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

Pain Medicine ◽  
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.

The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain

2017 ◽  
Vol 17 (1) ◽  
pp. 156-166 ◽  
Author(s):  
Katherine B. Curtin ◽  
Deborah Norris
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Pain Catastrophizing ◽  
Pain Severity ◽  
Fear Avoidance ◽  
Pain Anxiety ◽  
Fear Avoidance Model ◽  
Chronic Pain Patients ◽  
The Relationship ◽  
Pain Patients

AbstractBackground and purposeThe Fear-Avoidance Model of Chronic Pain proposed by Vlaeyen and Linton states individuals enter a cycle of chronic pain due to predisposing psychological factors, such as negative affectivity, negative appraisal or anxiety sensitivity. They do not, however, address the closely related concept of anxious rumination. Although Vlaeyen and Linton suggest cognitive-behavioral treatment methods for chronic pain patients who exhibit pain-related fear, they do not consider mindfulness treatments. This cross-sectional study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if (1) ruminative anxiety is a risk factor for developing chronic pain and (2) mindfulness is a potential treatment for breaking the cycle of chronic pain.MethodsMiddle-aged adults ages 35-50 years (N = 201) with self-reported CMP were recruited online. Participants completed standardized questionnaires assessing elements of chronic pain, anxiety, and mindfulness.ResultsRuminative anxiety was positively correlated with pain catastrophizing, pain-related fear and avoidance, pain interference, and pain severity but negatively correlated with mindfulness. High ruminative anxiety level predicted significantly higher elements of chronic pain and significantly lower level of mindfulness. Mindfulness significantly predicted variance (R2) in chronic pain and anxiety outcomes. Pain severity, ruminative anxiety, pain catastrophizing, pain-related fear and avoidance, and mindfulness significantly predicted 70.0% of the variance in pain interference, with pain severity, ruminative anxiety and mindfulness being unique predictors.ConclusionsThe present study provides insight into the strength and direction of the relationships between ruminative anxiety, mindfulness and chronic pain in a CMP population, demonstrating the unique associations between specific mindfulness factors and chronic pain elements.ImplicationsIt is possible that ruminative anxiety and mindfulness should be added into the Fear-Avoidance Model of Chronic Pain, with ruminative anxiety as a psychological vulnerability and mindfulness as an effective treatment strategy that breaks the cycle of chronic pain. This updated Fear-Avoidance Model should be explored further to determine the specific mechanism of mindfulness on chronic pain and anxiety and which of the five facets of mindfulness are most important to clinical improvements. This could help clinicians develop individualized mindfulness treatment plans for chronic pain patients.

A cross-sectional analysis of the relationships of FAM components and their effects on quality of life in Chinese patients with chronic musculoskeletal pain

2016 ◽  
Vol 33 (S1) ◽  
pp. S207-S208
Author(s):  
W. Wong ◽  
H. Lim ◽  
P. Chen ◽  
S. Wong ◽  
Y. Chow ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Chinese Population ◽  
Pain Catastrophizing ◽  
Chronic Musculoskeletal Pain ◽  
Chinese Patients ◽  
Cross Sectional ◽  
Pain Anxiety

IntroductionA body of evidence has accrued supporting the Fear-Avoidance Model (FAM) of chronic pain which postulated the mediating role of pain-related fear in the relationships between pain catastrophizing and pain anxiety in affecting pain-related outcomes. Yet, relatively little data points to the extent to which the FAM be extended to understand chronic pain in Chinese population and its impact on quality of life (QoL).ObjectiveThis study explored the relationships between FAM components and their effects on QoL in a Chinese sample.MethodsA total of 401 Chinese patients with chronic musculoskeletal pain completed measures of three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety) and QoL. Cross-sectional structural equation modeling (SEM) assessed the goodness of fit of the FAM for two QoL outcomes, Physical (Model 1) and Mental (Model 2). In both models, pain catastrophizing was hypothesized to underpin pain-related fear, thereby influencing pain anxiety and subsequently QoL outcomes.ResultsResults of SEM evidenced adequate data-model fit (CFI30.90) for the two models tested (Model 1: CFI = 0.93; Model 2: CFI = 0.94). Specifically, pain catastrophizing significantly predicted pain-related fear (Model 1: stdb = 0.90; Model 2: stdb = 0.91), which in turn significantly predicted pain anxiety (Model 1: stdb = 0.92; Model 2: stdb = 0.929) and QoL outcomes in a negative direction (Model 1: stdb = −0.391; Model 2: stdb = −0.651) (all P < 0.001) (Table 1, Fig. 1).ConclusionOur data substantiated the existing FAM literature and offered evidence for the cross-cultural validity of the FAM in the Chinese population with chronic pain.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Patients’ Views on Self-Management of Chronic Musculoskeletal Pain

2020 ◽  
Vol 5 (4) ◽  
pp. 254-266
Author(s):  
Barbka Huzjan ◽  
Ivana Hrvatin
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Health Care Providers ◽  
Multidisciplinary Approach ◽  
Research Question ◽  
Chronic Musculoskeletal Pain ◽  
Self Management ◽  
Care Providers ◽  
The Individual

Research Question (RQ): Chronic musculoskeletal pain is a complex condition and one of the most important causes of suffering of modern times. Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. The research question is; what is the view on the selfmanagement of chronic musculoskeletal pain from the patient's perspective? Purpose: The purpose of this literature review was to review original articles that reported how selfmanagement educational programmes are viewed from the patient’s perspective. Method: We used an integrative review of the literature. The search was conducted from November 2019 to March 2020 on the PubMed, PEDro and OTseeker databases. We included original studies, written in English that examined the patients’ point of view on self-management. The included studies, needed to be conducted on adult patients of both sexes, that were suffering from chronic pain and were educated on self-management of their pain. Two authors independently searched for original studies. Results: Nine article were included in the review. Most of the studies included a multidisciplinary approach. Patients reported they more frequently used passive strategies to manage their pain. They want to be included in the management and be able to communicate with the provider of selfmanagement. There are several positive aspects of a multidisciplinary and groups approach. Organization: Health care providers can encourage an individual to proactively behave through ongoing processes of communication, partnerships and the creation of appropriate self-management plans over time. Society: We assume that the analysis will help to identify the social responsibility of the individual and society in the common concern for the health of the population and the individual within it. Originality: The research provides an up-to-date, new overview of the patients' perspective on self management on chronic pain. The review can be helpful to health care providers s they can compare their expectations with patients's. Limitations / further research: Further research would focus on high quality studies, and specific forms of multidisciplinary approach, and finding what patients use at a home setting and how to help them continue in the self management of their pain. Limitations of this review include the lack of risk of bias assessment and the fact that this is not a systematic review.

scholarly journals The Temporal Relation Between Pain and Fatigue in Individuals Receiving Treatment for Chronic Musculoskeletal Pain

2021 ◽  
Author(s):  
Keiko Yamada ◽  
Heather Adams ◽  
Tamra Ellis ◽  
Robyn Clark ◽  
Craig Sully ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Behavioral Activation ◽  
Post Treatment ◽  
Chronic Musculoskeletal Pain ◽  
Temporal Relation ◽  
Pain Severity ◽  
Path Coefficient ◽  
Cross Sectional ◽  
Random Intercept ◽  
Pre Treatment

Abstract Objective: Numerous investigations have revealed significant relations between pain and fatigue in individuals with persistent pain conditions. However, the direction of influence between pain and fatigue remains unclear. Shortcomings of design and analytic approaches used in previous research limit the nature of conclusions that can be drawn about possible causal relations between pain and fatigue. The present study investigated the temporal relation between changes in pain and changes in fatigue in individuals with musculoskeletal pain enrolled in a 10-week behavioral activation intervention. On the basis of previous findings, it was hypothesized that analyses would yield support for a bi-directional relation between pain and fatigue. Methods: The study sample consisted of 104 individuals with chronic musculoskeletal pain participating in a 10-week standardized rehabilitation intervention. Measures of pain intensity and fatigue were completed pre-, mid-, and post-treatment. The three-wave data panel permitted examination of the direction of influence between pain and fatigue through the course of the intervention. A random-intercept cross-lagged panel model (RI-CLPM) was used to examine the temporal relation between pain and fatigue. Results: Consistent with previous research, cross-sectional analyses of pre-treatment data revealed significant correlations between measures of pain and fatigue. Significant reductions in pain and fatigue were observed through the course of treatment (d=.33 and d =.66, p < .001, respectively). RI-CLPM revealed that pain severity predicted later fatigue (pre to mid-treatment standardized path coefficient (β) = 0.55, p = 0.02; mid to post-treatment β = 0.36, p = 0.001); however, fatigue did not predict later pain severity.Conclusions: Discussion addresses the processes that might underlie the temporal relation between pain and fatigue. Clinical implications of the findings are also discussed.

scholarly journals Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036151
Author(s):  
Rutger M J de Zoete ◽  
Kenneth Chen ◽  
Michele Sterling
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Physical Exercise ◽  
Clinical Outcomes ◽  
Musculoskeletal Pain ◽  
Exercise Intervention ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Brain Areas

ObjectivePrimary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes.DesignSystematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration’s Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers.InterventionsStudies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review.Primary and secondary outcome measuresPrimary outcome: any brain outcome assessed with any MR technique. Secondary outcomes: any self-reported clinical outcomes, and type and dosage of the exercise intervention.ResultsAll four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims.ConclusionsOnly a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included.PROSPERO registration numberCRD42018108179.

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

2007 ◽  
Vol 31 (2) ◽  
pp. 105-114 ◽  
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

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

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.

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

2012 ◽  
Vol 17 (5) ◽  
pp. 335-340 ◽  
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.

scholarly journals Exploring Patient Perceptions of Repetitive Transcranial Magnetic Stimulation as a Treatment for Chronic Musculoskeletal Pain: A Qualitative Study

2021 ◽  
Author(s):  
G Stillianesis ◽  
R Cavaleri ◽  
SJ Summers ◽  
CY Tang
Keyword(s):  
Chronic Pain ◽  
Transcranial Magnetic Stimulation ◽  
Qualitative Study ◽  
Musculoskeletal Pain ◽  
Treatment Option ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Structured Interview ◽  
Patient Perceptions ◽  
Chronic Musculoskeletal Pain

Abstract Background: Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, represents a novel avenue for the management of chronic musculoskeletal pain. Despite evidence for the effectiveness of rTMS in chronic pain conditions, the clinical uptake of rTMS remains limited. One plausible reason for this discrepancy may be a lack of understanding regarding patient perceptions and their willingness to engage with rTMS. Therefore, this study aimed to explore patient perceptions of rTMS as a treatment for chronic musculoskeletal pain. Methods: Using a phenomenological approach, this qualitative study utilised a semi-structured interview to explore overall knowledge, pre-conceived concerns and attitudes regarding rTMS as a treatment for chronic musculoskeletal pain. All participants had a diagnosis of chronic musculoskeletal pain, a history of seeking treatment, and no prior experience with rTMS. The interviews were transcribed verbatim and analysed thematically. Results: Majority of the participants were willing to consider the use of rTMS as a treatment option, with most having high expectations regarding the effectiveness of the treatment due to its sophisticated appearance. Acceptance to utilise rTMS was influenced by knowledge of pain, cost and travel, and the perceived sophistication of the intervention.Conclusions: This is the first qualitative study to the authors’ knowledge that explores the perception of rTMS as a treatment among people with chronic musculoskeletal pain, a key gap in the current literature. Repetitive transcranial magnetic stimulation appears to be accepted as a treatment option amongst individuals with chronic musculoskeletal pain. Adequate levels of funding support, accessibility and the need for medical professions to endorse the treatment are important considerations that influenced uptake. Developing targeted strategies to address these considerations may encourage use of rTMS in a clinical chronic pain setting.

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