Pain Interference Mediates the Relationship between Pain and Functioning in Pediatric Chronic Pain

Objective. To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design. Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017–2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results. 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1–45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1–89 mg or MEQ 0 mg. Conclusions. Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.

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Action identification and meaning in life in chronic pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.04.024 ◽

2015 ◽

Vol 9 (1) ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Helen Richardson ◽

Stephen Morley

Keyword(s):

Chronic Pain ◽

Meaning In Life ◽

Pain Interference ◽

Action Identification ◽

Life Meaning ◽

Behavioural Activity ◽

Chronic Pain Patients ◽

High Level ◽

The Relationship ◽

Pain Patients

AbstractBackground and aimsWe explore the relationship between behaviour and cognition in chronic pain by applying Action Identification Theory (AIT). AIT holds that every action may be construed in several ways. High level construals confer greater meaning than lower level construals. When an action is interrupted a lower level, more concrete identity with reduced meaning is elicited. We hypothesized that interference of activity by chronic pain affects the meaning ascribed to activity and thus a person’s overall sense of meaning in life.MethodsIn Study 1, a measure of Action Identification in Pain (AIP) is developed. In Study 2, the AIP was administered to 47 chronic pain patients who also completed the Meaningful Life Measure and measures of pain interference, depression, acceptance and optimism.ResultsHigh levels of action identification were positively correlated with meaning in life and high levels of interference were negatively correlated with meaning in life. Contrary to expectation interference and action identification were not associated. Further analyses showed that inclusion of depression, acceptance and optimism eliminated the effect of pain interference but only optimism abolished the effect of action identification.ConclusionChronic pain patients holding higher levels of action identification report a greater sense of meaning in life. Meaning in life is also associated with the amount of interference of behavioural activity. The anticipated relationship between action identification and interference was not observed. The present evidence suggests that interference and action identification contribute independently to a person’s sense of meaning in life.

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Good Sleep Quality Improves the Relationship Between Pain and Depression Among Individuals With Chronic Pain

Frontiers in Psychology ◽

10.3389/fpsyg.2021.668930 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zoe Zambelli ◽

Elizabeth J. Halstead ◽

Antonio R. Fidalgo ◽

Dagmara Dimitriou

Keyword(s):

Chronic Pain ◽

Sleep Quality ◽

Sleep Problems ◽

Pain Severity ◽

Pain Interference ◽

Poor Sleep ◽

Regression Analyses ◽

Cross Sectional Survey ◽

The Relationship ◽

Good Sleep

Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic pain conditions (Mage 43 years, 88% identified as women) and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression.

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Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy

Frontiers in Psychology ◽

10.3389/fpsyg.2021.576943 ◽

2021 ◽

Vol 12 ◽

Author(s):

Leonie J. T. Balter ◽

Camilla Wiwe Lipsker ◽

Rikard K. Wicksell ◽

Mats Lekander

Keyword(s):

Chronic Pain ◽

Neuropsychiatric Symptoms ◽

Autistic Traits ◽

Pain Interference ◽

Adhd Symptoms ◽

Psychological Inflexibility ◽

Autism Traits ◽

Pediatric Chronic Pain ◽

Chronic Pain Patients ◽

Pain Patients

Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.

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Electronic Health Literacy in Individuals with Chronic Pain and Its Association with Psychological Function

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312528 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12528

Author(s):

Elena Castarlenas ◽

Elisabet Sánchez-Rodríguez ◽

Rubén Roy ◽

Catarina Tomé-Pires ◽

Ester Solé ◽

...

Keyword(s):

Chronic Pain ◽

Health Literacy ◽

Self Efficacy ◽

Literacy Skills ◽

Pain Interference ◽

The Internet ◽

Online Information ◽

Ehealth Literacy ◽

Electronic Health ◽

The Relationship

Electronic health literacy skills and competences are important for empowering people to have an active role in making appropriate health care decisions. The aims of this cross-sectional study were to (1) examine the frequency of use of the Internet for seeking online information about chronic pain, (2) determine the level of eHealth literacy skills in the study sample, (3) identify the factors most closely associated with higher levels of eHealth literacy, and (4) examine self-efficacy as a potential mediator of the association between eHealth literacy and measures of pain and function in a sample of adults with chronic pain. One-hundred and sixty-one adults with chronic pain completed measures assessing internet use, eHealth literacy, pain interference, anxiety, depression, and pain-related self-efficacy. Results indicated that 70% of the participants are active users of the Internet for seeking information related to their health. The level of eHealth literacy skills was not statistically significantly associated with participants’ age or pain interference but was significantly negatively associated with both anxiety and depression. In addition, the findings showed that self-efficacy fully explained the relationship between eHealth literacy and depression and partially explained the relationship between eHealth literacy and anxiety. Self-efficacy should be considered as a treatment target in eHealth literacy interventions, due to its role in explaining the potential benefits of eHealth literacy.

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(162) Social disruption, but not pain interference, mediates the relationship between perceived injustice and anger in chronic pain: A Collaborative Health Outcomes Information Registry (CHOIR) study

Journal of Pain ◽

10.1016/j.jpain.2016.01.065 ◽

2016 ◽

Vol 17 (4) ◽

pp. S16

Author(s):

J. Sturgeon ◽

J. Carriere ◽

B. Darnall ◽

S. Mackey

Keyword(s):

Chronic Pain ◽

Health Outcomes ◽

Pain Interference ◽

Perceived Injustice ◽

Social Disruption ◽

The Relationship

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The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients

Children ◽

10.3390/children8010021 ◽

2021 ◽

Vol 8 (1) ◽

pp. 21

Author(s):

Anjana Jagpal ◽

Keri Hainsworth ◽

Ratka Galijot ◽

Katherine S. Salamon ◽

Kim Anderson Khan ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Functional Disability ◽

Future Research ◽

Clinical Interviews ◽

Pediatric Chronic Pain ◽

Patient Reported ◽

Poor Outcomes ◽

The Relationship

Youth with chronic pain and youth who have experienced stressors are at risk for poor outcomes; however, little is known about the intersection of pain and stressors. This study aims to understand the prevalence of stressors among youth with chronic pain and the relationship between stressors and pain-related outcomes. Seven hundred and seventy youth with chronic pain aged 8–18 (Mage = 14.15 years, 70% female) reported pain characteristics, stressors, anxiety, disability, and quality of life. Most participants (82%) endorsed at least one stressor. A greater number of stressors was significantly related to greater anxiety and disability, and lower levels of quality of life. School stressors were significantly associated with functional disability; family, school, and peer stressors were significantly associated with anxiety and quality of life. Stressors are common in youth with chronic pain, and the presence of stressors is related to greater functional impairment. The results of this preliminary study using semi-structured clinical interviews suggest the importance of developing a validated measure that encompasses a wide variety of stressors for youth with pain. Future research on patient-reported stressors, relative intensity, and impact are needed.

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The Effect of Pain Catastrophizing on Depression among Older Korean Adults with Chronic Pain: The Mediating Role of Chronic Pain Interference and Sleep Quality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17238716 ◽

2020 ◽

Vol 17 (23) ◽

pp. 8716

Author(s):

Kyoung-eun Lee ◽

Hyunju Ryu ◽

Sun Ju Chang

Keyword(s):

Chronic Pain ◽

Sleep Quality ◽

Sleep Problems ◽

Psychological Intervention ◽

Pain Catastrophizing ◽

Secondary Data ◽

The Elderly ◽

Pain Interference ◽

Korean Adults ◽

The Relationship

Pain catastrophizing is a notable concept associated with change in chronic pain interference and depression. Sleep quality is also one of the important factors affecting geriatric depression. This study examined the mediating effects of chronic pain interference and sleep quality on the relationship between pain catastrophizing and depression. This study is a secondary data analysis that analyzed a total of 138 older Korean adults with chronic pain. The participants were selected from a single elderly daycare center in a city in South Korea. Also, the multiple regression analysis and PROCESS macro with bootstrapping were used. The results revealed that chronic pain interference and sleep quality mediated the relationship between pain catastrophizing and depression, respectively. Furthermore, chronic pain interference and sleep quality sequentially and dually mediated the effect of pain catastrophizing on depression. In the management of depression in the elderly, persistent complaints of pain should not be disregarded, irrespective of the intensity of their chronic pain. Psychological intervention is needed to alleviate negative thoughts about chronic pain and to increase the ability to cope with chronic pain. In addition, it is important to assess sleep patterns and to develop interventions to improve sleep quality, because depression in the elderly could appear as a symptom of a sleep problems.

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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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