancing, and validated psychosocial questionnaires. Patients self-reported an overall significant increase in pain severity and pain interference, compared with before social distancing, although both pain severity and interference were quite variable among individuals under conditions of social distancing. Several demographic, socioeconomic, and psychosocial factors were associated with greater pain severity and interference during social distancing. Multivariable linear regression demonstrated that female sex, nonwhite race, lower education, disability, fibromyalgia, and higher pain catastrophizing were independently associated with greater pain severity, while female sex and pain catastrophizing were independently associated greater pain interference. The findings suggest that individual differences among patients with chronic pain should be considered in the planning, development, and prioritization of interventions to improve pain care and to prevent worsening of symptoms during the continuing COVID-19 pandemic.

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The “self” in pain: high levels of schema-enmeshment worsen fibromyalgia impact

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04740-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Myrella Paschali ◽

Asimina Lazaridou ◽

Eric S. Vilsmark ◽

Jeungchan Lee ◽

Michael Berry ◽

...

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Well Being ◽

Cross Sectional Study ◽

The Self ◽

Self Report ◽

Pain Severity ◽

Pictorial Representation ◽

Cross Sectional ◽

Mediation Analyses

Abstract Objective Chronic pain can have detrimental effects on quality of life and a profound impact on one’s identity. The Pictorial Representation of Illness- and Self-Measure (PRISM), is a visual tool designed to measure the self-illness separation (SIS) that represents the degree of schema-enmeshment (i.e., the degree to which the self-schema and the illness-schema come to overlap). Our aim was to investigate the relationship between schema-enmeshment and pain-related outcomes in patients with fibromyalgia. Methods In this cross-sectional study, 114 patients with fibromyalgia completed self-report assessments of pain catastrophizing, pain severity and interference, impact of symptoms, anxiety, and depression. SIS was assessed using an iPad version of PRISM. Mediation analyses evaluated the mediating role of schema-enmeshment on the association between pain catastrophizing and fibromyalgia impact. Results A higher degree of schema-enmeshment was associated with greater pain catastrophizing, pain severity and interference, impact of symptoms, and depression. Moreover, a mediation analysis revealed that schema-enmeshment significantly mediated the association between pain catastrophizing and fibromyalgia impact (p < 0.001). Conclusions Our results indicate that schema-enmeshment is associated with greater intrusiveness of chronic pain on everyday life, thereby posing significant limitations on the emotional and physical well-being of fibromyalgia patients. Schema-enmeshment also appears to partly account for the deleterious effect of pain catastrophizing on disease impact. The PRISM is a simple tool that may uniquely capture the extent to which chronic pain and illness infiltrates and affects one’s self-concept.

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Pain Catastrophizing Correlates with Early Mild Traumatic Brain Injury Outcome

Pain Research and Management ◽

10.1155/2016/2825856 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Geneviève Chaput ◽

Susanne P. Lajoie ◽

Laura M. Naismith ◽

Gilles Lavigne

Keyword(s):

Traumatic Brain Injury ◽

Chronic Pain ◽

Psychological Distress ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Pain Catastrophizing ◽

Self Report ◽

Pain Severity ◽

Cross Sectional ◽

Postconcussion Symptoms

Background.Identifying which patients are most likely to be at risk of chronic pain and other postconcussion symptoms following mild traumatic brain injury (MTBI) is a difficult clinical challenge.Objectives.To examine the relationship between pain catastrophizing, defined as the exaggerated negative appraisal of a pain experience, and early MTBI outcome.Methods.This cross-sectional design included 58 patients diagnosed with a MTBI. In addition to medical chart review, postconcussion symptoms were assessed by self-report at 1 month (Time 1) and 8 weeks (Time 2) after MTBI. Pain severity, psychological distress, level of functionality, and pain catastrophizing were measured by self-report at Time 2.Results.The pain catastrophizing subscales of rumination, magnification, and helplessness were significantly correlated with pain severity (r=.31to.44), number of postconcussion symptoms reported (r=.35to.45), psychological distress (r=.57to.67), and level of functionality (r=-.43to-.29). Pain catastrophizing scores were significantly higher for patients deemed to be at high risk of postconcussion syndrome (6 or more symptoms reported at both Time 1 and Time 2).Conclusions.Higher levels of pain catastrophizing were related to adverse early MTBI outcomes. The early detection of pain catastrophizing may facilitate goal-oriented interventions to prevent or minimize the development of chronic pain and other postconcussion symptoms.

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Pain catastrophizing, but not mental health or social support, is associated with menstrual pain severity in women with dysmenorrhea: A cross-sectional survey

Psychology Health & Medicine ◽

10.1080/13548506.2021.1948581 ◽

2021 ◽

pp. 1-11

Author(s):

Subhadra Evans ◽

Charlotte Dowding ◽

Lisa Olive ◽

Laura A Payne ◽

Marilla Druitt ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Pain Catastrophizing ◽

Pain Severity ◽

Menstrual Pain ◽

Cross Sectional Survey ◽

Cross Sectional

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Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results

Pain Medicine ◽

10.1093/pm/pnaa007 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1369-1376

Author(s):

Matthew J Bair ◽

Samantha D Outcalt ◽

Dennis Ang ◽

Jingwei Wu ◽

Zhangsheng Yu

Keyword(s):

Chronic Pain ◽

Musculoskeletal Pain ◽

Pain Catastrophizing ◽

Psychological Outcomes ◽

Stepped Care ◽

Chronic Musculoskeletal Pain ◽

Pain Severity ◽

Analysis Of Covariance ◽

Escape Trial ◽

Care Intervention

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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Social deprivation and paediatric chronic pain referrals in Ireland: a cross-sectional study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0031 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Eveline Matthews ◽

Maeve Muldoon ◽

Norma O’Keeffe ◽

Kevin F. McCarthy

Keyword(s):

Chronic Pain ◽

Social Deprivation ◽

School Attendance ◽

Pain Catastrophizing ◽

Sleep Onset ◽

Primary Objective ◽

Sleep Onset Latency ◽

Cross Sectional ◽

Disadvantaged Group ◽

Pain Characteristics

Abstract Objectives Social deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. Our primary objective was to determine if there was a relationship between social deprivation and paediatric chronic pain referrals in Ireland. Secondary objectives included analysing for differences between deprivation groups in pain characteristics and function that are recorded at first clinic visit. Methods Families attending the national paediatric complex pain service in Dublin, Ireland, complete questionnaires on pain characteristics, parental pain catastrophizing, and pain-related disability including sleep quality and school attendance. We retrospectively reviewed records from between February 2016 and November 2019 on 288 patients. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on data from the Irish national census. Results Referrals followed a normal distribution across deprivation grades. Children in the disadvantaged group had a longer duration of pain, greater use of screens at bedtime, and longer sleep onset latency. Parents in the disadvantaged group had significantly higher levels of parental pain catastrophizing. Conclusions In Ireland, while paediatric chronic pain referrals were normally distributed across deprivation group, the disadvantaged group was different in several ways that may be clinically significant. Further work will be needed to determine the longitudinal relationship between these factors before and after the referral and initial review. Screening for, and targeting, potential risk factors for pain chronicity may be needed to harmonize treatment outcomes in children from socially disadvantaged families.

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CHRONIC PAIN CONTRIBUTES TO INJURIOUS FALLS IN COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2318 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S622-S622

Author(s):

Yurun Cai ◽

Suzanne Leveille ◽

Ling Shi ◽

Tongjian You ◽

Ping Chen

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Community Dwelling ◽

Pain Severity ◽

Pain Interference ◽

Fall Injuries ◽

Injurious Falls ◽

Multisite Pain ◽

Community Dwelling Older Adults ◽

Pain Distribution

Abstract Fall injuries are a leading cause of death among older adults, and chronic pain has been identified as a fall risk factor. However, the potential impact of chronic pain on injurious falls is unknown. This prospective study examined the relation between chronic pain and injurious falls in a 4-year follow-up of community-dwelling older adults. The MOBILIZE Boston study recruited 765 older adults aged ≥70y living in the Boston area. Pain characteristics, including pain severity, pain interference, and pain location, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Musculoskeletal pain distribution was categorized as “no pain”, “single site pain”, or “multisite pain”. Injurious falls were ascertained in telephone interviews following reports of falls on the monthly fall calendar postcards. The overall rate of injurious falls was 35/100 person-years. Negative binomial models, adjusting for sociodemographics, BMI, chronic conditions, mobility difficulty, analgesic and psychiatric medications, and depression, showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls. Participants in the highest third of pain interference scores had a 53% greater risk of injurious falls compared to those in the lowest pain interference group (adj.IRR=1.53, 95% CI: 1.15, 2.05). Older adults with multisite pain had a 50% higher risk of injurious falls than those without pain (adj.IRR=1.50, 95% CI: 1.16, 1.93). Risk of injurious falls related to pain was stronger among women than men. Research is needed to determine effective strategies to prevent fall injuries among older adults with chronic pain.

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