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Calvert CM, Haley A, Hagel Campbell EM, Bangerter A, Taylor BC, Branson M, Cross LJS, Allen KD, Ferguson JE, Friedman J, Meis LA, Burgess DJ. Relationships Between Applied Mindfulness Practice, Chronic Pain, and Pain-Related Functioning in Veterans. THE JOURNAL OF PAIN 2024:104648. [PMID: 39111723 DOI: 10.1016/j.jpain.2024.104648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
Mindfulness-based interventions (MBIs) have been shown to improve chronic pain and associated conditions like depression, anxiety, and sleep disorders. However, there is limited research on how veterans with chronic pain apply mindfulness skills to manage pain in daily life. This cross-sectional study examined the association between applied mindfulness practice, pain, and several pain-related conditions among 1,737 veterans with chronic pain prior to enrollment in a trial of 2 MBIs. Applied mindfulness practice was assessed using the Applied Mindfulness Process Scale (AMPS). The outcomes included pain interference, pain intensity, pain catastrophizing, fatigue, sleep disturbance, anxiety, depression, post-traumatic stress disorder, physical function, and social participation. Higher overall AMPS scores, as well as the positive and negative emotional regulation subscales of the AMPS, were associated with less pain interference and catastrophizing, as well as better outcomes for all pain-related conditions. The positive emotional regulation subscale had the strongest associations with outcomes. There was no significant association between the AMPS and pain intensity. The results suggest applied mindfulness practice, especially positive emotional regulation, may improve pain and functioning. In addition, the AMPS shows promise as a process measure of mindfulness skills applied in daily life. Additional research is needed to examine different aspects of mindfulness in the context of MBIs. PERSPECTIVE: This article describes the relationship between applied mindfulness practice and pain-related outcomes, prior to a MBI, using a novel measure of mindfulness practice. These findings underscore the importance of measuring applied mindfulness practice prior to and during clinical interventions to treat chronic pain.
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Affiliation(s)
- Collin M Calvert
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Alex Haley
- Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, Minnesota
| | - Emily M Hagel Campbell
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | - Ann Bangerter
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mariah Branson
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | - Lee J S Cross
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina
| | - John E Ferguson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Rehabilitation Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Jessica Friedman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System (VAGLACS), Los Angeles, California
| | - Laura A Meis
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Women's Health Sciences Division, National Center for PTSD, Boston, Massachusetts
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Paschali M, Thompson GS, Mehta S, Howard PM, Yamin JB, Edwards RR, Donnino MW. Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale. FRONTIERS IN PAIN RESEARCH 2024; 5:1328495. [PMID: 39091382 PMCID: PMC11291320 DOI: 10.3389/fpain.2024.1328495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/24/2024] [Indexed: 08/04/2024] Open
Abstract
Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Garrett S. Thompson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shivani Mehta
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia M. Howard
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jolin B. Yamin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Torres ND, Newman AK, Day MA, Chan JF, Friedly JL, Jensen MP. The Moderating Effects of Cognitive Processes on Pain-related Outcomes. THE JOURNAL OF PAIN 2024; 25:104483. [PMID: 38296008 PMCID: PMC11180586 DOI: 10.1016/j.jpain.2024.01.348] [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: 10/22/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
Although evidence supports the importance of pain-related thoughts (ie, cognitive content, or what people think) as predictors of pain and pain-related function, evidence regarding the role of cognitive processes (ie, how people think about pain, eg, by accepting pain, not making judgments about pain, or being absorbed by the pain experience) in adjustment to chronic pain is in its early stages. Using baseline data from a clinical trial of individuals with chronic low back pain (N = 327), the study aimed to increase knowledge regarding the associations between cognitive processes, pain intensity, pain interference, and depression. The results indicate that a number of cognitive processes are significantly related to pain intensity when controlling for catastrophizing, although the pattern of associations found was opposite to those anticipated. One cognitive process (pain absorption) was found to be significantly associated with pain interference, and 9 of 10 cognitive processes were significantly associated with depression when controlling for catastrophizing. In each case, the processes thought to be adaptive were negatively associated with pain interference and depression, and processes thought to be maladaptive evidenced the opposite pattern. The findings are consistent with-but do not prove, given the cross-sectional nature of the data-the possibility that cognitive processes play an important role in adjustment to chronic pain. The potential role these variables play in depression was particularly noteworthy. Longitudinal and experimental studies to evaluate the causal nature of the associations identified are warranted. PERSPECTIVE: The study findings highlight the potential importance of cognitive process variables (ie, how people think) in adjustment to chronic pain. Research to evaluate cognitive processes as potential mechanism variables in pain treatment is warranted.
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Affiliation(s)
- Nikki D. Torres
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
| | - Andrea K. Newman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
| | - Melissa A. Day
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Joy F. Chan
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
| | - Janna L. Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washingto
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Ogden R, Moore D, Piovesan A, Poole H. Distortions to the passage of time during chronic pain: A mixed method study. Eur J Pain 2024; 28:705-718. [PMID: 38032340 DOI: 10.1002/ejp.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND A core aspect of the clinical assessment of pain is establishing how long pain has been present for. The reported length of pain can therefore influence diagnosis and treatment. Despite this, little is known about how chronic pain affects the passage of time. METHODS A mixed-methods cross-sectional study examined experiences of the passage of time in people identifying as living with chronic pain (n = 398). RESULTS Experiencing chronic pain slows the passage of time for most people. Greater pain intensity, rumination about pain, helplessness and identifying as disabled were associated with a greater slowing of the passage of time. Thematic analysis of responses to open-ended questions suggested that a slowing of time during pain was associated with (1) pain intrusion preventing activities which would otherwise enable time to pass quickly, (2) increased attention to time and (3) as sense that in retrospect, time throughout life was 'lost' to chronic pain. CONCLUSION Chronic pain causes widespread distortion to the passage of time. The slowing of time during pain means that periods of pain feel subjectively longer than periods without, exacerbating patient distress. SIGNIFICANCE This study examined how chronic pain impacts on the experience of time. Chronic pain substantially slowed the passage of time for most people, subjectively lengthening the period of time that pain lasted for, exacerbating distress. Given the importance of time processing in clinical assessments of pain, medication adherence and therapeutic interventions, these findings underscore the importance of raising awareness about altered temporal processing in patients and clinicians.
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Affiliation(s)
- Ruth Ogden
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - David Moore
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - Helen Poole
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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Lam CN, Larach DB, Chou CP, Black DS. Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:63-70. [PMID: 37643631 PMCID: PMC10765158 DOI: 10.1093/pm/pnad119] [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: 03/30/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress. PURPOSE This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path. METHODS During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path. RESULTS The average age of the sample was 54 years (range 18-98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0-10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (β = -0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (β = -0.10, P = .02) and stress (β = -0.08, P = .04) but not anxiety (β = -0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores. CONCLUSIONS We find statistical support to suggest that distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.
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Affiliation(s)
- Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Daniel B Larach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Chih-Ping Chou
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - David S Black
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
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Takaoka S, Wakaizumi K, Tanaka C, Tanaka S, Kawate M, Hoshino R, Matsudaira K, Fujisawa D, Morisaki H, Kosugi S. Decreased Interoceptive Awareness as a Risk Factor for Moderate to Severe Pain in Japanese Full-Time Workers: A Longitudinal Cohort Study. J Clin Med 2023; 12:jcm12082896. [PMID: 37109233 PMCID: PMC10146895 DOI: 10.3390/jcm12082896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Interoceptive awareness, the conscious perception of internal bodily states, is a key construct of mind-body interaction. Decreases in interoceptive awareness, as measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA), are found in chronic pain patients. In this study, we explored whether a specific aspect of interoceptive awareness is a risk for the onset and chronicity of pain. A longitudinal cohort study was conducted in 2018 and 2020 among a sample of full-time workers in an industrial manufacturing company in Japan. Participants completed a questionnaire on pain intensity, MAIA, exercise habits, kinesiophobia, psychological distress and work stress. Principal component analyses using the MAIA identified two principal components: self-control and emotional stability. Low emotional stability was associated with the prevalence of moderate to severe pain in 2020 among people with mild or no pain in 2018 (p < 0.01). Lack of exercise habits were associated with the prevalence of moderate to severe pain in 2020 among people with pain in 2018 (p < 0.01). Furthermore, exercise habits were associated with reduction in kinesiophobia among people with moderate to severe pain in 2018 (p = 0.047). Overall, these findings indicate that low emotional stability may be a risk for the onset of moderate to severe pain; lack of exercise habits may sustain kinesiophobia and be a risk for the chronicity of pain.
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Affiliation(s)
- Saki Takaoka
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
| | - Kenta Wakaizumi
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
| | - Chisato Tanaka
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shintaro Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Morihiko Kawate
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
| | - Reiko Hoshino
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
| | - Ko Matsudaira
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Daisuke Fujisawa
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shizuko Kosugi
- Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Interdisciplinary Pain Center, Keio University Hospital, Tokyo 160-0016, Japan
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Wilson JM, Haliwa I, Lee J, Shook NJ. The role of dispositional mindfulness in the fear-avoidance model of pain. PLoS One 2023; 18:e0280740. [PMID: 36706069 PMCID: PMC9882899 DOI: 10.1371/journal.pone.0280740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The fear-avoidance model of pain posits that a painful stimulus is interpreted through pain catastrophizing, which leads to negative downstream cognitions, emotions, and behaviors that shape the experience of pain. As dispositional mindfulness is associated with less catastrophizing and pain, some researchers have suggested incorporating mindfulness into the fear-avoidance model. Across two studies, we empirically tested dispositional mindfulness as a stand-alone component within the fear-avoidance model of pain. METHODS Two independent, online cross-sectional surveys (Ns = 362 and 580 U.S. adults) were conducted. Participants completed validated assessments of mindfulness, pain catastrophizing, fear of pain, pain vigilance, depression, pain intensity, and pain sensitivity. Using structural equation modeling, we tested the inclusion of dispositional mindfulness in the fear-avoidance model of pain. We proposed that greater mindfulness would be associated with less pain catastrophizing, which in turn would be associated with less fear of pain, leading to less depression, and then ultimately less pain intensity and pain sensitivity. RESULTS Across both studies, the fear-avoidance model of pain did not fit the data well, with or without mindfulness included. We found that a simplified model fit the data best (Study 1: χ2/df = 1.83; CFI = .981; RMSEA = .049, 90% CI [0.019, 0.076]; SRMR = 0.031; Study 2: χ2/df = 2.23; CFI = .976; RMSEA = .046, 90% CI [0.026, 0.067]; SRMR = .031), such that greater mindfulness was significantly associated with less pain catastrophizing and, in turn, lower levels of pain intensity and pain sensitivity. CONCLUSION Our findings suggest that a simplified model, compared to the traditional fear-avoidance model, may partly explain the experience of pain among individuals without chronic pain. Future work should examine the temporal associations among these variables to inform the employment of future empirically supported interventions for pain management.
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Affiliation(s)
- Jenna M. Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Ilana Haliwa
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
| | - Jerin Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Natalie J. Shook
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
- School of Nursing, University of Connecticut, Storrs, CT, United States of America
- * E-mail:
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Wilson JM, Colebaugh CA, Flowers KM, Edwards RR, Schreiber KL. Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:2010-2021. [PMID: 35587150 PMCID: PMC9384018 DOI: 10.1093/pm/pnac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/03/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later. METHODS In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19-related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. RESULTS A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism. CONCLUSIONS An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carin A Colebaugh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Finan PH, Vetter M, Seminowicz DA. Is Mindfulness Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network? A Replication and Extension Study in Healthy and Episodic Migraine Participants. THE JOURNAL OF PAIN 2022; 23:2110-2120. [PMID: 35934277 PMCID: PMC9729370 DOI: 10.1016/j.jpain.2022.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023]
Abstract
Formal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network, implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state default mode network functional connectivity in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold, pain intensity or unpleasantness, or pain catastrophizing in healthy controls, or between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients. There was no association between default mode network connectivity and mindfulness in either sample when probed via seed-based functional connectivity analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived default mode network node (ie, posterior cingulate cortex) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater functional connectivity between the posterior cingulate cortex-and cerebellum. Collectively, these findings suggest that the relationship between mindfulness and default mode network functional connectivity may be nuanced or non-robust, and encourage further investigation of how mindfulness relates to pain. PERSPECTIVE: This study found few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.
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Affiliation(s)
- Carly A Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Shana A B Burrowes
- Department of Medicine, Boston University School of Medicine, Section of Infectious Diseases, Boston, Maryland; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Vetter
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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10
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Bhattarai M, Smedema SM, Hoyt WT, Bishop M. The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study. Health Qual Life Outcomes 2022; 20:148. [PMID: 36310168 PMCID: PMC9620601 DOI: 10.1186/s12955-022-02059-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury. METHODS Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life. RESULTS In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant. CONCLUSION The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.
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Affiliation(s)
- Muna Bhattarai
- grid.264756.40000 0004 4687 2082School of Nursing, Texas A&M University, 8447 Riverside Pkwy, 77807-3260 Bryan, TX USA
| | - Susan Miller Smedema
- grid.14003.360000 0001 2167 3675Department of Rehabilitation Psychology & Special Education, University of Wisconsin–Madison, Madison, WI USA
| | - William T. Hoyt
- grid.14003.360000 0001 2167 3675Department of Counseling Psychology, University of Wisconsin–Madison, Madison, WI USA
| | - Malachy Bishop
- grid.14003.360000 0001 2167 3675Department of Rehabilitation Psychology & Special Education, University of Wisconsin–Madison, Madison, WI USA
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11
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An Overview of Mindfulness-Oriented Addiction and Pain Recovery. J Nerv Ment Dis 2022; 210:808-810. [PMID: 36179375 DOI: 10.1097/nmd.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is evidence that mindfulness-based interventions are effective as stress-reduction techniques in people with various stressor-related disorders. Research also shows overall improvement in mental health well-being in practitioners of mindfulness. However, there is limited literature probing the potential negative impacts of mindfulness practice. Relapse is a major challenge in substance use disorders (SUDs), particularly for people with chronic pain. There is an overlap between SUDs and chronic pain, which share common pathophysiological pathways that could contribute to poor pain control and mental instability. In this report, we discuss the possible effects of mindfulness on specified aspects of substance craving and chronic pain perception. We propose future directions for research in mindfulness practices to maximize the potential for relapse prevention and pain control.
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12
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The Argentinian version of the cognitive fusion questionnaire: Psychometric properties and the role of cognitive fusion as a predictor of pathological worry. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Saeedi Z, Ghorbani N, Shojaeddin A, Sarafraz MR. The experience of pain among patients who suffer from chronic pain: The role of suppression and mindfulness in the pain sensitivity and the autonomic nervous system activity. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Ding D, Zheng M. Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis. Front Psychiatry 2022; 13:893150. [PMID: 35898622 PMCID: PMC9309299 DOI: 10.3389/fpsyt.2022.893150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.
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Affiliation(s)
- Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mengna Zheng
- School of Educational Science, Anhui Normal University, Wuhu, China
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15
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Rabey M, Buldo B, Duesund Helland M, Pang C, Kendell M, Beales D. Significant other interactions in people with chronic low back pain: Subgrouping and multidimensional profiles. Br J Pain 2021; 16:326-340. [DOI: 10.1177/20494637211062045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Back pain is complex. Social support and significant other interactions influence the pain experience. Purpose: To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Research Design: Longitudinal cohort study. Study Sample: People with chronic axial low back pain ( n = 262). Data Collection and Analysis: Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Results: Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. Conclusions: These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people’s presentation.
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Affiliation(s)
- Martin Rabey
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
- Thrive Physiotherapy, Guernsey
| | - Brendan Buldo
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Magnus Duesund Helland
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Courtenay Pang
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Michelle Kendell
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
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16
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Vitale E. Gender Gap in Mindfulness Assessment Among Italian Nurses: A Pilot Descriptive Study. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Purpose: The present study aimed to explore gender differences in the
mindfulness tendency, specifically in the awareness and attention
dimensions and also in the observing, describing, acting with awareness and
accepting without judgement in Italian nurses.
Methods: In June 2020 an on-line questionnaire was administered to nurses
in order to analyze any differences both in the Mindfulness Attention
Awareness Scale (MAAS) and the Kentucky Inventory of Mindfulness Skills
(KIMS) according to gender variable.
Findings: 200 questionnaires were collected. Findings showed significant
higher MAAS total score in males than females (p=.004). Additionally, by
considering the four sub dimensions in the Mindfulness tendency, females
reported significant higher levels in some items of “Observe” (p=.004) and
“Act with awareness” (p=.001) than males, while males reported significant
higher scores in the “Accept without judgement” than females (p<.001).
Conclusions: The present study was a pilot research on exploring gender
differences in mindfulness in Italian nurses in order to hope that it will be
only the beginning of empirical research on this topic and to better address
future mindfulness training courses addressed to nurses by emphasizing
certain aspects of mindfulness for females compared to males and vice versa."
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Affiliation(s)
- Elsa Vitale
- Department of Mental Health, Local Health Authority Bari, Italy
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17
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You B, Wen H, Jackson T. Identifying resting state differences salient for resilience to chronic pain based on machine learning multivariate pattern analysis. Psychophysiology 2021; 58:e13921. [PMID: 34383330 DOI: 10.1111/psyp.13921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Studies have documented behavior differences between more versus less resilient adults with chronic pain (CP), but the presence and nature of underlying neurophysiological differences have received scant attention. In this study, we attempted to identify regions of interest (ROIs) in which resting state (Rs) brain activity discriminated more from less resilient CP subgroups based on multiple kernel learning (MKL). More and less resilient community-dwellers with chronic musculoskeletal pain (70 women, 39 men) engaged in structural and functional magnetic resonance imaging (MRI) scans, wherein MKL assessed Rs activity based on amplitude of low frequency fluctuations (ALFF), fractional amplitudes of low frequency fluctuations (fALFF), and regional homogeneity (ReHo) modalities to identify ROIs most salient for discriminating more versus less resilient subgroups. Compared to classification based on single modalities, multi-modal classification based on combined fALFF and ReHo features achieved a substantially higher classification accuracy rate (79%). Brain regions with the best discriminative power included those implicated in pain processing, reward, executive function, goal-directed action, emotion regulation and resilience to mood disorders though variation trends were not consistent between more and less resilient subgroups. Results revealed patterns of Rs activity that serve as possible biomarkers for resilience to chronic musculoskeletal pain.
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Affiliation(s)
- Beibei You
- Key Laboratory of Cognition and Personality (Ministry of Education), Faculty of Psychology, Southwest University, Chongqing, China.,School of Nursing, Guizhou Medical University, Guizhou, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), Faculty of Psychology, Southwest University, Chongqing, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, China
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18
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Chisari C, Budhraja M, Monajemi MB, Lewis F, Moss-Morris R, Scott W, McCracken LM. The role of psychological flexibility, perceived injustice and body image in Vulvodynia: A longitudinal study. Eur J Pain 2021; 26:103-113. [PMID: 34288269 DOI: 10.1002/ejp.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/15/2021] [Accepted: 07/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women with Vulvodynia experience pain, related impacts on sex and daily functioning, and depression. While psychosocial factors are associated with outcomes in Vulvodynia, longitudinal data are limited, especially in mixed/spontaneous Vulvodynia. Broad psychological models such as psychological flexibility (PF) and content-specific factors, such as body-exposure anxiety (BEA) and avoidance during sexual activities and perceived injustice, have not been adequately investigated in Vulvodynia. The aim of this study was to explore whether these factors assessed at baseline predict pain severity, pain interference, sexual functioning and satisfaction and depression 3 months later. METHODS A longitudinal study of 349 women with Vulvodynia was conducted. Participants completed online self-report measures of pain-related and sexual outcomes, depression, BEA, perceived injustice and facets of PF (present moment awareness, pain acceptance, committed action) at baseline and after 3 months, overlapping with the Coronavirus disease 2019 (COVID-19) pandemic. RESULTS Seventy percent of women responded at both assessments (n = 244). There were significant decreases in pain severity, pain interference, present moment awareness, committed action and a significant increase in depression at 3 months. All the baseline psychosocial factors significantly correlated with at least one outcome at 3 months. When adjusting for baseline outcome and demographics, committed action significantly positively predicted depression at 3 months and pain acceptance significantly positively predicted pain interference at 3 months. CONCLUSIONS Among women with Vulvodynia, pain acceptance and committed action are prospectively associated with pain interference and depression. The reliability and generalizability of these results needs to be established given the overlap with the COVID-19 pandemic. Future studies should investigate whether targeting these factors enhances outcomes in Vulvodynia. SIGNIFICANCE This longitudinal study explored the role of PF, perceived injustice and body image during sexual activities in predicting pain severity, pain interference, sexual functioning, sexual satisfaction and depression in women with Vulvodynia. The study findings reveal that two facets of PF (committed action and pain acceptance) predicted pain interference and depression over time. It may be important to incorporate these processes in treatments developed for Vulvodynia.
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Affiliation(s)
- Claudia Chisari
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mahira Budhraja
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mani B Monajemi
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Fiona Lewis
- St John's Institute of Dermatology, Guy's Hospital, NHS Foundation Trust, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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19
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Relationship between Mindfulness, Psychological Skills, and Mental Toughness in College Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136802. [PMID: 34202770 PMCID: PMC8297292 DOI: 10.3390/ijerph18136802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Numerous studies have shown that dispositional mindfulness is positively associated with many mental abilities related to sports performance, including psychological skills and mental toughness. The purpose of this study was to explore the relationship between dispositional mindfulness, psychological skills, and mental toughness among different types of athletes. For this cross-sectional study, 101 college athletes were recruited. Their dispositional mindfulness, psychological skills, and mental toughness were measured by the Mindfulness Attention Awareness Scale (MAAS), Athletic Psychological Skills Inventory (APSI), and Traits of Mental Toughness Inventory for Sports Scale (TMTIS). Pearson’s correlation was used to calculate how dispositional mindfulness is associated with psychological skills and mental toughness. The results revealed that dispositional mindfulness is positively associated with comprehensive APSI (r = 0.21–0.36, p < 0.05), TMTIS overall (r = 0.27, p < 0.01), positive effort (r = 0.26, p = 0.01), and pressure (r = 0.30, p < 0.01). These findings suggest a positive linkage between mindfulness and the two examined psychological characteristics related to sports performance. Other approaches to increase mindfulness may be considered in the future.
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20
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Marikar Bawa FL, Sutton JW, Mercer SW, Bond CM. "I'm empowered to look after myself" - Mindfulness as a way to manage chronic pain: An interpretative phenomenological analysis of participant experiences in Scotland. Soc Sci Med 2021; 281:114073. [PMID: 34120086 DOI: 10.1016/j.socscimed.2021.114073] [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] [Revised: 04/01/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PRIMARY AIM Chronic pain is a common problem that can impact on psychological and social wellbeing and activity levels. Despite pharmacological treatments, there is often a lack of improvement in physical and emotional functioning and health-related quality of life. Mindfulness meditation has become an increasingly popular self-management technique. The aim of the study was to explore the experiences of patients with chronic pain who took part in a mindfulness programme. METHODS A mixed-methods feasibility study was carried out. Participants were aged 18 years or over with non-malignant chronic pain recruited from general medical practices in Fort William, Scotland. In 2013 participants undertook an eight-week mindfulness programme based on Mindfulness-Based Stress Reduction (MBSR) and were interviewed immediately post-programme and at eight-months' post-programme. Analysis of qualitative data involved Interpretative Phenomenological Analysis (IPA). FINDINGS Thirty-four patients consented to take part in the study; twenty-four took part in the programme (14 attended four or more sessions, 10 attended one to three). Twenty-three were interviewed. Participant experiences of the programme were themed under: factors affecting experience (influence of earlier life events; the process of taking part in, and of relating to, the programme); and effects of the programme (impact on emotions, mental health, adverse events and a process of change). The process of change, resulting after better understanding the relationship between mindfulness and pain, involved learning to 'listen to the body', gaining a sense of community, learning to accept pain, and approaching life with more self-care, awareness, appreciation and empowerment. CONCLUSION Participants reported a variety of experiences. For some, these included undergoing a process of change which may have supported them in living with their painful condition. This contributes to our understanding of how mindfulness could benefit people with chronic pain.
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Affiliation(s)
- Fathima L Marikar Bawa
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Jane W Sutton
- Department of Pharmacy and Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Christine M Bond
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
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21
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Ohse L, Burian R, Hahn E, Burian H, Ta TMT, Diefenbacher A, Böge K. Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy. PAIN MEDICINE 2021; 22:2615-2626. [PMID: 33755159 DOI: 10.1093/pm/pnab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). SUBJECTS Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. METHODS Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. RESULTS Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). CONCLUSION The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.
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Affiliation(s)
- Ludwig Ohse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Ronald Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hannah Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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22
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Xiao X, Ding M, Zhang YQ. Role of the Anterior Cingulate Cortex in Translational Pain Research. Neurosci Bull 2021; 37:405-422. [PMID: 33566301 PMCID: PMC7954910 DOI: 10.1007/s12264-020-00615-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
As the most common symptomatic reason to seek medical consultation, pain is a complex experience that has been classified into different categories and stages. In pain processing, noxious stimuli may activate the anterior cingulate cortex (ACC). But the function of ACC in the different pain conditions is not well discussed. In this review, we elaborate the commonalities and differences from accumulated evidence by a variety of pain assays for physiological pain and pathological pain including inflammatory pain, neuropathic pain, and cancer pain in the ACC, and discuss the cellular receptors and signaling molecules from animal studies. We further summarize the ACC as a new central neuromodulation target for invasive and non-invasive stimulation techniques in clinical pain management. The comprehensive understanding of pain processing in the ACC may lead to bridging the gap in translational research between basic and clinical studies and to develop new therapies.
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Affiliation(s)
- Xiao Xiao
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Institute of Science and Technology for Brain-Inspired Intelligence, Behavioral and Cognitive Neuroscience Center, Fudan University, Shanghai, 200433, China.
| | - Ming Ding
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Institute of Science and Technology for Brain-Inspired Intelligence, Behavioral and Cognitive Neuroscience Center, Fudan University, Shanghai, 200433, China
| | - Yu-Qiu Zhang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Translational Neuroscience, Jing'an District Centre Hospital of Shanghai, Institutes of Brain Science; Institute of Integrative Medicine, Fudan University, Shanghai, 200032, China.
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23
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Paschali M, Lazaridou A, Paschalis T, Napadow V, Edwards RR. Modifiable Psychological Factors Affecting Functioning in Fibromyalgia. J Clin Med 2021; 10:jcm10040803. [PMID: 33671181 PMCID: PMC7922061 DOI: 10.3390/jcm10040803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 01/02/2023] Open
Abstract
Objective: To examine the role of several interrelated, potentially modifiable psychological factors (i.e., mindfulness and catastrophizing) in influencing patient-reported functioning. Methods: In this cross-sectional study, 107 patients with fibromyalgia completed self-report assessments of pain severity, functioning and impact of symptoms, mindfulness, and pain catastrophizing. Linear regression and bootstrapping mediation analyses were performed to assess the relationships between these factors. Results: Pain intensity was significantly and positively associated with pain catastrophizing and impact of fibromyalgia on functioning. Linear regression analyses indicated that pain intensity, catastrophizing, and mindfulness affect functioning in fibromyalgia. Follow-up mediation analysis revealed a significant indirect effect of pain catastrophizing on the relationship between pain intensity and fibromyalgia functioning. Conclusion: Individuals with fibromyalgia who have higher levels of pain and catastrophizing, and lower levels of mindfulness, are more likely to experience impaired functioning. Our findings suggest that pain catastrophizing appears to be an especially important variable contributing to reduced functioning in women with fibromyalgia. Therefore, catastrophizing-reducing treatments (e.g., cognitive behavioral therapy) are likely to have direct, beneficial impacts on functioning.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA 02467, USA; (A.L.); (R.R.E.)
- Correspondence:
| | - Asimina Lazaridou
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA 02467, USA; (A.L.); (R.R.E.)
| | - Theodoros Paschalis
- Department of Medicine, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Vitaly Napadow
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Boston, MA 02129, USA;
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA 02467, USA; (A.L.); (R.R.E.)
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24
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van Laake-Geelen CCM, Smeets RJEM, Goossens MEJB, Verbunt JA. Effectiveness of Exposure in Vivo for Patients with Painful Diabetic Neuropathy: a Pilot Study of Effects on Physical Activity and Quality of Life. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2021; 4:1000046. [PMID: 33884148 PMCID: PMC8054751 DOI: 10.2340/20030711-1000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the effects of personalized exposure in vivo on level of physical activity and quality of life in patients with painful diabetic neuropathy. DESIGN Randomized, single-case, ABC design. SUBJECTS Twelve patients with painful diabetic neuropathy, age > 18 years, diabetes mellitus type II, Clinical Neurological Examination score > 5, Diabetic Neuropathy Symptom Score ≥ 1 and Douleur Neuropathique 4 Questions score ≥ 3. METHODS The treatment consists of an Intensive screening, followed by an 8-week exposure in vivo intervention specifically adapted to the needs/risks of patients with painful diabetic neuropathy, and 6-months follow-up. Outcome measures included daily and non-daily measures of physical activity, quality of life, metabolic parameters, disability, depression, general and painful diabetic neuropathy-related anxiety, pain intensity and pain catastrophizing. RESULTS Due to high drop-out rates (n = 6 during screening, n = 2 during treatment, n = 1 after treatment), only 3 participants completed the study. Slight, but non-significant, changes in physical activity and disability were observed. In quality of life, no changes were observed. CONCLUSION Analysis of the reasons for the high drop-out rate indicate that exposure in vivo may have added value in patients with painful diabetic neuropathy only for those patients: (i) whose daily life functioning is impaired mainly by the painful diabetic neuropathy; (ii) in whom painful diabetic neuropathy-related fears are exaggerated and irrational; (iii) in whom specific activities evoke the painful diabetic neuropathy-related fears; (iv) whose spouse and healthcare providers are involved in the treatment; and (v) who are willing to change their daily behaviour. Further research is needed into this subject.
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Affiliation(s)
- Charlotte C M van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Revalidatie, Eindhoven, The Netherlands
| | - Marielle E J B Goossens
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
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Tran H, Sagi V, Jarrett S, Palzer EF, Badgaiyan RD, Gupta K. Diet and companionship modulate pain via a serotonergic mechanism. Sci Rep 2021; 11:2330. [PMID: 33526805 PMCID: PMC7851147 DOI: 10.1038/s41598-021-81654-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/08/2021] [Indexed: 01/30/2023] Open
Abstract
Treatment of severe chronic and acute pain in sickle cell disease (SCD) remains challenging due to the interdependence of pain and psychosocial modulation. We examined whether modulation of the descending pain pathway through an enriched diet and companionship could alleviate pain in transgenic sickle mice. Mechanical and thermal hyperalgesia were reduced significantly with enriched diet and/or companionship. Upon withdrawal of both conditions, analgesic effects observed prior to withdrawal were diminished. Serotonin (5-hydroxytryptamine, 5-HT) was found to be increased in the spinal cords of mice provided both treatments. Additionally, 5-HT production improved at the rostral ventromedial medulla and 5-HT accumulated at the dorsal horn of the spinal cord of sickle mice, suggesting the involvement of the descending pain pathway in the analgesic response. Modulation of 5-HT and its effect on hyperalgesia was also investigated through pharmaceutical approaches. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, showed a similar anti-nociceptive effect as the combination of diet and companionship. Depletion of 5-HT through p-chlorophenylalanine attenuated the anti-hyperalgesic effect of enriched diet and companionship. More significantly, improved diet and companionship enhanced the efficacy of a sub-optimal dose of morphine for analgesia in sickle mice. These findings offer the potential to reduce opioid use without pharmacological interventions to develop effective pain management strategies.
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Affiliation(s)
- Huy Tran
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Varun Sagi
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Sarita Jarrett
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Elise F. Palzer
- grid.17635.360000000419368657Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Rajendra D. Badgaiyan
- grid.267309.90000 0001 0629 5880Department of Psychiatry, Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas USA
| | - Kalpna Gupta
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA ,Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, 5901 East 7th St, Long Beach, CA 90822 USA
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Abstract
OBJECTIVE Dispositional mindfulness is associated with reduced pain in clinical and experimental settings. However, researchers have neglected the type of pain assessment, as dispositional mindfulness may have unique benefits for reduced pain sensitivity when relying on summary pain assessments, in contrast to assessing the pain of each noxious stimulus. Here, we test the association between dispositional mindfulness and pain using both trial-by-trial pain assessments and overall summary ratings after acute pain tasks. METHODS One hundred thirty-one healthy adult volunteers (mean age = 29.09 [8.00] years, 55.7% female) underwent two experimental thermal pain paradigms. We tested whether dispositional mindfulness measured with the Mindful Attention Awareness Scale was related to a) heat-evoked pain sensitivity, as measured by pain threshold, pain tolerance, average pain, trial-by-trial ratings, and heat-evoked skin conductance response, and b) summary judgments of sensory and affective pain assessed using the McGill Pain Questionnaire (MPQ). RESULTS Mindful Attention Awareness Scale ratings were associated with decreased pain on the MPQ sensory (B = -0.18, SE = 0.05, 95% confidence interval = -0.29 to -0.07, t = -3.28, p = .001) and affective (B = -0.11, SE = 0.03, 95% confidence interval = -0.18 to -0.05, t = -3.32, p = .001) dimensions but not with experimental thermal pain assessments, including threshold, tolerance, heat-evoked pain, or skin conductance response (p values ≥ .29). CONCLUSIONS In this study, dispositional mindfulness mitigated acute thermal pain only when pain was assessed using the MPQ. These findings may reflect differences in immediate versus retrospective judgments or the type of pain assessed by each measure. Future research should examine regulation processes that may explain these differential analgesic benefits, such as attention, rumination, or reappraisal.
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Inter-individual predictors of pain inhibition during performance of a competing cognitive task. Sci Rep 2020; 10:21785. [PMID: 33311585 PMCID: PMC7732830 DOI: 10.1038/s41598-020-78653-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
The main function of pain is to automatically draw attention towards sources of potential injury. However, pain sometimes needs to be inhibited in order to address or pursue more relevant tasks. Elucidating the factors that influence how people manage this relationship between pain and task performance is essential to understanding the disruptive nature of pain and its variability between individuals. Here, 41 healthy adults completed a challenging working memory task (2-back task) while receiving painful thermal stimulations. Examining the trial-by-trial relationship between pain perception and task performance revealed that pain's disruptive effects on performance were mediated by self-reported pain intensity, and that the analgesic effects of a competing task were influenced by task performance. We found that higher pain catastrophizing, higher trait anxiety, and lower trait mindfulness were associated with larger trade-offs between pain perception and task performance, suggesting that these psychological factors can predict increased fluctuations between disruption by pain and analgesia from a competing task. Altogether these findings provide an important and novel perspective on our understanding of individual differences in the interplay between pain and ongoing task performance.
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Saban M, Dagan E, Drach-Zahavy A. The Effects of a Novel Mindfulness-based Intervention on Nurses' State Mindfulness and Patient Satisfaction in the Emergency Department. J Emerg Nurs 2020; 47:412-425. [PMID: 33272560 DOI: 10.1016/j.jen.2020.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction. METHODS A pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses' sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients' sociodemographic and satisfaction, nurses' state mindfulness, and ED workload. RESULTS An increase in nurses' state mindfulness and patients' satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation. DISCUSSION By adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.
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Goldbart A, Bodner E, Shrira A. The role of emotion covariation and psychological flexibility in coping with chronic physical pain: an integrative model. Psychol Health 2020; 36:1299-1313. [PMID: 33136460 DOI: 10.1080/08870446.2020.1841766] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study focussed on the mutual role of emotion covariation and psychological flexibility in understanding the reciprocal effects of chronic pain and psychological distress. DESIGN A longitudinal design was applied with a sample of 177 adults (mean age = 58.3, 57.1% women) suffering from chronic back/neck pain. MAIN OUTCOME MEASURES Assessments were conducted at three timepoints: pain and psychological distress upon referral to a pain clinic (T1); emotion covariation (the correlation between daily reports of positive and negative emotions) and psychological flexibility (self-reported ability to withstand unpleasant experiences while acting upon personal values) during the weeks before undergoing an intrusive procedure (T2); pain and psychological distress one day prior to the procedure (T3). RESULTS T2 psychological flexibility and emotion covariation mediated the effect of T1 pain on T3 psychological distress. However, T2 psychological flexibility and emotion covariation did not mediate the effect of T1 psychological distress on T3 pain. CONCLUSION The findings highlight two complimentary mechanisms - emotion covariation and psychological flexibility - that mediate the relationship between pain and psychological distress for people with chronic back/neck pain. The findings inform future research on the effects of intervening on these mechanisms, which may lead to clinical interventions aimed at improving coping with pain.
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Affiliation(s)
- Anna Goldbart
- Interdisciplinary Department for Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Ehud Bodner
- Interdisciplinary Department for Social Sciences, Bar-Ilan University, Ramat-Gan, Israel.,Department of Music, Bar-Ilan University, Ramat-Gan, Israel
| | - Amit Shrira
- Interdisciplinary Department for Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Tsur N, Defrin R, Haller CS, Bercovitz K, Langer EJ. The effect of mindful attention training for pain modulation capacity: Exploring the mindfulness-pain link. J Clin Psychol 2020; 77:896-909. [PMID: 32997348 DOI: 10.1002/jclp.23063] [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] [Revised: 05/02/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Mindfulness has been shown to be beneficial for chronic pain. The underlying mechanisms of the mindfulness-pain link, however, are yet to be established. Particularly, the effects of mindfulness on pain modulation, which is shown to be dysfunctional among chronic pain patients, barely has been tested. This study investigated whether a short mindful attention training based on Langerian mindfulness mitigates reductions in pain modulation. METHOD Systemic quantitative-somatosensory testing of conditioned pain modulation (CPM) was conducted in 60 undergraduates, who were randomly assigned to one of three groups: (1) Pain-specific mindful attention training; (2) nonspecific mindful attention training; and (3) no mindful attention training. CPM was tested before and after the intervention. RESULTS As hypothesized, a reduction in CPM magnitude was observed only in the control group, whereas this reduction was abolished in the two mindfulness groups. CONCLUSIONS Langerian mindfulness may mitigate pain modulation reduction as observed in chronic pain, thus shedding light on its potential advantages.
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Affiliation(s)
- Noga Tsur
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chiara S Haller
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Division of Public Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA.,Cognicreate LLC, Cambridge, MA, USA
| | | | - Ellen J Langer
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
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31
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Kootstra TJM, Smeeing DPJ, Beks RB, Heijl MV, Kokke M, van der Velde D. Mindfulness in Patients with Upper-Extremity Conditions: A Summary of Existing Literature. J Hand Microsurg 2020; 12:S1-S8. [PMID: 33335364 PMCID: PMC7735556 DOI: 10.1055/s-0040-1701160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Mindfulness implies entering a mental state of awareness which allows for the reframing of an experience, and functionality has shown to be influenced by mindset. The aim of this systematic review was to assess effects of mindfulness in patients with upper-extremity conditions. PubMed, Embase, Cochrane, and CINAHL databases were searched on June 19, 2019, for studies investigating mindfulness in patients with upper-extremity conditions. Two validated instruments for methodologic assessment were used to assess study quality. Studies that reported pain, psychological, or functional outcome measures were included. One randomized controlled trials and three observational studies were included, which together included 335 patients that completed final follow-up. The weighted average age was 52.4 years and 48% of the patients were male. Evaluation of the outcome measures used was immediately after the mindfulness intervention or assessment in all studies. Mindfulness appeared to be positively associated with less pain (though below the minimal clinically important difference), increased mood, and better function. Mindfulness is associated with increased mood and possibly better functionality in adults with a large range of upper-extremity conditions when measured or used as an intervention. Future researcher should expand the subject as only four studies were included in this review. This is a Level IV study.
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Affiliation(s)
| | | | - Reinier B. Beks
- Department of Surgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - Mark van Heijl
- Department of Surgery, Universitair Medisch Centrum, Utrecht, The Netherlands
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Marike Kokke
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
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Jinich-Diamant A, Garland E, Baumgartner J, Gonzalez N, Riegner G, Birenbaum J, Case L, Zeidan F. Neurophysiological Mechanisms Supporting Mindfulness Meditation–Based Pain Relief: an Updated Review. Curr Pain Headache Rep 2020; 24:56. [DOI: 10.1007/s11916-020-00890-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pinel L, Perez-Nieto MA, Redondo M, Rodríguez-Rodríguez L, Gordillo F, León L. Emotional affection on a sustained attention task: The importance the aging process and depression. PLoS One 2020; 15:e0234405. [PMID: 32598346 PMCID: PMC7323986 DOI: 10.1371/journal.pone.0234405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic pain is a complex experience that has now become a major public health issue. This has prompted many researchers to study attention, understanding it to be a crucial factor that allows altering the experience of pain, while attributing considerable importance to sustained attention. Accordingly, the main studies in this field stress the importance of emotion regulation processes and emotions on the perception of painful stimuli and attentional processes themselves. Nevertheless, only a handful of studies have been found that directly study the relationship between these variables. Within this context, this article sets out to analyse emotional regulation processes, emotional variables (depression and anxiety), the experience of pain, and age on the ability to maintain the vigilance response in a sample of patients with chronic pain. This involved selecting a sample of 49 patients with rheumatoid arthritis and examining their performance in an ad-hoc sustained attention test. With a view to complying with the study's main purpose, the participants were also assessed through the use of the following self-report measures: the Beck Depression Inventory (BDI-I); the Hospital Anxiety and Depression Scale (HADS); the McGill Pain Questionnaire, and the Difficulties in Emotion Regulation Scale (DERS). Linear regression analyses revealed a significant impact of the aging process on the performance times in the attention task. Likewise, age and depression recorded a significant correlation with the mistakes made during the task. These results suggest that higher depression levels and an older age might be related to a worse adaptation to pain management techniques based on attention processes, such as mindfulness.
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Affiliation(s)
- Luis Pinel
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Marta Redondo
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Fernando Gordillo
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | - Leticia León
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
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34
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Zhang J, Song LJ, Ni D, Zheng X. Follower Mindfulness and Well-Being: The Mediating Role of Perceived Authentic Leadership and the Moderating Role of Leader Mindfulness. Front Psychol 2020; 11:879. [PMID: 32508714 PMCID: PMC7251051 DOI: 10.3389/fpsyg.2020.00879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Drawing on implicit leadership theory and the mindfulness literature, we propose that perceived authentic leadership mediates the relationship between follower mindfulness and follower well-being. Leader mindfulness plays a moderating role in this process. We validated these hypotheses with the two-wave data from 56 leaders and 275 followers in two private enterprises located in China. We used Mplus 8.0 to test our hypotheses. Consistent with our hypotheses, the results showed that perceived authentic leadership mediated the positive relationship between follower mindfulness and follower well-being. Higher leader mindfulness enhanced the effect of follower mindfulness on perceived authentic leadership and also strengthened the indirect effect of follower mindfulness on follower well-being via perceived authentic leadership. The theoretical and managerial implications are further discussed in the light of these findings.
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Affiliation(s)
- Jing Zhang
- Department of Human Resources Management, Hebei University of Economics and Business, Shijiazhuang, China
| | - Lynda J Song
- Management Division, University of Leeds, Leeds, United Kingdom
| | - Dan Ni
- Department of Leadership and Organization Management, Tsinghua University, Beijing, China
| | - Xiaoming Zheng
- Department of Leadership and Organization Management, Tsinghua University, Beijing, China
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35
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Conti Y, Vatine JJ, Levy S, Levin Meltz Y, Hamdan S, Elkana O. Pain Catastrophizing Mediates the Association Between Mindfulness and Psychological Distress in Chronic Pain Syndrome. Pain Pract 2020; 20:714-723. [PMID: 32285576 DOI: 10.1111/papr.12899] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/03/2023]
Abstract
AIM Trait mindfulness has been found to be inversely associated with emotional distress such as depression and anxiety among patients suffering from pain. The current study investigated the putative mechanisms underlying these associations by examining whether pain catastrophizing mediates the association between mindfulness and psychological distress and whether this model differs in patients suffering from chronic pain compared to patients experiencing nonchronic pain in a medical rehabilitation setting. METHODS Forty-eight patients in their subacute stage of recovery participated in the study. Seventeen participants had a diagnosis of chronic pain. Trait mindfulness was assessed using the Mindful Attention Awareness Scale, pain catastrophizing was assessed using the Pain Catastrophizing Scale, depression symptoms were assessed using the Patient Health Questionnaire, and anxiety was assessed using the Generalized Anxiety Disorder scale. Two mediation models were used, with pain catastrophizing mediating the association between mindfulness and depression and anxiety. RESULTS Catastrophizing significantly mediated the association between trait mindfulness and depression (P < 0.05, confidence interval [CI] = -0.35, -0.05). Catastrophizing also mediated the relationship between trait mindfulness and anxiety (P < 0.05, CI = -0.34, -0.04). Two moderated mediation models were tested, in which pain catastrophizing fully mediated the relationship between trait mindfulness and depression and anxiety, but only in patients with chronic pain. CONCLUSIONS The negative association between trait mindfulness and psychological distress may thus be partly attributed to pain catastrophizing: individuals high in trait mindfulness engage in less catastrophic thinking and therefore experience less distress. Importantly, this was only observed in the patients with chronic pain. These results further underscore the need to cope with pain catastrophizing and encourage mindfulness among patients with chronic pain.
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Affiliation(s)
- Yael Conti
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Jean-Jacques Vatine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Sigal Levy
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | | | - Sami Hamdan
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
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Pinel L, Perez-Nieto MA, Redondo M, Rodríguez-Rodríguez L, Mateos LL. The Impact of Cognitive Anxiety and the Rating of Pain on Care Processes in a Vigilance Task: The Important Part Played by Age. Pain Res Manag 2020; 2020:3204720. [PMID: 32399125 PMCID: PMC7201847 DOI: 10.1155/2020/3204720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022]
Abstract
Chronic pain is a serious public health problem that has grown exponentially in recent years, which is why it has received the attention of numerous researchers. Most of the studies in the field of chronic pain have focused on care as a mediating variable on the perception of painful stimuli and emotions. Nevertheless, there are very few studies that have gone in the opposite direction. This study's aim is therefore to analyse the impact of emotional variables (anxiety and depression), the rating of pain, and age on vigilance processes in a sample of patients with chronic pain. To do so, the attentional performance of a cohort of 52 patients with chronic pain was measured through the use of a modified dot-probe task. Furthermore, all the participants were evaluated using the following self-report measures: Beck's Depression Inventory-II (BDI-II), the McGill Pain Questionnaire, and the Pain Anxiety Symptoms Scale-20 (PASS-20). Stepwise multiple linear regression analysis revealed a significant negative correlation between the pain rating index and the number of mistakes the participants made during the attention test. There was also a positive and significant correlation with age and another negative and significant correlation with cognitive anxiety regarding the overall performance times during the undertaking of the experimental task. These results point to the importance of a more in-depth understanding of the impact that the emotional variables and other variables such as age have on attentional processes and the rating of pain. Finally, the discussion focuses on the implications these results could have for clinical practice or for future research studies in this field.
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Affiliation(s)
- Luis Pinel
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Marta Redondo
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Leticia L. Mateos
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
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Individuals perspectives related to acceptance, values and mindfulness following participation in an acceptance-based pain management programme. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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38
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Appel PR. A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2020; 62:330-343. [PMID: 32216629 DOI: 10.1080/00029157.2019.1709152] [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] [Indexed: 10/24/2022]
Abstract
The use of hypnosis to promote hypnoanalgesia has a long history and has been written about anecdotally as well as having been researched in the last several decades. Research has been both clinical in nature and, in the laboratory, trying to understand the brain physiology and processes involved. This article is not about a review of the research. It is about sharing what I have learned to do clinically using hypnosis to treat patients with persistent pain over the last 40 plus years. Due to the restraints of limited space, I can only discuss the various techniques briefly. I will describe a philosophical perspective that has served me well and driven my approach to treatment. I will discuss the concept of self-regulation training along the dimensions of Sensation, Affect, Cognition, and Behavior and share how hypnosis has been incorporated in working within each of those aspects of experiencing.
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Affiliation(s)
- Philip R. Appel
- MedStar National Rehabilitation Hospital, Washington DC, USA
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39
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Parmelee PA, Scicolone MA, Cox BS, DeCaro JA, Keefe FJ, Smith DM. Global Versus Momentary Osteoarthritis Pain and Emotional Distress: Emotional Intelligence as Moderator. Ann Behav Med 2019; 52:713-723. [PMID: 30010708 DOI: 10.1093/abm/kax044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association. Purpose Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels. Methods In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health. Results Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging. Conclusions Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.
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Affiliation(s)
- Patricia A Parmelee
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Monica A Scicolone
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Brian S Cox
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason A DeCaro
- Department of Anthropology, The University of Alabama, Tuscaloosa, AL, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dylan M Smith
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation. Curr Opin Organ Transplant 2019; 24:705-713. [PMID: 31689261 DOI: 10.1097/mot.0000000000000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk. RECENT FINDINGS Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors. SUMMARY Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
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Mindfulness and Chronic Headache/Migraine: Mechanisms Explored Through the Fear-Avoidance Model of Chronic Pain. Clin J Pain 2019; 34:638-649. [PMID: 29271796 DOI: 10.1097/ajp.0000000000000580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To replicate a study by Schutze and colleagues on a headache sample, rather than a heterogenous chronic pain sample, investigating whether level of mindfulness predicts key components in the Fear-Avoidance Model of chronic pain (pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability); to investigate the relationships between level of mindfulness and headache/migraine pain intensity, frequency, and duration. MATERIALS AND METHODS Participants were 217 individuals who self-reported chronic headache/migraine (51 male, 166 female), aged between 18 and 65 years. Participants completed an online survey measuring demographics, mindfulness, the key components of the Fear-Avoidance Model, and headache pain intensity, duration, and frequency. RESULTS Mindfulness had significant negative correlations (P<0.05) with all variables except headache pain intensity and headache frequency. Mindfulness significantly predicted negative affect, pain catastrophizing, fear of pain, pain hypervigilance, and headache duration (P<0.05). Mindfulness remained a significant predictor of negative affect and pain hypervigilance after controlling for other key components and background characteristics (P<0.05). Mindfulness did not moderate the relationship between pain intensity and pain catastrophizing (P=0.204). DISCUSSION Findings suggest that mindfulness may be integrated into the Fear-Avoidance Model of chronic pain for individuals with chronic headache/migraine. Directions for future research are discussed.
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The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer. Pain Rep 2019; 4:e759. [PMID: 31579851 PMCID: PMC6728003 DOI: 10.1097/pr9.0000000000000759] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022] Open
Abstract
The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind–body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.
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Vachon-Presseau E, Berger SE, Abdullah TB, Griffith JW, Schnitzer TJ, Apkarian AV. Identification of traits and functional connectivity-based neurotraits of chronic pain. PLoS Biol 2019; 17:e3000349. [PMID: 31430270 PMCID: PMC6701751 DOI: 10.1371/journal.pbio.3000349] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Psychological and personality factors, socioeconomic status, and brain properties all contribute to chronic pain but have essentially been studied independently. Here, we administered a broad battery of questionnaires to patients with chronic back pain (CBP) and collected repeated sessions of resting-state functional magnetic resonance imaging (fMRI) brain scans. Clustering and network analyses applied on the questionnaire data revealed four orthogonal dimensions accounting for 56% of the variance and defining chronic pain traits. Two of these traits-Pain-trait and Emote-trait-were associated with back pain characteristics and could be related to distinct distributed functional networks in a cross-validation procedure, identifying neurotraits. These neurotraits showed good reliability across four fMRI sessions acquired over five weeks. Further, traits and neurotraits all related to the income, emphasizing the importance of socioeconomic status within the personality space of chronic pain. Our approach is a first step in providing metrics aimed at unifying the psychology and the neurophysiology of chronic pain applicable across diverse clinical conditions.
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Affiliation(s)
- Etienne Vachon-Presseau
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Sara E. Berger
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Healthcare and Life Sciences Department, IBM Watson Research Center, Yorktown Heights, New York, United States of America
| | - Taha B. Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Thomas J. Schnitzer
- Departments of Internal Medicine and Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Might psychological flexibility processes and Acceptance and Commitment Therapy (ACT) apply in adults with painful diabetic neuropathy? A cross-sectional survey. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Harrison R, Zeidan F, Kitsaras G, Ozcelik D, Salomons TV. Trait Mindfulness Is Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network. THE JOURNAL OF PAIN 2019; 20:645-654. [DOI: 10.1016/j.jpain.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 01/29/2023]
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Edwards DJ. Age, Pain Intensity, Values-Discrepancy, and Mindfulness as Predictors for Mental Health and Cognitive Fusion: Hierarchical Regressions With Mediation Analysis. Front Psychol 2019; 10:517. [PMID: 30899236 PMCID: PMC6416201 DOI: 10.3389/fpsyg.2019.00517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Several studies have confirmed that higher levels of psychological flexibility predict better functioning for those suffering with chronic pain. However, few studies have investigated the role of the individual components of psychological flexibility within a chronic pain population in relation to aging specifically and the related indirect mediational processes. Aim: The present study aimed to compare how age, pain intensity, mindfulness, and values-discrepancy predicted mental health and cognitive fusion separately. It also explored the indirect process relations through the use of a mediated analysis. Methods: Two hundred and thirty three participants completed an online survey which included demographical questions as well as the following questionnaires; Short Form McGill Pain Questionnaire (SF-MPQ); General Health Questionnaire 12; Cognitive Fusion 7-Item Questionnaire (CFQ-7); Mindfulness Attention Awareness Scale (MAAS); and the Chronic Pain Values Inventory (CPVI). The relationships from the responses of the questionnaires and demographics were then analyzed through two hierarchical regression models followed by further mediation analysis. Results: In the first model, values-discrepancy, pain intensity, and mindfulness all predicted mental health, but age did not. However, age did account for a significant portion of the variance in the second model when cognitive fusion was used as the dependent measure. It was also found that cognitive fusion mediated the relationship between age and mental health. Conclusion: These results are discussed within the context of using indirect process relations of psychological flexibility and third wave therapies such as acceptance and commitment therapy for a chronic pain population.
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Affiliation(s)
- Darren J Edwards
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, United Kingdom
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Grandi F, Burgueño L, Irurtia MJ. [Effectiveness of a mindfulness-based stress reduction program for family caregivers of people with dementia. Systematic review of randomised clinical trials]. Rev Esp Geriatr Gerontol 2019; 54:109-115. [PMID: 30482461 DOI: 10.1016/j.regg.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
Family caregivers of people with dementia usually have high levels of anxiety, depression, and overload symptoms, and are reasons for being considered a clinically vulnerable population. The objective of the present review is to examine the effectiveness of the mindfulness-based stress reduction program (MBSR) applied to this population. A search was made in the electronic databases for randomised trials with pre-post measurement in the last 15 years. The methodological quality was obtained using the Jadad scale. Finally, 5 articles were included, obtaining a sample of 309 participants. The score on the Jadad scale was 3.4 out of 5. In general, the MBSR program reduces anxiety and depression symptoms, as well as overload levels in the post-measurement. However, some studies showed a significant reduction in the psychological effects of the program during follow-up. More empirical studies are needed that can establish a more homogeneous protocol that reduces the ambiguity of some results.
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Affiliation(s)
- Fabrissio Grandi
- Facultad de Psicología, Universidad Complutense, Madrid, España.
| | - Lucas Burgueño
- Consultoría Especialista en Gestión de Estrés y Mindfulness Aplicado (CEMYC), Valladolid, España
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Kraemer KM, McLeish AC. Evaluating the role of mindfulness in terms of asthma-related outcomes and depression and anxiety symptoms among individuals with asthma. PSYCHOL HEALTH MED 2019; 24:155-166. [PMID: 30286606 PMCID: PMC6741348 DOI: 10.1080/13548506.2018.1529326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the current study was to examine the unique role of mindfulness skills in terms of: (1) asthma-related outcomes (i.e., asthma control, asthma quality of life); (2) depression symptoms; and (3) anxiety symptomatology (i.e., anxiety sensitivity, panic symptoms, global anxiety) among non-smoking adults with current asthma. Participants were 61 (61.9% female; Mage = 34.72 years, SD = 13.58, range = 18-65) non-smoking adults with current asthma who completed a battery of self-report measures. Results indicated that, after controlling for the effects of race and age, greater ability to describe present moment experiences was significantly associated with better asthma-related quality of life and lower levels of anxiety symptoms. Though mindfulness skills together were associated with lower levels of panic symptoms, there were no significant individual associations between specific skills and panic symptoms. Greater nonjudgment of present moment experiences was associated with lower levels of anxiety and anxiety sensitivity. Greater nonreactivity was significantly associated with lower levels of depression symptoms and anxiety sensitivity. Lastly, a greater ability to observe present moment experiences was associated with lower levels of anxiety sensitivity. Mindfulness was not significantly associated with asthma control. These findings suggest that it may be useful to target the mindfulness skills of describing, nonjudgment, and nonreactivity among individuals with asthma, particularly those with elevated levels of anxiety and depression, in order to improve psychological and asthma-related outcomes.
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Affiliation(s)
- Kristen M. Kraemer
- Department of Psychology, University of Cincinnati, PO Box 210376 Cincinnati, OH 45221-0376, USA
- Division of General Medicine and Primary Care, Section for Research, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, 02446
| | - Alison C. McLeish
- Department of Psychology, University of Cincinnati, PO Box 210376 Cincinnati, OH 45221-0376, USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA; Tel: 001 502 8521450; Fax: 001 502 8528904
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Zeidan F, Salomons T, Farris SR, Emerson NM, Adler–Neal A, Jung Y, Coghill RC. Neural mechanisms supporting the relationship between dispositional mindfulness and pain. Pain 2018; 159:2477-2485. [PMID: 30015711 PMCID: PMC6237620 DOI: 10.1097/j.pain.0000000000001344] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interindividual differences in pain sensitivity vary as a function of interactions between sensory, cognitive-affective, and dispositional factors. Trait mindfulness, characterized as the innate capacity to nonreactively sustain attention to the present moment, is a psychological construct that is associated with lower clinical pain outcomes. Yet, the neural mechanisms supporting dispositional mindfulness are unknown. In an exploratory data analysis obtained during a study comparing mindfulness to placebo analgesia, we sought to determine whether dispositional mindfulness is associated with lower pain sensitivity. We also aimed to identify the brain mechanisms supporting the postulated inverse relationship between trait mindfulness and pain in response to noxious stimulation. We hypothesized that trait mindfulness would be associated with lower pain and greater deactivation of the default mode network. Seventy-six meditation-naive and healthy volunteers completed the Freiburg Mindfulness Inventory and were administered innocuous (35°C) and noxious stimulation (49°C) during perfusion-based functional magnetic resonance imaging. Higher Freiburg Mindfulness Inventory ratings were associated with lower pain intensity (P = 0.005) and pain unpleasantness ratings (P = 0.005). Whole brain analyses revealed that higher dispositional mindfulness was associated with greater deactivation of a brain region extending from the precuneus to posterior cingulate cortex during noxious heat. These novel findings demonstrate that mindful individuals feel less pain and evoke greater deactivation of brain regions supporting the engagement sensory, cognitive, and affective appraisals. We propose that mindfulness and the posterior cingulate cortex should be considered as important mechanistic targets for pain therapies.
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Affiliation(s)
- Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Tim Salomons
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights PO Box 217,United Kingdom
| | - Suzan R. Farris
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | | | - Adrienne Adler–Neal
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Youngkyoo Jung
- Department of Radiology, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Robert C. Coghill
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 45229
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Carvalho SA, Xavier A, Gillanders D, Pinto-Gouveia J, Castilho P. Rumination and valued living in women with chronic pain: How they relate to the link between mindfulness and depressive symptoms. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0052-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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