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George SZ, Bishop MD, Wu SS, Staud R, Borsa PA, Wallace MR, Greenfield WH, Dai Y, Fillingim RB. Biopsychosocial influence on shoulder pain: results from a randomized preclinical trial of exercise-induced muscle injury. Pain 2023; 164:305-315. [PMID: 35604152 PMCID: PMC9930191 DOI: 10.1097/j.pain.0000000000002700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Prior cohort studies validated that a subgroup defined by a specific COMT genotype and pain catastrophizing is at increased risk for heightened responses to exercise-induced or surgically induced shoulder pain. In this clinical trial, we used our preclinical model of exercise-induced muscle injury and pain to test the efficacy of interventions matched to characteristics of this high-risk subgroup (ie, personalized medicine approach). Potential participants provided informed consent to be screened for eligibility based on subgroup membership and then, as appropriate, were enrolled into the trial. Participants (n = 261) were randomized to 1 of 4 intervention groups comprised of pharmaceutical (propranolol or placebo) and informational (general education or psychologic intervention) combinations. After muscle injury was induced, participants received randomly assigned treatment and were followed for the primary outcome of shoulder pain intensity recovery over 4 consecutive days. Recovery rates were 56.4% (placebo and psychologic intervention), 55.4% (placebo and general education), 62.9% (propranolol and psychologic intervention), and 56.1% (propranolol and general education). No statistical differences were found between intervention groups in the primary analyses. Additional analyses found no differences between these intervention groups when shoulder pain duration was an outcome, and no differential treatment responses were detected based on sex, race, or level of pain catastrophizing. This trial indicates that these treatments were not efficacious for this high-risk subgroup when shoulder pain was induced by exercise-induced muscle injury. Accordingly, this phenotype should only be used for prognostic purposes until additional trials are completed in clinical populations.
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Affiliation(s)
- Steven Z. George
- Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27715 USA
| | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610 USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, FL 32610 USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL 32610 USA
| | - Paul A. Borsa
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611 USA
| | - Margaret R. Wallace
- Department of Molecular Genetics and Microbiology, UF Genetics Institute, University of Florida, Gainesville, FL 32610 USA
| | | | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL 32610 USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610 USA
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Anagnostopoulos F, Paraponiari A, Kafetsios K. The Role of Pain Catastrophizing, Emotional Intelligence, and Pain Intensity in the Quality of Life of Cancer Patients with Chronic Pain. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09921-5. [PMID: 36342590 PMCID: PMC10390631 DOI: 10.1007/s10880-022-09921-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/09/2022]
Abstract
AbstractPain catastrophizing (PC) is a negative cognitive distortion to actual or anticipated pain. This study aims to investigate the relationship between pain catastrophizing, emotional intelligence, pain intensity, and quality of life (QoL) in cancer patients with chronic pain. Eighty-nine outpatients with chronic pain attending pain clinics and palliative care units were recruited. Participants were men (42.7%) and women (57.3%) with an average age of 56.44 years (SD = 14.82). Self-report psychological measures were completed, including a measure of emotional intelligence, a standard measure of PC, a scale assessing pain intensity, and a scale measuring QoL. The PC scale was found to assess three correlated yet different dimensions of pain catastrophizing (helplessness, magnification, and rumination). Moreover, as expected, patients with PC scale scores ≥ 30 had lower scores in functional QoL dimensions and higher scores in the fatigue, pain, and insomnia symptom dimensions. Regression analyses demonstrated that PC (B = − 0.391, p = 0.004), pain intensity (B = − 1.133, p < 0.001), and education (B = 2.915, p = 0.017) remained the only significant variables related to QoL, when controlling for demographic and clinical confounders. Regarding mediating effects, PC and pain intensity were jointly found to be significant mediators in the relationship between emotional intelligence and QoL. Results are discussed in the context of the clinical implications regarding interventions designed to improve cancer patients’ quality of life and offer new insight, understanding, and evaluation targets in the field of pain management.
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Susceptibility to movement-evoked pain following resistance exercise. PLoS One 2022; 17:e0271336. [PMID: 35862479 PMCID: PMC9302845 DOI: 10.1371/journal.pone.0271336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the: (1) role of basic muscle pain sensitivity and psychological factors in the prediction of movement-evoked pain (MEP) following delayed onset muscle soreness (DOMS), and (2) association of MEP with changes in systemic muscle pain sensitivity following DOMS induction. Methods Fifty-one participants were assigned to either eccentric resistance exercise or control groups. They completed questionnaires evaluating psychological distress and underwent muscle pain sensitivity evaluation by the pressure pain threshold (PPT) test at the exercised and remote muscles, before and 24 hours following the intervention. MEP intensity was determined in response to lifting a 3kg canister using a visual analogue scale (VAS). Results The exercise group demonstrated MEP intensity of 5/10 on VAS and reduced PPTs at the main exercised muscle (p<0.001). A regression tree analyses revealed that the level of anxiety trait predicted a higher MEP intensity. A secondary analysis showed that 53% participants who were DOMS responders (MEP > mild intensity; ≥ 3/10 VAS) exhibited decreased PPTs in the exercised (p<0.001) and remote (p = 0.027) muscles following eccentric exercise. Characterization of DOMS responders revealed that, at baseline, they had lower PPTs in the exercised (p = 0.004) and remote (p = 0.001) muscles and reported higher psychological distress i.e., anxiety trait and depression symptoms (p<0.05), compared to non-responders. A regression analysis revealed that lower PPT or high levels of anxiety trait increased the probability to become a responder (p = 0.001). Conclusions Susceptibility to MEP following DOMS is determined by muscle pain hypersensitivity and high levels of anxiety trait. MEP at the early stage of DOMS is linked with an increase in systemic muscle pain sensitivity suggestive of central mechanisms. This knowledge is valuable in translating science into clinical musculoskeletal pain management.
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It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther 2022; 52:345-374. [PMID: 35128943 DOI: 10.2519/jospt.2022.10527] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate the effects of musculoskeletal rehabilitation interventions on movementevoked pain and to explore the assessment methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Three electronic databases (PubMed, Web of Science, and Scopus) were searched. STUDY SELECTION CRITERIA Randomized controlled trials investigating musculoskeletal rehabilitation interventions for movement-evoked pain in adults with musculoskeletal pain were included. DATA SYNTHESIS Meta-analysis was conducted for outcomes with homogeneous data from at least 2 trials. The mean change in movementevoked pain was the primary outcome measure. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS Thirty-eight trials were included, and 60 different interventions were assessed. There was moderate-certainty evidence of a beneficial effect of exercise therapy compared to no treatment (standardized mean difference [SMD], -0.65; 95% confidence interval [CI]: -0.83, -0.47; P<.001) on movement-evoked pain in adults with musculoskeletal pain. There was low-certainty evidence of a beneficial effect of transcutaneous electrical nerve stimulation compared to no treatment (SMD, -0.46; 95% CI: -0.71, -0.21; P = .0004). There was no benefit of transcutaneous electrical nerve stimulation when compared to sham transcutaneous electrical nerve stimulation (SMD, -0.28; 95% CI: -0.60, 0.05; P = .09; moderate-certainty evidence). CONCLUSION There was moderate-certainty evidence that exercise therapy is effective for reducing movement-evoked pain in patients with musculoskeletal pain compared to no treatment. Consider exercise therapy as the first-choice treatment for movement-evoked pain in clinical practice. J Orthop Sports Phys Ther 2022;52(6):345-374. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10527.
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Gava V, Fialho HRF, Calixtre LB, Barbosa GM, Kamonseki DH. Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Games Health J 2022; 11:369-384. [PMID: 35613404 DOI: 10.1089/g4h.2021.0232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.
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Affiliation(s)
- Vander Gava
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Hilmaynne Renaly Fonseca Fialho
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Germanna Medeiros Barbosa
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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Mittinty MM, Santiago PHR, Jamieson L. Assessment of Pain-Related Fear in Indigenous Australian Populations Using the Fear of Pain Questionnaire-9 (FPQ-9). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106256. [PMID: 35627793 PMCID: PMC9141503 DOI: 10.3390/ijerph19106256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
In this study, we examined the psychometric properties of the Fear of Pain Questionnaire (FPQ-9) in Indigenous Australian people. FPQ-9, a shorter version of the original Fear of Pain Questionnaire-III, was developed to support the demand for more concise scales with faster administration time in the clinical and research setting. The psychometric properties of FPQ-9 in Indigenous Australian participants (n = 735) were evaluated with network psychometrics, such as dimensionality, model fit, internal consistency and reliability, measurement invariance, and criterion validity. Our findings indicated that the original FPQ-9 three-factor structure had a poor fit and did not adequately capture pain-related fear in Indigenous Australian people. On removal of two cross-loading items, an adapted version Indigenous Australian Fear of Pain Questionnaire-7 (IA-FPQ-7) displayed good fit and construct validity and reliability for assessing fear of pain in a sample of Indigenous Australian people. The IA-FPQ-7 scale could be used to better understand the role and impact of fear of pain in Indigenous Australian people living with chronic pain. This could allow for more tailored and timely interventions for managing pain in Indigenous Australian communities.
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Affiliation(s)
- Manasi Murthy Mittinty
- Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2050, Australia
- Correspondence: ; Tel.: +61-088-3134-611
| | - Pedro H. R. Santiago
- Indigenous Oral Health Unit, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (P.H.R.S.); (L.J.)
| | - Lisa Jamieson
- Indigenous Oral Health Unit, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (P.H.R.S.); (L.J.)
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8
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Hegde T, Bhavyashri P, Vasthare R, Karthik M, Munoli R. Evaluation of Parental Dental Fear and Anxiety (DFA) on Adolescent Dental Treatment: A Narrative review. J Int Soc Prev Community Dent 2022; 12:12-19. [PMID: 35281685 DOI: 10.4103/jispcd.jispcd_261_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Parental dental fear and anxiety (DFA) is an important factor, which has an impact on adolescence receiving dental treatment and maintenance of their oral health. It is necessary to recognize and know how parental DFA affects the dental treatment of children and adolescents. Aim This narrative review was planned with the objective of evaluating parental DFA influence on adolescent dental treatment. Materials and Methods A broad search of literature published between 2005 and 2021 from electronic databases through Scopus, PubMed, Web of Science, Google Scholar was performed. We included the studies in which parental dental anxiety was a major criterion affecting different dental health conditions. Articles referring to adolescents facing different oral health problems were also included. This narrative review included 12 articles of which 8 cross-sectional studies, 3 longitudinal studies, and 1 descriptive study, all of which met the inclusion criteria and the specified age group of adolescents ranging between 10 and 19 years. Results After screening 83 abstracts, 12 articles were selected, which included all the inclusion criteria. In this study, we found that parental DFA showed a positive association with their adolescent's DFA, which hinders the dental treatment received. Conclusion Parental DFA influences the adolescent behavior and can impact the seeking of dental treatment. Hence, it is important to address parental DFA prior to the intervention and treatment. An appropriate address will facilitate in reducing or eliminating DFA in adolescents.
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Affiliation(s)
- Thrisha Hegde
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - P Bhavyashri
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ramprasad Vasthare
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M Karthik
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindra Munoli
- Department of Psychiatry, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kamonseki DH, Pott-Junior H, Haik MN, Almeida LAD, Camargo PR. Pain-related fear phenotypes are associated with function of the upper limbs in individuals with shoulder pain. Musculoskelet Sci Pract 2021; 55:102416. [PMID: 34175789 DOI: 10.1016/j.msksp.2021.102416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and describe phenotypes related to kinesiophobia, fear-avoidance, and pain catastrophizing, and determine clinical and demographic characteristics related to each phenotype as a function of self-reported function of the upper limbs in individuals with shoulder pain. METHODS One hundred and seventy-seven individuals with shoulder pain participated in this study. Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Numerical Pain of Rating Scale, and the angular onset of pain during the elevation of the arm were measured in all participants. A cluster analysis was performed considering kinesiophobia, fear-avoidance, and pain catastrophizing, then clinical and demographic characteristics of clusters were used to model individual's chance to belong to one of the clusters as a function of DASH. RESULTS Two clusters were identified based on kinesiophobia, fear-avoidance, and pain catastrophizing. The cluster with worse pain-related fear profile presented (p < 0.05) higher age, worse function, and higher pain intensity. This same cluster was also associated with involvement of the dominant side (OR = 2.10, 95% CI = 1.03, 4.41) and worse function (OR = 0.96, 95% CI = 0.94, 0.98). CONCLUSION This study identified that individuals with worse pain-related fear profile were older, with worse function, and higher pain intensity. Worse function and involvement of the dominant side were associated with the phenotype with a worse pain-related fear condition.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Melina Nevoeiro Haik
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Lucas Araújo de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
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Jiang D, Tang J, Guan Q, Cui F, Luo YJ. Money gained through suffering is less valuable: Pain reduces the sensitivity to outcome magnitude in monetary decision making. Soc Neurosci 2021; 16:564-572. [PMID: 34229571 DOI: 10.1080/17470919.2021.1953135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Enduring pain would change individuals' behavioral preferences and neural responses in multiple decision-making tasks. Yet few studies have investigated how money's casual association with painful experience would modify people's decisions with it. It is an important and common social situation. The present study investigated how money's association with pain influences the way people make monetary decisions. Participants gambled with money that they earned in four different ways: enduring pain (Pain), randomly assigned (Random), non-painful effort task (Effort), and observing negative images (NO). Results revealed two different patterns. In the Random and Pain conditions, participants were not sensitive to the gambling risk such that they more randomly chose high- and low-risk options; the differences in FNR amplitude triggered by high- and low-risk choices were comparable on the neural level. In contrast, in the Effort and NO conditions, participants showed higher sensitivity to the magnitude and larger differences in FNR amplitudes between high- and low-risk choices. These findings suggested that pain cannot increase the subjective value of monetary gain like other non-painful efforts can do and monetary rewards may not be the optimal way to compensate for the physical suffering or loss in society.
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Affiliation(s)
- Duo Jiang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Jie Tang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Qing Guan
- Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, Shenzhen, China
| | - Fang Cui
- College of Psychology, Shenzhen University, Shenzhen, China.,Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, Shenzhen, China
| | - Yue-Jia Luo
- Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, Shenzhen, China.,School of Psychology, Beijing Normal University, Beijing, China
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Butera KA, Bishop MD, Greenfield WH, Staud R, Wallace MR, Borsa PA, Fillingim RB, George SZ. Sensory and Psychological Factors Predict Exercise-Induced Shoulder Injury Responses in a High-Risk Phenotype Cohort. THE JOURNAL OF PAIN 2021; 22:669-679. [PMID: 33400997 PMCID: PMC8197727 DOI: 10.1016/j.jpain.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
Our prior studies identified a high-risk phenotype (ie, high pain sensitivity variant of the catechol-O-methyltransferase gene (Single Nucleotide Polymorphism [SNP] rs6269) and pain catastrophizing scores) for shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced shoulder injury. Healthy participants (N = 131) with the SNP rs6269 catechol-O-methyltransferase gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established shoulder fatigue protocol, to induce muscle injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours postinjury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the shoulder disability outcome (full model R2 = .20, parsimonious R2 = .13). In parsimonious models, the individual predictors identified were: 1) 1st pulse heat pain sensitivity for isometric shoulder movement-evoked pain and pain intensity; 2) pressure pain threshold for shoulder disability; 3) fear of pain for active shoulder movement-evoked pain and shoulder disability; and 4) depressive symptoms for shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. PERSPECTIVE: The current study extends previous work by providing insight regarding how poor shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different shoulder outcomes.
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Affiliation(s)
- Katie A Butera
- Department of Physical Therapy, Rehabilitation Science Doctoral Program, University of Florida, Gainesville, Florida
| | - Mark D Bishop
- Department of Physical Therapy, Rehabilitation Science Doctoral Program, University of Florida, Gainesville, Florida
| | - Warren H Greenfield
- Department of Physical Therapy, Rehabilitation Science Doctoral Program, University of Florida, Gainesville, Florida
| | - Roland Staud
- Department of Rheumatology and Clinical Immunology, University of Florida, Gainesville, Florida
| | - Margaret R Wallace
- Department of Molecular Genetics and Microbiology, University of Florida and UF Genetics Institute, Gainesville, Florida
| | - Paul A Borsa
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, Florida
| | - Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina.
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12
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Piwowarczyk P, Kaczmarska A, Kutnik P, Hap A, Chajec J, Myśliwiec U, Czuczwar M, Borys M. Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084098. [PMID: 33924523 PMCID: PMC8068817 DOI: 10.3390/ijerph18084098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.
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Affiliation(s)
- Paweł Piwowarczyk
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
- Correspondence:
| | - Agnieszka Kaczmarska
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Paweł Kutnik
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Aleksandra Hap
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Joanna Chajec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Urszula Myśliwiec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Mirosław Czuczwar
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Michał Borys
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
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Olds M, Ellis R, Parmar P, Kersten P. The immediate and subsequent impact of a first-time traumatic anterior shoulder dislocation in people aged 16-40: Results from a national cohort study. Shoulder Elbow 2021; 13:223-232. [PMID: 33897854 PMCID: PMC8039766 DOI: 10.1177/1758573220921484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited evidence exists which details changes in quality of life, shoulder activity level, kinesiophobia, shoulder pain and disability following a first-time traumatic anterior shoulder dislocation (FTASD) in people treated non-operatively. This study had three objectives: (1) to examine quality of life, pain, disability and kinesiophobia after an FTASD within 12 weeks, (2) to examine whether these variables were different in people with and without recurrent shoulder instability and (3) to assess how these variables changed over 12 months. METHODS A prospective cohort study was undertaken in people with an FTASD aged between 16 and 40 years. Measures of quality of life, kinesiophobia, shoulder activity, shoulder pain and disability were recorded within 12 weeks of an FTASD and at 3, 6, 9 and 12 months. RESULTS An FTASD negatively impacted quality of life, shoulder pain and function and these variables improved over time. People with recurrent shoulder instability had poorer quality of life 12 months after an FTASD. Across the entire cohort, kinesiophobia did not significantly change across time in people following an FTASD. CONCLUSIONS Quality of life was significantly affected by an FTASD in people with recurrent shoulder instability. Across the entire cohort of people with an FTASD, kinesiophobia remained elevated in people following an FTASD. LEVEL OF EVIDENCE Level 1 prognostic study.
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Affiliation(s)
- M Olds
- Flawless Motion Ltd, Auckland, New
Zealand,M Olds, Flawless Motion Ltd, 7/88 Cook St,
Auckland 1010, New Zealand.
| | - R Ellis
- Faculty of Health and Environmental
Sciences, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of
Technology, Auckland, New Zealand
| | - P Parmar
- Department of Biostatistics and
Epidemiology, Faculty of Health and Environmental Sciences, School of Public Health
and Psychosocial Studies, Auckland University of
Technology, Auckland, New Zealand
| | - P Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wideman TH. A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain-Related Outcomes. Pain Pract 2021; 21:523-535. [PMID: 33316140 DOI: 10.1111/papr.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Risk constructs based on psychological risk factors (eg, pain catastrophizing, PC) and sensitization risk factors (eg, pressure pain threshold, PPT) are important in research and clinical practice. Most research looks at individual constructs but does not consider how different constructs might interact within the same individual. An evaluation of the cumulative impact of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological (PC) and sensitization (PPT) risk factors on pain-related outcomes (activity avoidance, pain severity, and disability) considering covariates. METHODS We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis, who completed all measures of this study. Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability, and pain severity). Subgroups were constructed by dichotomizing of PC and PPT scores, resulting in four groups: (1) low catastrophizing and low sensitivity (N = 26), (2) high catastrophizing and low sensitivity (N = 27), (3) low catastrophizing and high sensitivity (N = 25), and (4) high catastrophizing and high sensitivity (N = 31). RESULTS One-way analysis of variance (ANOVA) revealed significant group differences (P < 0.05, η2 = 0.08 to 0.14) in all outcomes of this study (except functional avoidance), and post hoc analysis indicated the significant differences are between group 1 and 4. A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = 0.8 to 1). The group 2 and 3 (one risk dimension groups: either high-PC or high-PPT) represent 47% of the total participants. CONCLUSIONS The study suggests both higher level of PC and pressure sensitivity have a cumulative impact on risk screening for pain-related outcomes, considering gender in functional avoidance (task-related outcome). A clinical presentation with high-PC (one dimension of risk) is not associated with high-PPT (another dimension of risk). This finding has important clinical and theoretical implications.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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15
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Macías-Toronjo I, Rojas-Ocaña MJ, Sánchez-Ramos JL, García-Navarro EB. Pain catastrophizing, kinesiophobia and fear-avoidance in non-specific work-related low-back pain as predictors of sickness absence. PLoS One 2020; 15:e0242994. [PMID: 33301458 PMCID: PMC7728279 DOI: 10.1371/journal.pone.0242994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
The influence of pain catastrophizing, kinesiophobia and fear-avoidance attitudes towards non-specific low-back pain has been scarcely studied in an occupational insurance provider context. The objective of this work is to ascertain the relationship between these psychosocial variables with work absence, its duration and the disability of subjects with work-related low back pain. This is a descriptive observational methodological strategy. All patients with work-related non-specific low back pain who attended to an occupational health hospital during the study period were included consecutively. Clinical variables of kinesiophobia, pain catastrophizing, fear-avoidance attitudes, disability and pain were collected; sociodemographic variables of sex, age, type of work, educational level, occupational status and duration in days of work absence were recorded. Kinesiophobia (b = 1.43, P = 0.011, r = 0.333), fear-avoidance beliefs in its global dimension (b = 0.910, P = 0.014, r = 0.321), fear-avoidance beliefs in its work dimension (b = 1.255, P = 0.016, r = 0.321) and pain catastrophizing (b = 0.997, P = 0.013, r = 0.340) show individual association with the duration of sickness absence. Kinesiophobia (b = 0.821, P = 0.011, r = 0.30) and fear-avoidance beliefs (b = 1.760, P = 0.016, r = 0.28) are associated with disability (Kinesiophobia, b = 0.880, P = 0.045, r = 0.26; Fear-avoidance beliefs, b = 0.724, P = 0.010, r = 0.34). Kinesiophobia, fear-avoidance beliefs and pain catastrophizing are related to an increase in the duration of work absence and disability in patients with back pain in an occupational insurance provider context.
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Affiliation(s)
- Israel Macías-Toronjo
- Physical Therapy, Department of Rehabilitation, Huelva Fremap Hospital, Huelva, Andalucía, Spain
| | | | | | - E. Begoña García-Navarro
- Department of Nursing and Health Sciences, University of Huelva, Huelva, Spain
- Research Group ESEIS, Social Studies and Social Intervention, Center for Research in Contemporary Thought and Innovation for Development (COIDESO), University of Huelva, Huelva, Spain
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16
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Fear-Avoidance Behavior and Sickness Absence in Patients with Work-Related Musculoskeletal Disorders. ACTA ACUST UNITED AC 2020; 56:medicina56120646. [PMID: 33255875 PMCID: PMC7760519 DOI: 10.3390/medicina56120646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
(1) Background and objectives: The purpose of this work is to determine the association of fear-avoidance attitudes with sickness absence status, its duration and disability in a work accident context. (2) Materials and Methods: This is a descriptive observational design, conducting the study in two occupational insurance provider clinics with patients with nonspecific low back and neck pain during the study period. Clinical variables were the Fear Avoidance Questionnaire, Roland Morris Disability Questionnaire, Neck Disability Index, Numerical Pain Scale; sociodemographic variables were sex, age, occupational, educational level, sickness absence status, and duration in days of absence from work. Multiple logistic and linear regressions were used to explore the association between variables. (3) Results: Fear-avoidance behavior is related to sickness absence status (OR = 1.048, p = 0.007), and the physical activity dimension (OR = 1.098, p = 0.013) is more relevant than the work dimension (OR = 1.056, p = 0.028). The duration of sickness absence is related to higher values on the fear-avoidance behavior scale in its global dimension (b = 0.84, p = 0.003, r = 0.327), and the results of the physical activity dimension (B = 1.37, p = 0.035, r = 0.236) were more relevant than the work dimension (B = 1.21, p = 0.003, r = 0.324). Fear-avoidance behavior is related to disability in both dimensions (B = 0.912, p ˂ 0.001, r = 0.505). (4) Conclusions: Fear-avoidance behaviors may influence the typification of sickness absence status, its duration both in its physical activity and work dimension, and its disability reported with higher values than in other healthcare contexts.
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Mertens MGCAM, Hermans L, Crombez G, Goudman L, Calders P, Van Oosterwijck J, Meeus M. Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults. Eur J Pain 2020; 25:243-256. [DOI: 10.1002/ejp.1665] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/14/2020] [Accepted: 09/16/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Michel GCAM Mertens
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
| | - Linda Hermans
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology Ghent University Ghent Belgium
| | - Lisa Goudman
- Departments of Physiotherapy and Human Physiology Faculty of Physical Education & Physiotherapy Vrije Universiteit Brussel Ixelles Belgium
- Department of Neurosurgery University Hospital Brussels Jette Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Jessica Van Oosterwijck
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Research Foundation – Flanders (FWO) Brussels Belgium
| | - Mira Meeus
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
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Plasma Concentrations of Select Inflammatory Cytokines Predicts Pain Intensity 48 Hours Post-Shoulder Muscle Injury. Clin J Pain 2020; 36:775-781. [PMID: 32675582 DOI: 10.1097/ajp.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The relationship between elevated inflammatory cytokine levels and peak pain intensity following acute musculoskeletal injury has not been fully elucidated in high risk subgroups. Identifying the role that these cytokines have on pain responses may help with developing tailored therapeutic approaches. METHODS Data were collected from 54 participants who were vulnerable to a robust pain response and delayed recovery following musculoskeletal injury. Participants completed baseline active and resting pain measurements and a blood draw before an exercised induced shoulder muscle injury. Participants returned at 24 and 48 hours postinjury for follow-up pain measurements and blood draws. Blood plasma was analyzed for interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor α. Pearson bivariate correlations were performed between cytokines and pain measurements to identify candidate variables for stepwise multiple linear regression predicting pain intensity reports. RESULTS Pearson bivariate correlation identified 13/45 correlations between inflammatory cytokines and resting pain intensity and 9/45 between inflammatory cytokines and active pain (P<0.05, r≥0.3 or r≤-0.3). This led to 5 stepwise multiple linear regression models, of which 4 met the statistical criterion (P<0.0167); including IL-10 baseline plasma concentrations predicting active pain (r=0.19) and resting pain (r=0.15) intensity 48 hours postinjury. IL-6 and IL-10 plasma concentrations at 48 hours were respectively associated with active and resting pain at 48 hours. DISCUSSION These findings suggest that elevated concentrations of inflammatory cytokines, specifically IL-10 (at baseline and 48 h) and IL-6 (at 48 h), may play a role in heightened pain responses following exercise-induced muscle injury.
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19
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Chen A, Argoff C, Crosby E, De EJ. Chronic Pelvic Pain Patients Demonstrate Higher Catastrophizing in Association with Pelvic Symptoms and Comorbid Pain Diagnoses. Urology 2020; 150:146-150. [PMID: 32668289 DOI: 10.1016/j.urology.2020.06.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To elucidate the relationship between catastrophization and pelvic pain symptomatology in chronic pelvic pain (CPP) patients using standardized questionnaires. METHODS CPP patients completed standardized questionnaires which included: genitourinary pain index, patient health questionnaire for anxiety and depression, interstitial cystitis symptom index, and pelvic floor distress inventory. Scores and number of comorbidities were compared to Pain Catastrophizing Scale (PCS) by linear regression. Patients categorized as "extreme catastrophizing" (PCS score ≥30), traditionally associated with worse outcomes in the pain literature [10-11], were also analyzed separately. RESULTS 184 patients were included (mean age 42 years, N = 23 male). Higher number of pain comorbidities was correlated to PCS (P < .001) as well as higher scores on all standardized questionnaires (P < .001). Forty-four percent of patients (81/184) were extreme catastrophizers and scored significantly worse on all standardized measures when compared to nonextreme catastrophizers. Mean scores for nonextreme vs extreme catastrophizers were: genitourinary pain index (25.7 ± 6.8 vs 32.7 ± 6.5, P < .001), interstitial cystitis symptom index (6.5 ± 4.7 vs 9.4 ± 5.8, P < .001), pelvic floor distress inventory (88.8 ± 52 vs 121.1 ± 62.8, P < .001), patient health questionnaire anxiety (1.7 ± 2.0 vs 3.6 ± 2.1, P < .001), and depression (1.4 ± 1.6 vs 3.3 ± 2.0, P < .001). Number of comorbidities was not significant predictor of extreme catastrophizing (3.5 vs 3.7 P = .22). CONCLUSION Higher scores on standardized questionnaires and more comorbidities was associated with more catastrophizing in CPP patients. This study highlights the significance of standardized questionnaires, including the PCS, to predict which patients may be extreme catastrophizers and thus subject to worse outcomes. Future studies are needed to look at catastrophization as a potentially modifiable and treatable risk factor.
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Affiliation(s)
- Annie Chen
- Stony Brook University Hospital, Stony Brook Medicine HSC T9 Room 040, Stony Brook, NY 11794.
| | | | | | - Elise Jb De
- Massachusetts General Hospital, Department of Urology, 165 Cambridge St 7th Floor, Boston, MA 02114
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20
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Akbas A, Dagmura H, Daldal E, Dasiran FM, Deveci H, Okan I. Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery. Breast Care (Basel) 2020; 16:66-71. [PMID: 33716634 DOI: 10.1159/000506922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prolonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca-tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period. Patients and Methods The present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups. Results The average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5-32) and the shoulder pain severity score was 4 (range 0-8), while in the group with normal shoulder range of motion these values were 11 (range 3-39) and 2 (range 0-6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation. Conclusion Determining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.
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Affiliation(s)
- Ahmet Akbas
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Hasan Dagmura
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Emin Daldal
- Department of General Surgery, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | | | - Hülya Deveci
- Department of Physical Therapy and Rehabilitation, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ismail Okan
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
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Cresswell C, Galantino ML, Myezwa H. The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1326. [PMID: 32161823 PMCID: PMC7059507 DOI: 10.4102/sajp.v76i1.1326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa. Objectives To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg. Method The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations. Results A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001). Conclusion FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC. Clinical implications Identifying FA and PC in patients with CNP is important to facilitate holistic management.
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Affiliation(s)
- Clare Cresswell
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary L Galantino
- School of Health Sciences, Stockton University, Galloway, United States
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Pain perception and coping strategies influence early outcomes following knee surgery in athletes. J Sci Med Sport 2019; 23:100-104. [PMID: 31563440 DOI: 10.1016/j.jsams.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 07/23/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia. DESIGN Prospective cohort study. METHODS 101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure. RESULTS Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02). CONCLUSIONS Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.
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Berniger Romariz JA, Nonnemacher C, Abreu M, Dickel Segabinazi J, Bandeira JS, Beltran G, Souza A, Torres IL, Caumo W. The Fear of Pain Questionnaire: psychometric properties of a Brazilian version for adolescents and its relationship with brain-derived neurotrophic factor (BDNF). J Pain Res 2019; 12:2487-2502. [PMID: 31496790 PMCID: PMC6689757 DOI: 10.2147/jpr.s199120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/22/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives The primary aim was to assess the psychometric properties (including internal consistency, construct validity, criterion validity, criterion-group validity and responsiveness) of the Fear of Pain Questionnaire (FOPQ) for adolescents (FOPQ-A) and parents (FOPQ-P) translated to Brazilian Portuguese (BrP). The secondary aim was to analyze the factor structures and their ability to identify subjects with chronic pain conditions and identify the relationship of the BrP FOPQ-A with saliva brain-derived neurotrophic-factor (BDNF). Methods A cross-sectional study was conducted with 286 adolescents aged 11 to 18 (257 healthy adolescents [157 females] and 29 adolescents with chronic pain [16 females]). Parents and adolescents completed the BrP-FOPQ. A team of experts translated the FOPQ according to international guidelines. Convergent validity and factor analysis were performed. Later, a subsample (n=146) was used to correlate the BrP-FOPQ-A with saliva BDNF. Results The BrP-FOPQ for adolescents and parents presented strong psychometric properties (Cronbach’s α equal to 0.92 and 0.91, respectively). BrP-FOPQ-A confirmatory factor analysis yielded a two-factor structure while the factorial analyses of BrP-FOPQ-P demonstrated that the best solution was a three-structure factorial. The BrP-FOPQ-P scores in healthy adolescents and those in chronic pain conditions was 34.13 (16.71) vs 43.14 (18.08), respectively. A generalized mixed model demonstrated that the scores in the BrP-FOPQ-A are higher in those with chronic pain conditions compared to healthy subjects (29.20 [12.77] vs 33.80 [10.76], respectively; Wald χ2= 17.80; df=1, P<0.0001). The model revealed that the BDNF was positively correlated with the score of BrP-FOPQ-A and subjects with chronic pain showed higher levels of BDNF. Conclusion The BrP-FOPQ scores for adolescents and parents were found to be psychometrically robust and reliable instruments, with primary evidence of validity. Higher scores on the BrP-FOPQ-A were correlated positively with saliva BDNF and permitted the identification of subjects with chronic pain conditions.
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Affiliation(s)
- José Ary Berniger Romariz
- Postgraduate Program in Medical Sciences, Faculdade de Medicina,Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre , Brazil
| | - Cássio Nonnemacher
- Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre , Brazil
| | - Mylena Abreu
- Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre , Brazil
| | | | | | - Gerardo Beltran
- Postgraduate Program in Medical Sciences, Faculdade de Medicina,Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre , Brazil.,Psychology Department, Cuenca Catholic University, Cuenca, Ecuador
| | - Andressa Souza
- Postgraduate Program in Health and Human Development, La Salle Universitary Center , Canoas, Brazil
| | - Iraci Ls Torres
- Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wolnei Caumo
- Postgraduate Program in Medical Sciences, Faculdade de Medicina,Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre , Brazil.,Pain and Anesthesia,Surgery Department, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Corbett DB, Simon CB, Manini TM, George SZ, Riley JL, Fillingim RB. Movement-evoked pain: transforming the way we understand and measure pain. Pain 2019; 160:757-761. [PMID: 30371555 PMCID: PMC6424644 DOI: 10.1097/j.pain.0000000000001431] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Duane B. Corbett
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
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25
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Van Wyngaarden JJ, Noehren B, Archer KR. Assessing psychosocial profile in the physical therapy setting. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Kristin R. Archer
- Department of Orthopaedic Surgery, Department of Physical Medicine and Rehabilitation Vanderbilt University Medical Center Nashville Tennessee
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26
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Odole A, Ekediegwu E, Ekechukwu END, Uchenwoke C. Correlates and predictors of pain intensity and physical function among individuals with chronic knee osteoarthritis in Nigeria. Musculoskelet Sci Pract 2019; 39:150-156. [PMID: 30623891 DOI: 10.1016/j.msksp.2018.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/02/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the correlates between pain intensity (PI) and physical function (PF) and psychosocial factors {kinesiophobia (K), Pain Catastrophizing (PC) and Self-efficacy (SE)} among patients diagnosed with knee osteoarthritis in developing countries like Nigeria. OBJECTIVE To investigate the correlates of PI and PF and psychosocial factors in patients with knee osteoarthritis in Nigeria. DESIGN Eighty-nine consecutively sampled patients diagnosed with knee osteoarthritis from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey. METHOD Brief Fear of Movement Scale for Osteoarthritis, Pain Catastrophizing Scale and Arthritis Self-Efficacy Scale-8 item were used to assess kinesiophobia, pain catastrophizing and Self-efficacy respectively. Visual Analogue Scale and Ibadan Knee or Hip Osteoarthritis Measure were used to assess PI and PF respectively. Data were analysed using Pearson's correlation coefficient and multiple regression at p = 0.05. RESULTS/FINDINGS Participants were aged 59.11 ± 12.46years involving male (17.9%) and female (82.1%) participants. There were no significant gender differences in the scores of kinesiophobia, PI, PF, PC and self-efficacy. Pain intensity was significantly proportional to kinesiophobia (r = 0.38), and PC(r = 0.39). Better physical function was associated with high self-efficacy (r = 0.35), low kinesiophobia (r = -0.43) and low PC(r = -0.28). Significant predictive markers of PI included kinesiophobia (β = 0.24) and PC(β = 0.11) while that of PF, included kinesiophobia (β = -0.41) and SE(β = 2.39). CONCLUSIONS Kinesiophobia and pain catastrophizing correlate and predict PI significantly. Kinesiophobia and SE are significant correlates and predictors of PF among patients with knee osteoarthritis in Nigeria.
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Affiliation(s)
- Adesola Odole
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Ekediegwu
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria; Astella Physiotherapy Clinics, Enugu, Nigeria.
| | - E N D Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Chigozie Uchenwoke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Anambra, Nigeria
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27
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the novel added value of neurophysiological pain sensitivity within the fear-avoidance model of pain. Eur J Pain 2019; 23:957-972. [PMID: 30648781 DOI: 10.1002/ejp.1364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The fear-avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM-related outcomes, beyond model-relevant psychological predictors. METHODS The study sample consisted of 80 adults with chronic and widespread musculoskeletal pain. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain-related fear, activity avoidance (self-report and functional measures), pain-related disability, depression and pain severity, as well as a battery of quantitative sensory testing that included measures of pressure pain threshold and temporal summation of mechanical pain across eight body sites. RESULTS A series of hierarchical regression analyses revealed that after controlling for the psychological predictors of the FAM, indices of pain sensitivity significantly predicted 4 of the 5 FAM-related outcomes (p < 0.05). Depression was the only outcome not significantly predicted by pain sensitivity. Interestingly, measures of pain sensitivity, but not FAM psychological factors, predicted the functional measure of activity avoidance. CONCLUSIONS These findings provide further evidence for the importance of neurophysiological factors within the FAM and have important clinical and theoretical implications. SIGNIFICANCE This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Rebekah Wickens
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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28
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Sakamoto Y, Amari T, Shimo S. The relationship between pain psychological factors and job stress in rehabilitation workers with or without chronic pain. Work 2018; 61:357-365. [PMID: 30373991 DOI: 10.3233/wor-182814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Yuta Sakamoto
- Department of Rehabilitation Technique, Fuefuki Central Hospital, Fuefuki, Yamanashi, Japan
| | - Takashi Amari
- Department of Rehabilitation Technique, Fuefuki Central Hospital, Fuefuki, Yamanashi, Japan
| | - Satoshi Shimo
- Department of Occupational Therapy, Health Science University, Fujikawaguchiko, Yamanashi, Japan
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29
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Sharma S, Pathak A, Jha J, Jensen MP. Socioeconomic factors, psychological factors, and function in adults with chronic musculoskeletal pain from rural Nepal. J Pain Res 2018; 11:2385-2396. [PMID: 30425551 PMCID: PMC6200427 DOI: 10.2147/jpr.s173851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Both socioeconomic and psychological factors have been shown to predict patient function in samples of individuals with chronic pain in Western countries. However, little is known about their role as predictors of function in individuals with chronic pain from developing countries. Purpose The purpose of this study was to examine the associations between measures of socioeconomic factors (income, education) and psychological factors (catastrophizing and resilience) and measures of function in a sample of individuals with chronic pain from rural Nepal. In addition, we sought to evaluate the moderating effects of socioeconomic factors on the associations between the psychological variables and function. Methods We interviewed 143 adults with chronic musculoskeletal pain from rural areas of Nepal to assess income, education level, pain intensity, catastrophizing, resilience, physical function, and depression. We performed two regression analyses to evaluate the direct and unique effects of the socioeconomic and psychological variables and pain intensity as predictors of patient function, as well as the moderating influence of income, education level, and pain intensity on the associations between the psychological variables and function. Results Education and income both predicted physical function, but only income predicted depression. In addition, pain catastrophizing, but not resilience, evidenced a direct and significant independent association with depression. Neither catastrophizing nor resilience made independent and significant direct contributions to the prediction of physical function. The association between resilience and physical function was moderated by pain intensity and income, and income (but not education or pain intensity) moderated the associations between both 1) resilience and depression and 2) catastrophizing and depression. Conclusion The results suggest the possibility that cultural differences may influence the role that psychosocial factors play in chronic pain adjustment. These findings have important implications regarding how psychosocial pain interventions should be adapted by individuals in developing countries.
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Affiliation(s)
- Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal, .,Center for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand,
| | - Anupa Pathak
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal, .,School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jyoti Jha
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal, .,Department of Physiotherapy, Grande International Hospital, Kathmandu, Nepal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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30
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Borsa PA, Parr JJ, Wallace MR, Wu SS, Dai Y, Fillingim RB, George SZ. Genetic and psychological factors interact to predict physical impairment phenotypes following exercise-induced shoulder injury. J Pain Res 2018; 11:2497-2508. [PMID: 30425562 PMCID: PMC6205136 DOI: 10.2147/jpr.s171498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background We investigated interactions between genetic and psychological factors in predicting shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes. Subjects and methods Altogether, 190 participants completed a 5-day experimental protocol. An experimental shoulder injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype. Results Strong statistical evidence was provided for interactions between: 1) IL-1β (rs1143634) and fear of pain for predicting loss of shoulder flexion and abduction, 2) IL-1β (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1β (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss. Conclusion Pro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1β [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss).
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Affiliation(s)
- Paul A Borsa
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA,
| | - Jeffrey J Parr
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Margaret R Wallace
- Department of Molecular Genetics and Microbiology, Center for Epigenetics, UF Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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31
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Martinez-Calderon J, Struyf F, Meeus M, Luque-Suarez A. The association between pain beliefs and pain intensity and/or disability in people with shoulder pain: A systematic review. Musculoskelet Sci Pract 2018; 37:29-57. [PMID: 29980139 DOI: 10.1016/j.msksp.2018.06.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pain beliefs might play a role in the development, transition, and perpetuation of shoulder pain. OBJECTIVE To systematically review and critically appraise the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain. METHODS An electronic search of PubMed, EBSCOhost, AMED, CINAHL, EMBASE, and PubPsych, and grey literature was searched from inception to July 2017. Study selection was based on observational studies exploring the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain. RESULTS A total of thirty-three articles were included with a total sample of 10,293 participants with shoulder pain. In the cross-sectional analysis, higher levels of pain catastrophizing and kinesiophobia were significantly associated with more pain intensity and disability, whereas higher levels of expectations of recovery and self-efficacy were significantly associated with lower levels of pain intensity and disability. In the longitudinal analysis, higher levels of pain catastrophizing, fear-avoidance and kinesiophobia at baseline predicted greater pain intensity and disability overtime. Higher levels of self-efficacy and expectations of recovery at baseline predicted a reduction in levels of pain intensity and disability overtime. CONCLUSIONS Evidence suggests that pain beliefs are associated with and predict the course of pain intensity and disability in shoulder pain. However, the overall body of the evidence after applying the GRADE approach was very low across studies. Further research using higher quality longitudinal designs and procedures would be needed to establish firm conclusions.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences and Physiotherapy Department, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Belgium(1)
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32
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Arendsen LJ, Hugh-Jones S, Lloyd DM. Transcranial Alternating Current Stimulation at Alpha Frequency Reduces Pain When the Intensity of Pain is Uncertain. THE JOURNAL OF PAIN 2018; 19:807-818. [DOI: 10.1016/j.jpain.2018.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 01/15/2018] [Accepted: 02/22/2018] [Indexed: 12/31/2022]
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Tuna Z, Oskay D. Fear of movement and its effects on hand function after tendon repair. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30092-6. [PMID: 29887493 DOI: 10.1016/j.hansur.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/12/2018] [Accepted: 05/20/2018] [Indexed: 11/18/2022]
Abstract
After tendon injuries, it has been observed clinically that patient-reported disability is more severe than the patient's actual performance. This is thought to result from a fear of movement (kinesiophobia) after surgery. The aim of this study was to investigate the presence of kinesiophobia in this patient population and its effects on the clinical outcomes. Patients (n=118) with tendon repairs were included. All the participants received early passive mobilization and were assessed at the end of the 8th week. Grip and pinch strengths were measured and the Nine-Hole Peg Test (9HPT) was conducted. Patients also filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and Tampa Scale for Kinesiophobia (TSK). Patients were divided according to their kinesiophobia: Group 1 with low kinesiophobia (TSK<37) and Group 2 with high kinesiophobia (TSK≥37). The groups were compared on the assessed parameters. Fifty-nine percent of the patients had a high kinesiophobia level. The performance-based test results were similar between the groups (P>0.05). Patient-reported MHOQ and TSK scores were significantly lower in the high kinesiophobic group (P=0.001 and P=0.000, respectively). Patients with tendon repairs often develop kinesiophobia, which may contribute to difficulty when starting to re-use their hand in daily life. None of the objective results were affected by this fear of movement-only patient-reported disability. Clinicians should be aware that clinical outcomes may be affected by the patient's kinesiophobic thinking and must be cautious during treatment.
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Affiliation(s)
- Z Tuna
- Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey.
| | - D Oskay
- Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, 06500 Ankara, Turkey
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Cowley JC, Gates DH. Influence of remote pain on movement control and muscle endurance during repetitive movements. Exp Brain Res 2018; 236:2309-2319. [PMID: 29869692 DOI: 10.1007/s00221-018-5303-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022]
Abstract
During fatiguing tasks, people adapt their movement strategies to offset effects of muscle fatigue. Painful stimuli may compete for cognitive resources during this process, impairing fatigue adaptation. This study determined how pain affected movement control and muscle endurance during a repetitive task and how pain catastrophizing moderated these effects. Twenty-two healthy young adults performed timed reaching movements until voluntary exhaustion on two separate days. On 1 day, subjects simultaneously experienced ischemic pain in the contralateral arm. Subjective pain, and effort were recorded at regular intervals. Timing errors, distance and speed were calculated for each movement. Detrended fluctuation analysis was used to quantify temporal persistence in each time series. Subjects made shorter, slower movements during the last compared to the first minute of fatigue on both days (p < 0.001). Deviations in movement speed were corrected faster in the no pain condition compared to the pain condition (p = 0.042), but only early during the condition. Time to fatigue was influenced by pain and the order of testing. Subjects performed the task longer on the second day whether the condition was pain or no pain. This effect was larger when the pain condition was first (3.4 compared to 1.1 min. increase). Subjects with high and low pain catastrophizing responded similarly to the painful stimuli. The results suggest that pain causes people to adopt more conservative movement strategies which can affect the fatigue rate, but these effects depend on familiarity with the painful stimulus and the fatiguing task.
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Affiliation(s)
- Jeffrey C Cowley
- School of Kinesiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
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Archey M, Goldey K, Crockett E, Boyette-Davis J. An Investigation of the Effects of Testosterone and Behavioral Expressions of Pain on Sex/Gender Differences in Pain Perception. Psychol Rep 2018; 122:826-840. [DOI: 10.1177/0033294118781320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Research indicates that women are more susceptible to pain than men, but the reason for this difference is unclear. While estrogen and progesterone have been implicated, testosterone has not received adequate consideration in the literature. Additionally, incorporating behavioral expressions, or exaggerations, of pain as an important aspect of pain perception is receiving increasing attention. The current study examined the role of testosterone in female pain expression and perception via the cold pressor test. Following all participant exclusions, 46 healthy participants (32 women) provided saliva samples for testosterone analysis using enzyme-linked immunosorbent assay before and after rating their pain during the cold pressor test. Participants used a visual analog scale to indicate how the 2℃ water was perceived, ranging from “worst pain imaginable” to “no pain.” The researcher also noted whether a participant displayed overt behavioral expressions of pain such as jumping and cursing. The results revealed that men reported lower visual analog scale scores than women, indicating less perceived pain. A subgroup of women who displayed overt behavioral responses to pain seemed to be driving this sex/gender difference. It was expected that this subgroup of females would have corresponding changes in testosterone that would further explain the observed sex/gender differences, but this was not supported. Collectively, these data add to the previous literature investigating sex/gender differences in pain perception and highlight the importance of studying overt behavioral expressions of pain. Testosterone may alter this behavior and subsequent pain perception, but the contributions of testosterone are likely subtle and were not detected in this study.
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Affiliation(s)
- Meggan Archey
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Katherine Goldey
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
| | - Erin Crockett
- Department of Psychology, Southwestern University, Georgetown, TX, USA
| | - Jessica Boyette-Davis
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
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36
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Greenwald JD, Shafritz KM. An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior. Front Integr Neurosci 2018; 12:18. [PMID: 29875641 PMCID: PMC5974053 DOI: 10.3389/fnint.2018.00018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic pain can result from many pain syndromes including complex regional pain syndrome (CRPS), phantom limb pain and chronic low back pain, among others. On a molecular level, chronic pain syndromes arise from hypersensitization within the dorsal horn of the spinal cord, a process known as central sensitization. Central sensitization involves an upregulation of ionotropic and metabotropic glutamate receptors (mGluRs) similar to that of long-term potentiation (LTP). Regions of the brain in which LTP occurs, such as the amygdala and hippocampus, are implicated in fear- and memory-related brain circuity. Chronic pain dramatically influences patient quality of life. Individuals with chronic pain may develop pain-related anxiety and pain-related fear. The syndrome also alters functional connectivity in the default-mode network (DMN) and salience network. On a cellular/molecular level, central sensitization may be reversed through degradative glutamate receptor pathways. This, however, rarely happens. Instead, cortical brain regions may serve in a top-down regulatory capacity for the maintenance or alleviation of pain. Specifically, the medial prefrontal cortex (mPFC), which plays a critical role in fear-related brain circuits, the DMN, and salience network may be the driving forces in this process. On a cellular level, the mPFC may form new neural circuits through LTP that may cause extinction of pre-existing pain pathways found within fear-related brain circuits, the DMN, and salience network. In order to promote new LTP connections between the mPFC and other key brain structures, such as the amygdala and insula, we propose a holistic rehabilitation program including cognitive behavioral therapy (CBT) and revolving around: (1) cognitive reappraisals; (2) mindfulness meditation; and (3) functional rehabilitation. Unlike current medical interventions focusing upon pain-relieving medications, we do not believe that chronic pain treatment should focus on reversing the effects of central sensitization. Instead, we propose here that it is critical to focus on non-invasive efforts to promote new neural circuits originating from the mPFC.
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Affiliation(s)
- Jess D. Greenwald
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | - Keith M. Shafritz
- Department of Psychology, Hofstra University, Hempstead, NY, United States
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, United States
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37
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Adams LM, Turk DC. Central sensitization and the biopsychosocial approach to understanding pain. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/jabr.12125] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Leah M. Adams
- Department of Psychology; George Mason University; Fairfax VA
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine; University of Washington; Seattle WA
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38
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McNeil D, Kennedy S, Randall C, Addicks S, Wright C, Hursey K, Vaglienti R. Fear of Pain Questionnaire-9: Brief assessment of pain-related fear and anxiety. Eur J Pain 2018; 22:39-48. [PMID: 28758306 PMCID: PMC5730485 DOI: 10.1002/ejp.1074] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fear and anxiety are important considerations in both acute and chronic pain. Effectively and efficiently measuring fear and anxiety associated with pain in healthcare settings is critical for identifying vulnerable patients. The length and administration time of current measures of pain-related fear and anxiety inhibit their routine use, as screening tools and otherwise, suggesting the need for a shorter, more efficient instrument. METHODS A 9-item shortened version of the Fear of Pain Questionnaire - III (FPQ-III), the Fear of Pain Questionnaire-9 (FPQ-9), was developed based upon statistical analyses of archival data from 275 outpatients with chronic pain and 275 undergraduates. Additionally, new data were collected from 100 outpatients with chronic pain and 190 undergraduates to directly compare the standard and short forms. Exploratory and confirmatory factor analyses, and other psychometric analyses, were conducted to examine and establish the FPQ-9 as a reliable and valid instrument. RESULTS The original three-factor structure of the FPQ-III was retained in the shortened version; a confirmatory factor analysis produced good model fit (RMSEA = 0.00, CFI = 1.00, TLI = 1.00, SRMR = 0.03). Results suggested a high degree of correlation between the original FPQ-III and the new FPQ-9 (r = 0.77, p < 0.001). Measures of internal consistency for FPQ-9 subscales were high; correlations with other pain and anxiety instruments suggested concurrent, convergent and divergent validity. CONCLUSIONS The FPQ-9 is a psychometrically sound alternative to longer instruments assessing fear and anxiety associated with pain, for use in both clinical and research situations that only allow brief screening. SIGNIFICANCE The FPQ-9 has considerable potential for dissemination and utility for routine, brief screening, given its length (completion time ~2 min; scoring time ~1 min), reading level and psychometric properties.
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Affiliation(s)
- D.W. McNeil
- Department of PsychologyWest Virginia UniversityMorgantownWVUSA
- Department of Dental Practice & Rural HealthWest Virginia University School of DentistryMorgantownWVUSA
| | - S.G. Kennedy
- Department of PsychologyWest Virginia UniversityMorgantownWVUSA
| | - C.L. Randall
- Department of PsychologyWest Virginia UniversityMorgantownWVUSA
| | - S.H. Addicks
- Department of PsychologyWest Virginia UniversityMorgantownWVUSA
| | - C.D. Wright
- Department of PsychologyWest Virginia UniversityMorgantownWVUSA
| | - K.G. Hursey
- Aachenor Psychology Consulting of West VirginiaMorgantownWVUSA
| | - R. Vaglienti
- Department of NeurosurgeryWest Virginia University School of MedicineMorgantownWVUSA
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Rodríguez I, Herskovic V, Gerea C, Fuentes C, Rossel PO, Marques M, Campos M. Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review. J Med Internet Res 2017; 19:e364. [PMID: 29079550 PMCID: PMC5681725 DOI: 10.2196/jmir.7279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation. OBJECTIVE The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain. METHODS A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. RESULTS In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. CONCLUSIONS The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain.
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Affiliation(s)
- Iyubanit Rodríguez
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carmen Gerea
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Fuentes
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Pedro O Rossel
- Department of Computer Science, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Maíra Marques
- Department of Computer Science, Universidad de Chile, Santiago, Chile
| | - Mauricio Campos
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Mortazavi Nasiri FS, Pakdaman S, Dehghani M, Togha M. The Relationship between Pain Catastrophizing and Headache-Related Disability: The Mediating Role of Pain Intensity. JAPANESE PSYCHOLOGICAL RESEARCH 2017. [DOI: 10.1111/jpr.12162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Randall CL, McNeil DW, Shaffer JR, Crout RJ, Weyant RJ, Marazita ML. Fear of Pain Mediates the Association between MC1R Genotype and Dental Fear. J Dent Res 2017; 95:1132-7. [PMID: 27555332 DOI: 10.1177/0022034516661151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Fear of pain is experienced in acute and chronic pain populations, as well as in the general population, and it affects numerous aspects of the orofacial pain experience, including pain intensity, pain-related disability, and pain behavior (e.g., avoidance). A related but separate construct-dental fear-is also experienced in the general population, and it influences dental treatment-seeking behavior and oral and systemic health. Minimal work has addressed the role of genetics in the etiologies of fear of pain and dental fear. Limited available data suggest that variants of the melanocortin 1 receptor (MC1R) gene may predict greater levels of dental fear. The MC1R gene also may be etiologically important for fear of pain. This study aimed to replicate the finding that MC1R variant status predicts dental fear and to determine, for the first time, whether MC1R variant status predicts fear of pain. Participants were 817 Caucasian participants (62.5% female; mean ± SD age: 34.7 ± 8.7 y) taking part in a cross-sectional project that identified determinants of oral diseases at the community, family, and individual levels. Participants were genotyped for single-nucleotide polymorphisms on MC1R and completed self-report measures of fear of pain and dental fear. Presence of MC1R variant alleles predicted higher levels of dental fear and fear of pain. Importantly, fear of pain mediated the relation between MC1R variant status and dental fear (B = 1.60, 95% confidence interval: 0.281 to 3.056). MC1R variants may influence orofacial pain perception and, in turn, predispose individuals to develop fears about pain. Such fears influence the pain experience and associated pain behaviors, as well as fears about dental treatment. This study provides support for genetic contributions to the development/maintenance of fear of pain and dental fear, and it offers directions for future research to identify potential targets for intervention in the treatment of fear of pain and dental fear.
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Affiliation(s)
- C L Randall
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV, USA
| | - D W McNeil
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Psychology and Department of Dental Practice and Rural Health, West Virginia University, Morgantown, WV, USA
| | - J R Shaffer
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - R J Crout
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - R J Weyant
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Marazita
- Center for Oral Health Research in Appalachia, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA Center for Craniofacial and Dental Genetics, Departments of Oral Biology, Human Genetics, Clinical and Translational Science, and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. Pain 2017; 158:1599-1608. [DOI: 10.1097/j.pain.0000000000000924] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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The Associations Between Pain-related Beliefs, Pain Intensity, and Patient Functioning: Hypnotizability as a Moderator. Clin J Pain 2017; 32:506-12. [PMID: 26340655 DOI: 10.1097/ajp.0000000000000294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES On the basis of the idea that thoughts held about pain may represent "self-suggestions" and evidence indicating that people with higher levels of trait hypnotizability are more responsive to suggestions, the current study evaluated hypothesized moderating effects of hypnotizability on the associations between pain-related thoughts and both pain intensity and pain interference. METHODS Eighty-five individuals with chronic pain were given measures of hypnotizability, pain intensity, pain interference, and pain-related thoughts (control beliefs, catastrophizing). RESULTS Analyses supported a moderating role of hypnotizability on the association between control beliefs and pain interference. Specifically, the negative association between pain control beliefs and pain interference were stronger among those with higher trait hypnotizability than between those with lower trait hypnotizability. DISCUSSION The study findings, if replicated in additional samples of individuals with chronic pain, have important clinical and theoretical implications. For example, if trait hypnotizability is found to predict an individual's response to a particular technique of cognitive therapy-such as focusing on and repeating pain control belief self-statements-measures of hypnotizability could be used to identify individuals who might be most responsive to this technique. The current findings indicate that research to further examine this possibility is warranted.
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George SZ, Staud R, Borsa PA, Wu SS, Wallace MR, Greenfield WH, Mackie LN, Fillingim RB. Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial. Contemp Clin Trials 2017; 56:9-17. [PMID: 28315479 DOI: 10.1016/j.cct.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic musculoskeletal pain conditions are a prevalent and disabling problem. Preventing chronic musculoskeletal pain requires multifactorial treatment approaches that address its complex etiology. Prior cohort studies identified a high risk subgroup comprised of variation in COMT genotype and pain catastrophizing. This subgroup had increased chance of heightened pain responses (in a pre-clinical model) and higher 12month post-operatives pain intensity ratings (in a clinical model). This pre-clinical trial will test mechanisms and efficacy of personalized pain interventions matched to the genetic and psychological characteristics of the high-risk subgroup. METHODS Potential participants will be screened for high risk subgroup membership, appropriateness for exercise-induced muscle injury protocol, and appropriateness for propranolol administration. Eligible participants that consent to the study will then be randomized into one of four treatment groups; 1) personalized pharmaceutical and psychological education; 2) personalized pharmaceutical and general education; 3) placebo pharmaceutical and psychological education; 4) placebo pharmaceutical and psychological education. Over the 5-day study period participants will complete an exercise-induced muscle injury protocol and receive study interventions. Pain and disability assessments will be completed daily, with primary outcomes being duration of shoulder pain (number of days until recovery), peak shoulder pain intensity, and peak shoulder disability. Secondary outcomes include inflammatory markers, psychological mediators, and measures of pain sensitivity regulation. CONCLUSION This pre-clinical trial builds on prior cohort studies and its completion will provide foundational data supporting efficacy and mechanisms of personalized interventions for individuals that may be at increased risk for developing chronic shoulder pain. TRIAL REGISTRATION ClinicalTrials.gov registry, NCT02620579 (Registered on November 13, 2015).
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Affiliation(s)
- Steven Z George
- Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC 27715, USA.
| | - Roland Staud
- Department of Medicine, Univ. of Florida, Gainesville, FL 32610, USA.
| | - Paul A Borsa
- Applied Physiology and Kinesiology, Univ. of Florida, Gainesville, FL 32611, USA.
| | - Samuel S Wu
- Biostatistics, Univ. of Florida, Gainesville, FL 32610, USA.
| | - Margaret R Wallace
- Molecular Genetics and Microbiology, UF Genetics Institute, Univ. of Florida, Gainesville, FL 32610, USA.
| | - Warren H Greenfield
- Department of Physical Therapy, Univ. of Florida, Gainesville, FL 32610, USA.
| | - Lauren N Mackie
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA.
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, Univ. of Florida, Gainesville, FL 32610, USA.
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Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD. THE JOURNAL OF PAIN 2017; 18:1-10. [DOI: 10.1016/j.jpain.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022]
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The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model. Psychol Health 2017; 32:422-438. [DOI: 10.1080/08870446.2016.1275628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Optimism Moderates the Influence of Pain Catastrophizing on Shoulder Pain Outcome: A Longitudinal Analysis. J Orthop Sports Phys Ther 2017; 47:21-30. [PMID: 27819191 DOI: 10.2519/jospt.2017.7068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Secondary analysis of prospectively collected data. Background An abundance of evidence has highlighted the influence of pain catastrophizing and fear avoidance on clinical outcomes. Less is known about the interaction of positive psychological resources with these pain-associated distress factors. Objective To assess whether optimism moderates the influence of pain catastrophizing and fear avoidance on 3-month clinical outcomes in patients with shoulder pain. Methods Data from 63 individuals with shoulder pain (mean ± SD age, 38.8 ± 14.9 years; 30 female) were examined. Demographic, psychological, and clinical characteristics were obtained at baseline. Validated measures were used to assess optimism (Life Orientation Test-Revised), pain catastrophizing (Pain Catastrophizing Scale), fear avoidance (Fear-Avoidance Beliefs Questionnaire physical activity subscale), shoulder pain intensity (Brief Pain Inventory), and shoulder function (Pennsylvania Shoulder Score function subscale). Shoulder pain and function were reassessed at 3 months. Regression models assessed the influence of (1) pain catastrophizing and optimism and (2) fear avoidance and optimism. The final multivariable models controlled for factors of age, sex, education, and baseline scores, and included 3-month pain intensity and function as separate dependent variables. Results Shoulder pain (mean difference, -1.6; 95% confidence interval [CI]: -2.1, -1.2) and function (mean difference, 2.4; 95% CI: 0.3, 4.4) improved over 3 months. In multivariable analyses, there was an interaction between pain catastrophizing and optimism (β = 0.19; 95% CI: 0.02, 0.35) for predicting 3-month shoulder function (F = 16.8, R2 = 0.69, P<.001), but not pain (P = .213). Further examination of the interaction with the Johnson-Neyman technique showed that higher levels of optimism lessened the influence of pain catastrophizing on function. There was no evidence of significant moderation of fear-avoidance beliefs for 3-month shoulder pain (P = .090) or function (P = .092). Conclusion Optimism decreased the negative influence of pain catastrophizing on shoulder function, but not pain intensity. Optimism did not alter the influence of fear-avoidance beliefs on these outcomes. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2017;47(1):21-30. Epub 5 Nov 2016. doi:10.2519/jospt.2017.7068.
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George SZ, Wu SS, Wallace MR, Moser MW, Wright TW, Farmer KW, Greenfield WH, Dai Y, Li H, Fillingim RB. Biopsychosocial Influence on Shoulder Pain: Influence of Genetic and Psychological Combinations on Twelve-Month Postoperative Pain and Disability Outcomes. Arthritis Care Res (Hoboken) 2016; 68:1671-1680. [PMID: 26945673 DOI: 10.1002/acr.22876] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/10/2015] [Accepted: 02/23/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To identify novel combinations of genetic and psychological factors that predicted 12-month postoperative pain and disability outcomes following arthroscopic shoulder surgery. METHODS A prospective presurgical cohort (n = 150) was recruited to complete validated psychological questionnaires and have their DNA collected from saliva. DNA was genotyped for a priori selected genes involved with pain modulation (ADRB2, OPRM1, AVPR1A, GCH1, and KCNS1) and inflammation (IL1B, TNF/LTA, and IL6). The outcome measures of interest were the Brief Pain Inventory and Disabilities of the Arm, Shoulder, and Hand questionnaire. Followup for the cohort was at 3, 6, and 12 months postoperatively. After controlling for age, sex, race, and preoperative status, genetic and psychological factors were entered as main effects and interaction terms in separate general linear models for predicting postoperative pain and disability outcomes. RESULTS Seven interactions involving pain-modulatory genes were identified. Three provided strong statistical evidence for different outcomes, including KCNS1 and kinesiophobia for preoperative pain intensity, ADRB2 and depressive symptoms for postoperative course, and GCH1 and anxiety symptoms for 12-month pain-intensity outcome. Ten interactions involving inflammatory genes were identified. Three provided strong statistical evidence for the 12-month postoperative course outcome, including 2 different IL6 single-nucleotide polymorphism and pain catastrophizing, and IL6 and depressive symptoms. CONCLUSION The current study identified novel genetic and psychological interactions that can be used in future studies to further understand the development of persistent postoperative pain and investigate the effectiveness of tailored treatment.
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Affiliation(s)
| | | | - Margaret R Wallace
- University of Florida Genetics Institute, University of Florida, Gainesville
| | | | | | | | | | | | - Hua Li
- University of Florida Genetics Institute, University of Florida, Gainesville
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Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program. Pain Rep 2016; 1:e567. [PMID: 29392192 PMCID: PMC5741354 DOI: 10.1097/pr9.0000000000000567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022] Open
Abstract
The present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men) with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.
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