Pain-related attitudes and functioning in elderly primary care patients

Short and long-term predictors of pain severity and interference in primary care patients with chronic musculoskeletal pain and depression

BACKGROUND

Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain.

OBJECTIVE

To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression.

METHODS

Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes.

RESULTS

83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (β = 0.53; 95% CI = 0.37-0.68) and at 12 months (β = 0.48; 95% CI = 0.29-0.67). Also, pain > 2 years of evolution predicted long term pain severity (β = 0.91; CI95%=0.11-1.71). Baseline pain interference predicted interference at 3 and 12 months (β = 0.27; 95%CI = 0.11-0.43 and β = 0.21; 95%CI = 0.03-0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (β = 0.26; 95%CI = 0.10-0.42 and β = 0.20; 95%CI = 0.02-0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (β = 0.91; CI95%=0.11-1.71, and β = 1.23; CI95%=0.41-2.04). Depression severity predicted more interference at 12 months (β = 0.58; CI95%=0.04-1.11). Occupational status as active worker predicted less interference throughout the follow-up (β=-0.74; CI95%=-1.36 to -0.13 and β=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (β=-0.77; CI95%=1.52 - 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (β = 0.03; 95% CI = 0.00-0.05 and β = 0.03; 95% CI = 0.00-0.05), but not at long term.

CONCLUSION

In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02605278), registered 16/11/2015.

Coping and Beliefs as Predictors of Functioning and Psychological Adjustment in Fibromyalgia Subgroups

Objectives

Research has pointed to two profiles of persons with fibromyalgia according to differences in functionality, thus distinguishing between functional and dysfunctional patients. The role of psychological factors underlying such clusters is unclear. This study aims to explore the contribution of pain beliefs and coping on fibromyalgia clustering.

Methods

A cluster analysis was performed to classify 238 women with fibromyalgia using the Fibromyalgia Impact Questionnaire and the Beck Depression Inventory as clustering variables. Cluster differences in physical functioning, depression, pain beliefs, coping, and age were then calculated (Student's t-test). Finally, a binary logistic regression was conducted to study the unique contribution of age, beliefs, and coping on cluster classification.

Results

Two clusters were revealed. Cluster 1 had a poor adaptation to fibromyalgia regarding physical functioning and depression. They generally embraced less adaptive beliefs (i.e., disability, harm, emotion, and requests) and coping strategies (i.e., guarding, resting, and asking for assistance). Cluster 2 showed a better adaptation to fibromyalgia and adopted more favorable beliefs (i.e., control) and coping strategies (i.e., exercise and task persistence). Cluster differences in age were significant but small. The backward binary logistic regression suggested a final model with six predictors (guarding, task persistence, harm, emotion, solicitude, and age) that explained 31% of the variance of group membership. Discussion. These results suggest that only a subset of psychological variables uniquely and independently contribute to functional/dysfunctional group membership. The results support the need to address psychological components in the management of fibromyalgia and point to a subset of preferred target beliefs and coping strategies.

Expanding Targets for Intervention in Later Life Pain: What Role Can Patient Beliefs, Expectations, and Pleasant Activities Play?

Clinicians are often challenged to find targets for intervention in older adults with chronic pain. This article highlights 3 targets clinicians should consider when formulating their multimodal treatment plans to include older patients' attitudes and beliefs about pain and pain treatments, expectations regarding treatment outcomes, and pleasurable activity pursuits.

The Survey of Pain Attitudes: A revised version of its pediatric form

BACKGROUND AND AIMS

Valid and reliable measures of patients' pain beliefs are needed by clinicians and researchers to better understand the efficacy and mechanisms of pain treatments. The objective of this work was to address this need by further developing the pediatric version of the Survey of Pain Attitudes (Peds-SOPA), one of the most commonly used measures of pain beliefs.

METHODS

A convenience sample of three hundred and seven adolescents (mean age= 14.35; SD=1.62; 59% girls) participated in the study. They rated the intensity of their worst pain experienced in the 3 months prior to the assessment and completed both the Functional Disability Inventory and a revised version of a pediatric version of the Survey of Pain Attitudes (Peds-SOPA-R).

RESULTS

Factor analyses confirmed a seven-factor solution of the questionnaire, and the revised version demonstrated improvements in the internal consistency of several of the scales (values ranged between adequate and good: 0.71-0.87), except for the Medical Cure scale which showed an internal consistency value of 0.65. The results support the validity of the Peds-SOPA-R scale scores by showing, as predicted, positive relationships between beliefs thought to be maladaptive (e.g., the belief that one is unable to function because of pain) and pain intensity and disability, and negative relationships with beliefs thought to be adaptive (e.g., the belief that exercise is beneficial for pain management) and these criterion variables.

CONCLUSIONS

These findings will be helpful to researchers who wish to study the role that pain beliefs play in adjustment to pain in youth.

IMPLICATIONS

The results provide critical psychometric information about a revised version of one of the most used questionnaires to assess pain beliefs. The evidence presented will be helpful to researchers who want to study the role that pain beliefs play in adjustment to chronic pain in young people.