Cutoff scores for the 8-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8) to identify different profiles of pain acceptance patterns, levels of function and behavioral flexibility

Validation of the Thai Version of the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8T) in Chronic Pain Patients

Purpose

Chronic pain significantly affects patients' quality of life, leading to the avoidance of activities that exacerbate their pain. Embracing pain acceptance and willingness is crucial to maintain patients' functionality. This study aimed to translate and validate the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8) into the Thai language and to facilitate the assessment of pain acceptance in Thai patients.

Patients and Methods

The study involved the translation of the English CPAQ-8 into a Thai version, subsequently, referred to as the CPAQ-8T. The psychometric properties of the CPAQ-8T were examined. Study participants were administered a set of questionnaires, including the 100-mm Visual Analog Scale (VAS), CPAQ-8T, and the Barthel Index for Activities of Daily Living (ADL). Test-retest reliability was assessed by readministering the CPAQ-8T two weeks after the initial test. The validity and overall reliability of the CPAQ-8T were thoroughly assessed.

Results

A total of 160 patients with chronic pain at pain clinic, Ramathibodi Hospital completed all the questionnaires. The mean CPAQ-8T score was 24.2 (SD = 7.26). The CPAQ-8T score exhibited the expected correlation with the Barthel Index for ADL but showed no significant correlation with the VAS score, indicating moderate convergent validity. The internal consistency and test-retest reliability findings support the validity and reliability of the CPAQ-8T.

Conclusion

The translation and validation of the CPAQ-8 into the Thai language offers a reliable and valid instrument for assessing pain acceptance in Thai patients with chronic pain. The results suggested that the CPAQ-8T is a valuable tool for healthcare professionals and researchers working in the field of chronic pain management.

Case Report: Reduction in post-amputation phantom limb pain intensity accompanying the onset of phantom limb telescoping

Introduction

Individuals with limb loss frequently report post-amputation phenomena, including nonpainful phantom sensations, phantom limb pain (PLP), and residual limb pain (RLP). Although post-amputation pain is common, not all patients benefit from widely accepted treatments. A greater understanding of phantom limb "telescoping", the experience of one's phantom hand or foot gradually approaching the residual limb, may assist in developing more effective interventions for reducing post-amputation pain. This case report explores the relationships between PLP, RLP, telescoping, and psychosocial experience in one person with a lower limb amputation. The aim of this case is to illustrate one possible relationship between telescoping and PLP as the mechanisms linking the two remain equivocal.

Methods

The participant is a 35-year-old male who underwent a transfemoral amputation due to a traumatic injury to his right leg approximately 4 years prior. He responded to questionnaires evaluating demographic and health-related information (e.g., age, sex, marital status, reason for amputation), pain and psychological variables via the Brief Pain Inventory (BPI-SF), ID Pain Questionnaire (IDPQ), Pain Catastrophizing Scale (PSC-4), Patient Health Questionnaire-4 (PHQ-4), Life Orientation Test-Revised (LOT-R), Connor-Davidson Resilience Scale (CD-RISC2), and Chronic Pain Acceptance Questionnaire (CPAQ-8) and telescoping, measured by a newly developed app. The participant completed a semi-structured interview that was designed to ascertain patterns in the overlapping experience of phantom limb telescoping and post-amputation pain.

Results

The participant rated his average PLP as 10 on a Numeric Rating Scale (NRS) from 0 ("no pain") to 10 ("worst pain imaginable") shortly after amputation. Approximately 12 months later, the participant noticed a shortening of his phantom limb, with a concurrent decrease in PLP. At present, his average NRS pain intensity is a 5/10. The participant described how the daily, debilitating PLP intensity diminished to weekly, manageable pain over time. Most notably, his responses on questionnaires were consistent with neuropathic PLP, mild to moderate levels of pain interference, a high level of catastrophic thinking about pain, low optimism, and mild symptoms of anxiety and depression.

Discussion

In this report, telescoping appeared to be preceded by an initial reduction in PLP intensity but these findings are based on a single case report and must be replicated with a large sample size before we have a clearer idea of the relationship between telescoping and PLP. This study provides insight into factors that may maintain PLP, generating targets for further investigation.

Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population

OBJECTIVES

The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.

METHOD

A cross-sectional study was conducted at a Swedish tertiary pain rehabilitation clinic serving CnCP patients. The study population comprised 1,604 patients ≥18 years old registered in the Swedish Quality Registry for Pain Rehabilitation between 2018 and 2020. Data on dispensed opioids were extracted from the Swedish Prescribed Drug Register. Dependent variables were as follows: LTOT vs non-LTOT and exposed opioid dosage <50 mg morphine equivalent/day (MME/day) vs ≥50 MME/day.

RESULTS

Of the included patients, 681 (42.5%) had at least one dispensation of opioids 180 days prior to assessment, 601 with a calculated opioid dosage ≥1 MME/day, and 424 (26.4%) were exposed to LTOT. The type of opioid prescribed was, in descending order, oxycodone (42.3% of all dispensations), codeine in combination with paracetamol (17.6%), tramadol (13.8%), and morphine (8.1%). A total of 89 cases had dosages of ≥50 MME/day and 430 patient dosages <50 MME/day. Patients exposed to LTOT exhibited an increased odds ratio (OR) of 2.685 (95% CI, 1.942-3.711) for concomitant use of benzodiazepines and male sex (OR, 1.694; 95% CI, 1.227-2.337). Patients receiving doses ≥50 MME/day were all, except one, exposed to LTOT. The concomitant use of benzodiazepines (OR 1.814, 95% CI 1.264-3.331) and male sex (OR, 1.777; 95% CI, 1.178-3.102) indicated a higher OR for opioid doses ≥50 MME/day.

CONCLUSIONS

LTOT strongly influenced the opioid dose. Furthermore, concomitant benzodiazepine dispensation and male sex were over-represented in patients exposed to LTOT as well as those exposed to opioid doses ≥50 MME/day.

To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale

OBJECTIVES

Inflexibly relying on avoidance of expression may increase and perpetuate pain-related emotional distress in patients with chronic pain. The context-insensitive avoidance (CIA) scale was recently developed to measure the degree to which patients avoid expressing their pain and distress in social situations. This study explored the psychometric properties of the CIA scale in a new sample.

METHODS

This study uses baseline data from a treatment trial for n = 115 patients with chronic pain and co-occurring emotional distress. Reliability and construct and criteria validity were studied using the same instruments as in the original psychometric study and further explored in two new measures. A series of multiple regression analyses were conducted to assess the relationship between the CIA scale and criteria variables compared to the other psychological constructs.

RESULTS

The CIA scale showed good reliability. Significant correlations between high scores on the CIA scale and low scores on self-compassion and activity engagement could be replicated. Significant correlations between high scores on the CIA scale and high scores of pain intensity and pain interference could also be replicated. In the exploring part of this study, validity was extended to general problems with emotion regulation and to satisfaction with life in general and contact with friends but not to satisfaction with family, partner, or sexual life. Avoidance of expression was the only significant predictor of pain intensity.

CONCLUSION

This study could replicate acceptable psychometric properties of a scale measuring CIA of expression. As in the original study, avoidance of expression was associated with increased suffering. Clinically, this instrument may be used to identify patients who may otherwise remain in aggravating silence. Theoretically, it introduces the important concept of context sensitivity to the field of chronic pain. Limitations include uncertainty about causal relationships, and that several important social situations were not examined.

Examining a brief measure and observed cutoff scores to identify reward and relief drinking profiles: Psychometric properties and pharmacotherapy response

BACKGROUND

Precision medicine approaches attempt to reduce variability in alcohol use disorder (AUD) outcomes by identifying patient characteristics that predict response to a particular treatment. Recent work has examined the extent to which individuals with AUD may seek alcohol to enhance positive experiences (reward drinking) or relieve negative states (relief drinking) and shown that a high reward/low relief phenotype predicts naltrexone treatment response. Yet, limitations of reward/relief drinking measures may hamper efforts to translate findings to clinical practice. We sought to refine a brief measure of reward/relief drinking and develop cutoff scores to identify reward/relief subgroups that predict pharmacotherapy response.

METHODS

The Inventory of Drinking Situations (IDS), used in previous studies to measure reward/relief drinking, was administered to 426 participants (77% male; average age = 45.3) in a clinical trial examining naltrexone and acamprosate.

RESULTS

Item response theory and tests of differential item functioning across sex, age, and alcohol dependence severity were used to create a 10-item measure, titled the Reward and Relief IDS (RR-IDS). Cutoff scores on the RR-IDS for the reward/relief drinking subgroups were identified using latent profile and area under the curve analyses. The cutoff scores demonstrated good construct validity. Individuals in the high reward/low relief subgroup who received naltrexone or acamprosate had a decreased likelihood of heavy drinking (large effect sizes) versus those who received placebo.

CONCLUSIONS

The RR-IDS is a practical measure for identifying reward/relief subgroups and predicting pharmacotherapy response. Pending replication of these findings, the RR-IDS could be a critical precision medicine tool for prescribing AUD medications.

The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: Moderating role of fear of movement

Objectives

Knowledge is lacking on the interaction between fear of movement (FOM) and work‐related physical and psychosocial factors in the development and persistence of musculoskeletal disorders (MSDs).

Methods

In this cross‐sectional study, 305 healthcare workers from several Belgian hospitals filled out a questionnaire including sociodemographic factors, work‐related factors (social support, autonomy at work, workload, and physical job demands), FOM, and MSDs for different body regions during the past year. Path analysis was performed to investigate (1) the association between the work‐related factors, FOM and MSDs, and (2) the moderating role of FOM on the association between the work‐related factors and MSDs among healthcare workers.

Results

Complaints were most frequently located at the neck–shoulder region (79.5%) and lower back (72.4%). Physical job demands (odds ratio [OR] 2.38 and 95% confidence interval [CI] 1.52–3.74), autonomy at work (OR 1.64 CI [1.07–2.49]) and FOM (OR 1.07 CI [1.01–1.14] and OR 1.12 CI [1.06–1.19]) were positively associated with MSDs. Healthcare workers who experienced high social support at work (OR 0.61 CI [0.39–0.94]) were less likely to have MSDs. Fear of movement interacted negatively with workload (OR 0.92 CI [0.87–0.97]) and autonomy at work (OR 0.94 CI [0.88–1.00]) on MSDs.

Conclusions

Work‐related physical and psychosocial factors as well as FOM are related to MSDs in healthcare workers. FOM is an important moderator of this relationship and should be assessed in healthcare workers in addition to work‐related physical and psychosocial factors to prevent or address MSDs.

Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome

BACKGROUND

Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders.

OBJECTIVES

To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL.

METHODS

A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL.

RESULTS

Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity.

CONCLUSIONS

A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.