Pain Acceptance Predicts Expansive Outlooks on the Future in Older Chronic Pain Patients

Abstract As chronic conditions continue to rise in the US, associated pain symptoms are rising as well, affecting 65% of those 65 and older. In an attempt to help patients lessen the burdensome physical/psychological effects of chronic pain, researchers have investigated the effectiveness of therapeutic interventions with pain acceptance-based models yielding the most promising effect sizes. However, these interventions do not explicitly account for how patients perceive their future. Qualitative work has shown that chronic pain patients with positive and expansive views of their futures report fewer pain-related anxiety and depression symptoms, and are more likely to engage in long-term (and often more effective) treatment regiments. This study aims to investigate whether pain acceptance scores predict future time perspective to enhance treatment effects of chronic pain interventions. Multivariate linear regression analyses were conducted with a sample of 148 non-cancer patients age 45 and older with chronic pain, i.e. pain lasting three or more months. Pain duration, neuroticism, sex, race, income, and age were included in the model to explore potential mediating or moderating effects. A significant positive association was found between pain acceptance and future time perspective (r=.42, p<.001, r2=.17). Additionally, with the inclusion of all covariates, our model significantly explained 24.1% of the variance in future time perspective in the sample, F(7,132)=5.99, p<.001. With an established association between these two psychological constructs, strategies to bolster future time perspective can easily be integrated into pain acceptance interventions for older chronic pain patients, hopefully pushing effect sizes past the ‘moderate’ level.

Download Full-text

Is Pain Time Pattern Predictive of Future Time Perspective in Older Chronic Pain Patients?

Innovation in Aging ◽

10.1093/geroni/igaa057.1392 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 431-431

Author(s):

Gillian Fennell ◽

Abby Pui Wang Yip ◽

M Cary Reid ◽

Susan Enguidanos ◽

Elizabeth Zelinski ◽

...

Keyword(s):

Chronic Pain ◽

Temporal Pattern ◽

Time Perspective ◽

Subjective Health ◽

Future Time Perspective ◽

Future Time ◽

Time Pattern ◽

Chronic Pain Patients ◽

Pain Duration ◽

Pain Patients

Abstract Chronic pain patients constitute 65% of those ages 65 and older in the US. Many affected older adults are challenged to manage physical and psychological consequences tied to the intensity, interference, and temporal pattern of their pain. However, little quantitative research highlights the psychological impact of constant versus intermittent or ever-present-yet-variable pain, even though temporal pain pattern may have meaningful predictive power for wellbeing and future time perspective (FTP). A positive and expansive view of the future is particularly adaptive for this population because it is positively associated with treatment adherence. In this study, we analyzed secondary data to determine whether pain temporal pattern and pain duration are associated with differences in participant scores on Carstensen & Lang’s Future Time Perspective scale. All participants (N=142) were 45 years old and older with non-cancer chronic pain lasting three months or more. There was no significant association between pain time pattern and FTP (p=.35). Additionally, controlling for pain duration, average FTP scores did not vary significantly as a function of time pattern (p=.07). Our analyses demonstrated no significant relationship between pain time pattern and FTP and no significant moderating effect of pain duration. However, in contrast to the previous literature, FTP was not significantly associated with age and negatively (rather than positively) associated with subjective health (r=-.08, p=.35; r=-.24, p<.01), thus raising concerns about the generalizability of these findings. Implications for understanding time perceptions in older pain patients are discussed.

Download Full-text

Personality assessment in chronic pain patients

Estudos de Psicologia (Campinas) ◽

10.1590/1982-02752016000400008 ◽

2016 ◽

Vol 33 (4) ◽

pp. 645-653

Author(s):

Lucas de Francisco CARVALHO ◽

Ricardo PRIMI ◽

Cláudio Garcia CAPITÃO

Keyword(s):

Chronic Pain ◽

Personality Assessment ◽

Predictive Power ◽

Minnesota Multiphasic Personality Inventory ◽

Personality Characteristics ◽

Effect Sizes ◽

Clinical Context ◽

Brazilian Version ◽

Chronic Pain Patients ◽

Pain Patients

Abstract In Brazil, studies investigating the personality characteristics of chronic pain patients are scarce. The present study aimed to evaluate the personality characteristics of patients with chronic pain and to compare them with those of patients without this condition. To this end, the Personality Disorders Dimensional Inventory and the Hypochondriasis scale of the Brazilian version of the Minnesota Multiphasic Personality Inventory were administered. Two different statistical analyses were carried out: the t - test to determine the differences between the scores for the two groups and the logistic regression analysis to examine the predictive power of the scales for the diagnosis of chronic pain. The results revealed significant differences (p < 0.05) among the Histrionic, Hypochondriasis, and Sadistic scales as predictors for the groups studied, with larger effect sizes on the Histrionic and Hypochondriasis scales. The authors suggest that the use of these scales in a clinical context may provide important information for health professionals.

Download Full-text

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Journal of Clinical Medicine ◽

10.3390/jcm9082374 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2374

Author(s):

Björn Gerdle ◽

Katja Boersma ◽

Pernilla Åsenlöf ◽

Britt-Marie Stålnacke ◽

Britt Larsson ◽

...

Keyword(s):

Chronic Pain ◽

Sex Education ◽

Clinical Situation ◽

Effect Sizes ◽

Country Of Birth ◽

Quality Registry ◽

Clinical Presentations ◽

Chronic Pain Patients ◽

Pain Patients ◽

European Women

This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.

Download Full-text

A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.06.011 ◽

2016 ◽

Vol 13 (1) ◽

pp. 43-58 ◽

Cited By ~ 31

Author(s):

Emily B. Kroska

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Cultural Differences ◽

Meta Analysis ◽

Positive Association ◽

Cultural Dimensions ◽

Effect Sizes ◽

Fear Avoidance ◽

Chronic Pain Patients ◽

Pain Patients

AbstractBackgroundThe fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples.MethodThe present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede’s cultural dimensions). Publication bias was examined using the funnel plot and the p-curve.ResultsResults indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed for studies that utilized measures of experiential avoidance when compared to studies that utilized pain-specific fear-avoidance measures. Studies that utilized multiple measures of fear-avoidance had stronger effect sizes than studies that utilized a single measure of fear-avoidance. Three of Hofstede’s cultural dimensions moderated the association, including Power Distance Index, Individualism versus Collectivism, and Indulgence versus Restraint.ConclusionsThe present meta-analysis synthesizes the results from studies examining the association between fear-avoidance and pain intensity among individuals with chronic pain. The positive association indicates that those with increased fear-avoidance have higher pain intensity, and those with higher pain intensity have increased fear-avoidance. Findings indicate that cultural differences and measurement instruments are important to consider in understanding the variables that affect this association. The significant cultural variations may indicate that it is important to consider the function of avoidance behavior in different cultures in an effort to better understand each patient’s cultural beliefs, as well as how these beliefs are related to pain and associated coping strategies.ImplicationsThe results from the current meta-analysis can be used to inform interventions for patients with chronic pain. In particular, those with more intense pain or increased fear-avoidance should be targeted for prevention and intervention work. Within the intervention itself, avoidance should be undermined and established as an ineffective strategy to manage pain in an effort to prevent disability, depression, and physical deconditioning.

Download Full-text

Validation of a Chinese version of the Chronic Pain Acceptance Questionnaire (CAPQ) and CPAQ-8 in chronic pain patients

Medicine ◽

10.1097/md.0000000000004339 ◽

2016 ◽

Vol 95 (33) ◽

pp. e4339 ◽

Cited By ~ 3

Author(s):

Yaqun Liu ◽

Lei Wang ◽

Yibo Wei ◽

Xiaolin Wang ◽

Tianming Xu ◽

...

Keyword(s):

Chronic Pain ◽

Chinese Version ◽

Pain Acceptance ◽

Chronic Pain Patients ◽

Pain Patients

Download Full-text

An Evaluation of the Depression Symptoms Level Using the Beck Depression Inventory Scale in Patients Receiving Acupuncture for Chronic Pain

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16112663844914 ◽

2021 ◽

Vol 45 (2) ◽

pp. 107-114

Author(s):

Hayriye Alp

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Depression Scale ◽

Depression Score ◽

Medical Faculty ◽

Depression Symptoms ◽

Chronic Pain Patients ◽

Clinically Significant ◽

Pain Patients ◽

Made In

Women respond more severely than men. Organs are living in acupuncture; vitality is provided by life energy called raw. Pathogens that interrupt the flow that blocks the raw flow form diseases. Acupuncture needles are placed in the special spot on the Bonghan channels to regulate the qi flow by electron transfer. This study made in GETAT Center, Konya Necmettin Erbakan University Meram Medical Faculty in 2018 between March and November, it was carried out with the approval of the ethics committee of Necmettin Erbakan University Meram Medical Faculty 2018/1252. The study design is cross sectionel study; included 46 participants of female sex who had experienced chronic pain for approximately six months. Beck depression scale was applied to both sexes with chronic pain. Acupuncture was applied in different numbers according to the severity of the pain and the reasons for the illness. Senses were first performed at intervals of once a week, then once a week, then every 15 days. Sessions lasted 20 minutes. In fact, a decrease of five units was considered clinically significant. Each patient was informed about the procedure before acupuncture and an informed consent was obtained. Before beginning the acupuncture sessions, each patient was given a participant number and the BDI was administered. The scale was discussed with each patient personally. The BDI consists of 21 questions, including questions about the participants's mood during the previous week. Significant effect of time and visual analog scale were determined on depression score.(p<0.01) Before acupuncture Beck Depression score 15.±10.28, after acupuncture score 9±6.81. Acupuncture may be effective in treating chronic pain-related depressive symptoms. Acupuncture is a method that does not have any reliable side effects which can be applied in depressive symptoms in chronic pain patients. Comparative controlled studies are needed in patients with and without acupuncture.

Download Full-text

Pain Acceptance Creates an Emotional Context That Protects against the Misuse of Prescription Opioids: A Study in a Sample of Patients with Chronic Noncancer Pain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063054 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3054

Author(s):

Rosa Esteve ◽

Estefanía Marcos ◽

Ángela Reyes-Pérez ◽

Alicia E. López-Martínez ◽

Carmen Ramírez-Maestre

Keyword(s):

Chronic Pain ◽

Structural Equation ◽

Opioid Analgesics ◽

Anxiety And Depression ◽

Opioid Misuse ◽

Chronic Noncancer Pain ◽

Pain Acceptance ◽

Emotional Context ◽

Chronic Pain Patients ◽

Pain Patients

There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.

Download Full-text

Do Acute and Chronic Pain Patients Differ on Affirmation of One Aspect of Pain Acceptance? Acknowledgement that a Cure Is Unlikely

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e597 ◽

2015 ◽

Vol 18;4 (4;18) ◽

pp. E597-E604

Author(s):

David Fishbain

Keyword(s):

Chronic Pain ◽

Acute Pain ◽

Prediction Models ◽

Behavior Pattern ◽

Face Validity ◽

Health Improvement ◽

Pain Acceptance ◽

Disability Status ◽

Chronic Pain Patients ◽

Pain Patients

Background: Many chronic pain patients (CPPs) cannot be cured of their pain, but can learn to manage it. This has led to research on pain “acceptance” which is defined as a behavior pattern with awareness of pain but not directed at changing pain. Objective: CPPs who have accepted their pain generally acknowledge that a cure is unlikely. Time with pain may be necessary to reach such an acknowledgment. It was therefore hypothesized that fewer acute pain patients (APPs) than CPPs should affirm that a cure is unlikely and that other described aspects of acceptance such as denial of disability status should be associated with cure is unlikely in both APPs and CPPs. Study Design: APPs and CPPs were compared for frequency of endorsement of 2 items/questions with face validity for cure is unlikely: little hope of getting better from pain (LH) and physical problem (pain) can’t be cured (CBC). Demographic variables and variables reported associated with acceptance were utilized in logistic prediction models for the above items in APPs and CPPs. Setting: Rehabilitation programs/offices. Results: CPPs were statistically more likely than APPs to affirm both LH and CBC. In both APPs and CPPs, items reported associated with acceptance, e.g., denial of disability status, predicted LH and CBC. Limitations: Information gathered from CPP self-reports. Conclusions: APPs versus CPPs differ on their affirmation on acknowledgement that a cure is unlikely. Key Words: Acceptance, pain acceptance, chronic pain, acute pain, chronic pain patients, acute pain patients, Battery of Health Improvement (BHI 2), cure disability, illness uncertainty

Download Full-text

Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.617871 ◽

2021 ◽

Vol 12 ◽

Author(s):

Matthias Feldmann ◽

Hauke Jeldrik Hein ◽

Ulrich Voderholzer ◽

Robert Doerr ◽

Thomas Hoff ◽

...

Keyword(s):

Chronic Pain ◽

Structural Equation ◽

Structural Equation Models ◽

Cognitive Restructuring ◽

Cognitive Change ◽

Effect Sizes ◽

Mechanisms Of Change ◽

Relaxation Techniques ◽

Chronic Pain Patients ◽

Pain Patients

Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.

Download Full-text