The role of identity in chronic pain cognitions and pain-related disability within a clinical chronic pain population

Objective Chronic pain has a significant impact on functioning and results in the disruption of one’s assumed life trajectory, potentially altering their self-perceived identity. The present research is designed to determine whether identity-related issues are associated with common chronic pain cognitions and pain-related disability, which may help inform understanding of clinical chronic pain populations. Method Ninety-eight adult chronic pain patients were assessed at a local pain clinic during a regularly scheduled appointment focusing on pain management. Multivariate hierarchal regression was used to determine whether issues related to identity and death anxiety were associated with pain catastrophizing, pain acceptance, and pain-related disability, above and beyond pain severity, fear-avoidance, and age. Results Self-concept clarity was significantly related to pain catastrophizing and pain acceptance, above and beyond death anxiety, pain severity, fear-avoidance, and age. Death anxiety was associated with pain catastrophizing, pain acceptance, and pain-related disability above and beyond pain severity, fear-avoidance, and age. Conclusions To the best of our knowledge, the present study is the first examination of self-concept clarity and death anxiety as they relate to pain catastrophizing, pain acceptance, and pain-related disability. These descriptive results support the inclusion of identity and death anxiety within the pain experience and could serve as a foundation for future directions relevant to clinical applications.

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

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.08.006 ◽

2017 ◽

Vol 17 (1) ◽

pp. 156-166 ◽

Cited By ~ 6

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.

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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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Depressive symptoms and pain evaluations among persons with chronic pain: Catastrophizing, but not pain acceptance, shows significant effects

Pain ◽

10.1016/j.pain.2009.08.030 ◽

2009 ◽

Vol 147 (1) ◽

pp. 147-152 ◽

Cited By ~ 36

Author(s):

Elizabeth J. Richardson ◽

Timothy J. Ness ◽

Daniel M. Doleys ◽

James H. Baños ◽

Leanne Cianfrini ◽

...

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Pain Catastrophizing ◽

Pain Acceptance

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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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The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0160 ◽

2019 ◽

Vol 19 (2) ◽

pp. 365-373 ◽

Cited By ~ 5

Author(s):

Lars-Petter Granan ◽

Silje Endresen Reme ◽

Henrik Børsting Jacobsen ◽

Audun Stubhaug ◽

Tone Marte Ljoså

Keyword(s):

Chronic Pain ◽

Real World ◽

Self Efficacy ◽

Pain Catastrophizing ◽

Baseline Data ◽

University Hospital ◽

Pain Clinic ◽

General Function ◽

Pain Clinics ◽

Chronic Pain Conditions

Abstract Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0–10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient’s perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients’ self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.

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Gender-dependent difference in the relationship between pain aspects and pain catastrophizing

Social Behavior and Personality An International Journal ◽

10.2224/sbp.7718 ◽

2019 ◽

Vol 47 (2) ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

ChongNak Son ◽

Daegu Son ◽

Jeongwi An ◽

Sungkun Cho

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Republic Of Korea ◽

Pain Clinic ◽

Affective Pain ◽

High Level ◽

Gender Dependence ◽

Study Participants ◽

The Relationship

We examined the gender dependence of the relationships between sensory and affective pain and pain catastrophizing. Study participants were 170 people who were receiving treatment for chronic pain at a university pain clinic in Daegu, Republic of Korea. For men, higher levels of sensory pain were associated with greater pain catastrophizing at low and average levels of affective pain, but not at a high level of affective pain. For women, higher levels of affective pain were associated with greater pain catastrophizing, regardless of the degree of sensory pain. These results suggest that sensory pain, affective pain, and their combination may have gender-dependent effects on pain catastrophizing in people who are experiencing chronic pain. Most importantly, affective pain appears to play a major role in pain catastrophizing, regardless of gender and, for men, the role of sensory pain in pain catastrophizing requires consideration.

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