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Thomas PA, Goodin BR, Meints SM, Owens MA, Wiggins AM, Quinn T, Long L, Aroke EN, Morris MC, Sorge RE, Overstreet DS. Adverse Childhood Experiences and Chronic Low Back Pain in Adulthood: The Role of Emotion Regulation. THE JOURNAL OF PAIN 2024; 25:104551. [PMID: 38692399 DOI: 10.1016/j.jpain.2024.104551] [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: 12/06/2023] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in a substantial burden at the individual, community, and health care system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation (DER), depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = .15 [95% CI {.06-.25}]) and with movement (indirect effect = 1.50 [95% CI {.69-2.57}]). Findings suggest ACEs are linked to cLBP severity in adulthood through DER. This aligns with research demonstrating that childhood maltreatment can lead to DER, which perpetuate over the lifespan to impact adult health outcomes. PERSPECTIVE: This study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to cLBP in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention. TRIAL REGISTRATION: This study utilized baseline data collected as part of a parent trial titled "Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain" (ClinicalTrials.gov ID: NCT03338192).
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Affiliation(s)
- Pavithra A Thomas
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, Missouri
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Michael A Owens
- Department of Psychiatry and Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Asia M Wiggins
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tammie Quinn
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Edwin N Aroke
- Nurse Anesthesia Program, Department of Acute, Chronic, & Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew C Morris
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert E Sorge
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Demario S Overstreet
- Division of Gastrointestinal, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Rütgen M, Lamm C. Dissecting shared pain representations to understand their behavioral and clinical relevance. Neurosci Biobehav Rev 2024; 163:105769. [PMID: 38879099 DOI: 10.1016/j.neubiorev.2024.105769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
Accounts of shared representations posit that the experience of pain and pain empathy rely on similar neural mechanisms. Experimental research employing novel analytical and methodological approaches has made significant advances in both the identification and targeted manipulation of such shared experiences and their neural underpinnings. This revealed that painful experiences can be shared on different representational levels, from pain-specific to domain-general features, such as negative affect and its regulation. In view of direct links between such representations and social behaviors such as prosocial behavior, conditions characterized by aberrant pain processing may come along with heavy impairments in the social domain, depending on the affected representational level. This has wide potential implications in light of the high prevalence of pain-related clinical conditions, their management, and the overuse of pain medication. In this review and opinion paper, we aim to chart the path toward a better understanding of the link between shared affect and prosocial behavior.
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Affiliation(s)
- Markus Rütgen
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; Vienna Cognitive Science Hub, University of Vienna, Vienna, Austria.
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Yuan Y, Schreiber K, Flowers KM, Edwards R, Azizoddin D, Ashcraft L, Newhill CE, Hruschak V. The relationship between emotion regulation and pain catastrophizing in patients with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:468-477. [PMID: 38374234 DOI: 10.1093/pm/pnae009] [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: 04/17/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Pain catastrophizing (PC) is a cognitive/emotional response to and in anticipation of pain that can be maladaptive, further exacerbating pain and difficulty in emotion regulation (ER). There is a lack of research on the interplay between PC and ER and its impact on pain. Our aim was to investigate whether ER exacerbated the pain experience through PC. METHODS Adults with chronic non-cancer pain of >3 months' duration (n = 150) who were taking opioid medication were recruited from a large medical center in Pennsylvania. A battery of questionnaires was conducted to gather data on demographics, substance use, mental health histories, and health and pain outcomes. Measures used included the 18-Item Difficulties in Emotion Regulation Scale, the Pain Catastrophizing Scale, the Brief Pain Inventory-Short Form, and the Hospital Anxiety and Depression Scale. A structural equation model with latent variables was conducted to examine our aim. RESULTS Both pain interference and severity were significantly positively associated with several psychosocial variables, such as anxiety, depression, ER constructs, PC, and distress intolerance. The associations between subscales and pain interference were larger than the associations between subscales and pain severity. PC fully mediated the paths from ER to pain experiences. DISCUSSION Our results highlight the importance of several cognitive and emotional constructs: nonacceptance of negative emotions, lack of emotional awareness, magnification of the pain experience, and a sense of helplessness. Furthermore, by showing the indirect effects of PC in affecting ER and pain, we posit that ER, mediated by PC, might serve a critical role in influencing the pain experience in patients with chronic pain.
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Affiliation(s)
- Yan Yuan
- School of Social Work, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Kristin Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Robert Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Desiree Azizoddin
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, United States
| | - LauraEllen Ashcraft
- Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Christina E Newhill
- Professor and Doctoral Program Director, School of Social Work, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, United States
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Rogers AH, Rabbitts JA, Saper MG, Schmale GA, Palermo TM, Groenewald CB. Ecological momentary assessment of sleep, pain, and opioid use among adolescents following surgery. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae039. [PMID: 39036744 PMCID: PMC11258804 DOI: 10.1093/sleepadvances/zpae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/20/2024] [Indexed: 07/23/2024]
Abstract
Background Opioids are effective for acute pain management following surgery among adolescents, yet are associated with significant negative consequences, including respiratory depression and opioid misuse. Sleep deficiency is common following surgery and extant research indicates strong cross-sectional associations between sleep deficiency and increased problematic opioid use. Objective This study examined longitudinal associations between postsurgical sleep deficiency and opioid use among adolescents undergoing outpatient surgery. We also examined daily pain and mood as mechanisms linking previous night's sleep deficiency and next day prescription opioid use. Methods This prospective, observational study enrolled 106 adolescents (11-19 years) who underwent orthopedic outpatient surgery and collected pre-surgery and longitudinal measurements. Participants were 52% female, African-American (7%), American Indian/Alaska Native (7%), Hispanic (9%), Native Hawaiian or Other Pacific Islander (4%), or white, non-Hispanic (66%). Using ecological momentary assessment methods, participants reported sleep, pain, and mood in real time over the first 14 days following surgery. Postsurgical opioid use was measured using an electronic medication cap monitoring device, eCAPTM. Associations between variables were measured using multilevel structural equation modeling. Results Using multi-level mediation models, pain, but not mood-mediated associations between postsurgical sleep deficiency (sleep quality, total sleep time, sleep onset latency, and wake after sleep onset) and opioid use, at both the within-person and between-person levels. Results highlight that greater previous night's sleep deficiency (both generally and greater than a person's mean level) was associated with higher next day pain (both generally and greater than a person's mean level), which, in turn, was associated with higher opioid use. Furthermore, between-person total effect models provide support for sleep deficiency predicting higher opioid use. Conclusions Our findings should be considered preliminary yet underscore the need for a comprehensive and personalized approach to postsurgical pain management and opioid use, potentially implementing interventions targeting sleep quality and quantity to reduce pain and opioid use.
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Affiliation(s)
- Andrew H Rogers
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer A Rabbitts
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael G Saper
- Department of Orthopedic Surgery and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Orthopedic Surgery and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Gregory A Schmale
- Department of Orthopedic Surgery and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Orthopedic Surgery and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415842. [PMID: 38869899 PMCID: PMC11177167 DOI: 10.1001/jamanetworkopen.2024.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
Importance Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. Objectives To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Interventions Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. Main Outcomes and Measures The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Results Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. Conclusions and Relevance The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. Trial Registration ClinicalTrials.gov Identifier: NCT03918642.
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Affiliation(s)
- Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Nicholas J. Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alexander Alas
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
| | - Rebecca J. Melrose
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - David L. Sultzer
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine
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Schepis TS, Rogers AH, Munoz L, Zvolensky MJ. Indirect effects of emotion regulation in the relationship between pain and cannabis use in adults 18-64 years. Addict Behav 2024; 153:107983. [PMID: 38367507 PMCID: PMC11360606 DOI: 10.1016/j.addbeh.2024.107983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Individuals with chronic pain often receive prescription opioid medication, and they may use cannabis to treat pain as well, although the risks of cannabis-opioid co-use are significant. This study aimed to investigate whether two transdiagnostic factors, emotion regulation and distress tolerance, had significant indirect effects in the relationship between pain and cannabis use in adults with chronic pain and an opioid prescription. METHODS Participants (n = 450; mean age = 38.6 ± 11.09) were recruited using Qualtrics panel service and were 75 % female and 79 % White, non-Hispanic. Participants completed a 30-minute self-report survey capturing three-month cannabis use, the Difficulties in Emotional Regulation Scale (DERS), and the Distress Tolerance Scale (DTS). The Graded Pain Scale (GCPS) assessed pain severity/intensity and disability. Analyses used the SPSS PROCESS macro, with both single (i.e., one transdiagnostic factor) and parallel indirect effects (i.e., both the DERS and DTS) examined. RESULTS There were statistically significant indirect effects for both the DERS and DTS in the relationship between pain intensity or disability and three-month cannabis use in single factor models. In the parallel indirect effect model, only the DERS was statistically significant (intensity indirect effect coefficient = 0.0195 % confidence interval [95 %CI] = 0.0065, 0.390; disability indirect effect coefficient = 0.0147, 95 %CI = 0.0055, 0.0274). CONCLUSIONS When examining parallel indirect effects, only emotional regulation and not distress tolerance mediated the relationship between chronic pain and cannabis use among those with an opioid prescription. Clinically, interventions aimed at improving emotional regulation in individuals with chronic pain can help limit cannabis and opioid co-use.
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Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, USA; Translational Health Research Center, Texas State University, USA; Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, USA.
| | - Andrew H Rogers
- Department of Psychology, University of Houston, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA
| | - Liliana Munoz
- Department of Psychology, Texas State University, USA
| | - Michael J Zvolensky
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA
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Buzzanca-Fried KE, Snyder AR, Bauer RM, Morgan-Daniel J, de Corcho CP, Addeo R, Lahey SM, Houck Z, Beneciuk JM. Psychological Constructs From the Fear Avoidance Model and Beyond as Predictors for Persisting Symptoms After Concussion: An Integrative Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00949-3. [PMID: 38663576 DOI: 10.1016/j.apmr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC. DATA SOURCES Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions. Gray literature, with the exception of doctoral dissertations, was excluded. STUDY SELECTION We included studies in the English language consisting of human participants aged ≥18 years. Articles must have included both outcomes pertaining to PSaC (≥3mo after injury) and psychological constructs. DATA EXTRACTION One reviewer extracted data from the resulting studies using a standardized data extraction form designed for this review. Two reviewers independently assessed risk of bias using the Quality in Prognosis Studies tool. DATA SYNTHESIS This review found numerous psychological constructs, some directly linked to the FAM, that have potential prognostic relationships with PSaC. However, research remains limited and some psychological factors central to FAM were only identified in a small number of studies (catastrophizing, cogniphobia, and avoidance), whereas other psychological factors were studied more extensively (anxiety and depression). CONCLUSIONS There is the need for additional evidence, and this integrative review provides an adaptation of the FAM for PSaC to be used as a guiding preliminary framework for future research. Future research should aim to include psychological factors proposed in this modified FAM to fully understand PSaC.
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Affiliation(s)
- Katherine E Buzzanca-Fried
- Department of Rehabilitation Science, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL.
| | - Aliyah R Snyder
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Christopher Perez de Corcho
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL
| | - Russell Addeo
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Sarah M Lahey
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Zachary Houck
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Jason M Beneciuk
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL; Department of Physical Therapy, University of Florida, Gainesville, FL, United States
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Kästner A, Petzke F. Personality systems interactions theory: an integrative framework complementing the study of the motivational and volitional dynamics underlying adjustment to chronic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1288758. [PMID: 38634004 PMCID: PMC11021701 DOI: 10.3389/fpain.2024.1288758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
In the endeavor to advance our understanding of interindividual differences in dealing with chronic pain, numerous motivational theories have been invoked in the past decade. As they focus on relevant, yet different aspects of the dynamic, multilevel processes involved in human voluntary action control, research findings seem fragmented and inconsistent. Here we present Personality Systems Interactions theory as an integrative meta-framework elucidating how different motivational and volitional processes work in concert under varying contextual conditions. PSI theory explains experience and behavior by the relative activation of four cognitive systems that take over different psychological functions during goal pursuit. In this way, it may complement existing content-related explanations of clinical phenomena by introducing a functional, third-person perspective on flexible goal management, pain acceptance and goal maintenance despite pain. In line with emerging evidence on the central role of emotion regulation in chronic pain, PSI theory delineates how the self-regulation of positive and negative affect impacts whether behavior is determined by rigid stimulus-response associations (i.e., habits) or by more abstract motives and values which afford more behavioral flexibility. Along with testable hypotheses, multimodal interventions expected to address intuitive emotion regulation as a central process mediating successful adaptation to chronic pain are discussed.
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Affiliation(s)
- Anne Kästner
- Department of Anesthesiology, Pain Clinic, University Hospital, Georg-August-University of Goettingen, Goettingen, Germany
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Baranoff JA, Clubb B, Coates JM, Elphinston RA, Loveday W, Connor JP. The contribution of pain catastrophizing, depression and anxiety symptoms among patients with persistent pain and opioid misuse behaviours. J Behav Med 2024; 47:342-347. [PMID: 37803191 DOI: 10.1007/s10865-023-00452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Anxiety, depression and pain catastrophizing are independently associated with risk of opioid misuse in patients with persistent pain but their relationship to current opioid misuse, when considered together, is poorly understood. This study will assess the relative contribution of these modifiable, and distinct psychological constructs to current opioid misuse in patients with persistent pain. METHODS One hundred and twenty-seven patients referred to a specialized opioid management clinic for prescription opioid misuse within a tertiary pain service were recruited for this study. The Pain Catastrophizing Scale, Depression, Anxiety and Stress Scales and the Current Opioid Misuse Measure were administered pre-treatment. Pain severity and morphine equivalent dose based on independent registry data were also recorded. RESULTS Higher levels of pain catastrophizing, depression, and anxiety were significantly associated with higher current opioid misuse (r = .475, 0.599, and 0.516 respectively, p < .01). Pain severity was significantly associated with pain catastrophizing (r = .301, p < .01). Catastrophizing, depression, and anxiety explained an additional 11.56% of the variance (R2 change = 0.34, p < .01) over and above age, gender, pain severity and morphine equivalent dose. Depression was the only significant variable at Step 2 (β = 0.62, p < .01). CONCLUSION Findings show that in a sample of people with persistent pain referred for treatment for opioid misuse, depression contributes over and above that of anxiety and pain catastrophizing. Theoretical and clinical practice implications are presented.
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Affiliation(s)
- John A Baranoff
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Bryce Clubb
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- The Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jason M Coates
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Rachel A Elphinston
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - William Loveday
- Monitored Medicines Unit, Queensland Department of Health, Chief Medical Officer and Healthcare Regulation, Brisbane, Australia
| | - Jason P Connor
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Körner AJ, Sabatowski R, Burdic L, Beyer L, Gärtner A, Schönbach B, Kaiser U. [Emotional competence of patients with chronic pain : A self- and third-party assessment]. Schmerz 2024; 38:125-131. [PMID: 37278837 PMCID: PMC10959775 DOI: 10.1007/s00482-023-00720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/07/2023]
Abstract
RESEARCH QUESTION The aim of the study is to assess the status quo of emotional competence in people with chronic pain. How do patients experience themselves regarding to their ability to perceive, express, and regulate emotions? And does this assessment coincide with the assessment of emotional competence (EC) by mental health professionals? METHODS The study took place in the context of interdisciplinary multimodal pain therapy at an outpatient clinic in N = 184 adult German-speaking individuals with non-cancer-related chronic pain. EC was assessed at the end of therapy using the self- and third-party assessment scales of the Emotional Competence Questionnaire. The external assessment was performed by the mental health team. Standard scores were created using the norm sample provided by questionnaires. These were analyzed descriptively and inferentially. RESULTS Self-perceived EC was average (Mself_total = 99.31; SD = 7.78). The mental health professionals predominantly rated the emotional competence of the patients significantly lower (Mexternal_total = 94,70; SD = 7,81; F(1.179) = 35,73; p < 0.001; η2 = 0.17). Emotional expressivity, as a component of EC, was externally rated as below average (Mexpressivity_external = 89.14, SD = 10.33). DISCUSSION Patients with chronic pain rate themselves as unimpaired in terms of their daily emotional awareness, expression, and regulation abilities. At the same time, mental health professionals rate these same individuals as significantly less emotionally competent. The question remains open as to what extent the divergent assessments can be explained by assessment bias.
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Affiliation(s)
- Anne Juliane Körner
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Rainer Sabatowski
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Lisa Burdic
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Linn Beyer
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Anne Gärtner
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Benjamin Schönbach
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Ulrike Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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11
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Kapadi R, Elander J, Bateman AH. Emotion Regulation and Psychological Dependence on Pain Medication among Hospital Outpatients with Chronic Spinal Pain: The Influence of Rumination about Pain and Alexithymia. Subst Use Misuse 2024; 59:1047-1058. [PMID: 38485654 DOI: 10.1080/10826084.2024.2320373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Objective: To examine the extent to which pain acceptance, pain catastrophising and alexithymia moderate associations between pain intensity and psychological pain medication dependence. Methods: Participants (106 hospital outpatients with chronic spinal pain) completed the Leeds Dependence Questionnaire (LDQ) to measure psychological dependence on pain medication, and the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), the Pain Catastrophising Scale (PCS) and the Toronto Alexithymia Scale-20 (TAS-20), plus the Depression, Anxiety and Stress Scale-21 (DASS-21). Results: Multiple linear regression showed that degree of psychological dependence (measured dimensionally across the range of LDQ scores) was associated with TAS subscale difficulty identifying feelings (DIF) (β = 0.249, p = <0.002) and PCS subscale rumination (β = 0.193, p = 0.030), independently of pain intensity and risk behaviors for medication misuse. The effect of pain intensity was moderated by rumination, with pain intensity more strongly associated with dependence when rumination was high (interaction β = 0.192, p = 0.004). Logistic regression showed that the effect of pain intensity on severe dependence (measured categorically as LDQ score ≥ 20) was moderated by alexithymia, so that severe dependence was independently associated with the combination of intense pain and high alexithymia (interaction odds ratio = 7.26, 95% CIs = 1.63-32.42, p = 0.009). Conclusions: Rumination and alexithymia moderated the associations between pain intensity and psychological pain medication dependence, consistent with emotion regulation theory. This raises the possibility that specifically targeting rumination about pain and symptoms of alexithymia could potentially improve the effectiveness of psychological interventions for chronic pain and help people to avoid or reduce their psychological dependence on pain medication.
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Affiliation(s)
| | - James Elander
- School of Psychology, University of Derby, Derby, UK
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12
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Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333846. [PMID: 37768666 PMCID: PMC10539987 DOI: 10.1001/jamanetworkopen.2023.33846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Importance In primary chronic back pain (CBP), the belief that pain indicates tissue damage is both inaccurate and unhelpful. Reattributing pain to mind or brain processes may support recovery. Objectives To test whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT) and to validate natural language-based tools for measuring patients' symptom attributions. Design, Setting, and Participants This secondary analysis of clinical trial data analyzed natural language data from patients with primary CBP randomized to PRT, placebo injection control, or usual care control groups and treated in a US university research setting. Eligible participants were adults aged 21 to 70 years with CBP recruited from the community. Enrollment extended from 2017 to 2018, with the current analyses conducted from 2020 to 2022. Interventions PRT included cognitive, behavioral, and somatic techniques to support reattributing pain to nondangerous, reversible mind or brain causes. Subcutaneous placebo injection and usual care were hypothesized not to affect pain attributions. Main Outcomes and Measures At pretreatment and posttreatment, participants listed their top 3 perceived causes of pain in their own words (eg, football injury, bad posture, stress); pain intensity was measured as last-week average pain (0 to 10 rating, with 0 indicating no pain and 10 indicating greatest pain). The number of attributions categorized by masked coders as reflecting mind or brain processes were summed to yield mind-brain attribution scores (range, 0-3). An automated scoring algorithm was developed and benchmarked against human coder-derived scores. A data-driven natural language processing (NLP) algorithm identified the dimensional structure of pain attributions. Results We enrolled 151 adults (81 female [54%], 134 White [89%], mean [SD] age, 41.1 [15.6] years) reporting moderate severity CBP (mean [SD] intensity, 4.10 [1.26]; mean [SD] duration, 10.0 [8.9] years). At pretreatment, 41 attributions (10%) were categorized as mind- or brain-related across intervention conditions. PRT led to significant increases in mind- or brain-related attributions, with 71 posttreatment attributions (51%) in the PRT condition categorized as mind- or brain-related, as compared with 22 (8%) in control conditions (mind-brain attribution scores: PRT vs placebo, g = 1.95 [95% CI, 1.45-2.47]; PRT vs usual care, g = 2.06 [95% CI, 1.57-2.60]). Consistent with hypothesized PRT mechanisms, increases in mind-brain attribution score were associated with reductions in pain intensity at posttreatment (standardized β = -0.25; t127 = -2.06; P = .04) and mediated the effects of PRT vs control on 1-year follow-up pain intensity (β = -0.35 [95% CI, -0.07 to -0.63]; P = .05). The automated word-counting algorithm and human coder-derived scores achieved moderate and substantial agreement at pretreatment and posttreatment (Cohen κ = 0.42 and 0.68, respectively). The data-driven NLP algorithm identified a principal dimension of mind and brain vs biomechanical attributions, converging with hypothesis-driven analyses. Conclusions and Relevance In this secondary analysis of a randomized trial, PRT increased attribution of primary CBP to mind- or brain-related causes. Increased mind-brain attribution was associated with reductions in pain intensity.
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Affiliation(s)
- Yoni K. Ashar
- Division of Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Tor D. Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
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13
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Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13:20451253231195274. [PMID: 37663084 PMCID: PMC10469275 DOI: 10.1177/20451253231195274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.
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Affiliation(s)
- David M. Carlson
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg. 401, Rm. A236, Mail Code 116AE, Los Angeles, CA 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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14
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Shih S, Donati MR, Cohen LL, Shneider C, Sil S. A dyadic analysis of parent and child pain catastrophizing and health-related quality of life in pediatric sickle cell disease. Pain 2023; 164:1537-1544. [PMID: 36645172 DOI: 10.1097/j.pain.0000000000002848] [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: 08/12/2022] [Accepted: 12/05/2022] [Indexed: 01/17/2023]
Abstract
ABSTRACT The purpose of this study was to examine the dyadic and individual level effects of parent and child pain catastrophizing on child health-related quality of life (HRQOL) in pediatric sickle cell disease. Questionnaires assessing child pain frequency, child and parent pain catastrophizing, and child HRQOL were completed by youth and their primary caregiver. A Common Fate Model was estimated to test the dyadic level relationship between parent and child pain catastrophizing and child HRQOL. An Actor-Partner-Common Fate Model hybrid was estimated to test the relationship between child HRQOL and individual-level child pain catastrophizing and parent pain catastrophizing, respectively. In each model, child HRQOL was modelled as a dyadic variable by factoring parent and child ratings. Patients (N = 100, M age = 13.5 years, 61% female) and their caregivers (M age = 41.8 years, 86% mothers) participated. Dyad-level pain catastrophizing was negatively associated with child HRQOL, demonstrating a large effect (β = -0.809). Individual-level parent and child pain catastrophizing were each uniquely negatively associated with child HRQOL, demonstrating small to medium effects (β = -0.309, β = -0.270). Individual level effects were net of same-rater bias, which was significant for both parents and children. Both the unique and the overlapping aspects of parent and child pain catastrophizing are significant contributors to associations with child HRQOL, such that higher levels of pain catastrophizing are associated with worse child HRQOL. Findings suggest the need for multipronged intervention targeting factors common to parent-child dyads and factors unique to parents and children, respectively.
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Affiliation(s)
- Sharon Shih
- Georgia State University, Atlanta, GA, United States
| | | | - Lindsey L Cohen
- Georgia State University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Soumitri Sil
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Emory University School of Medicine, Atlanta, GA, United States
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15
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Buzzanca‐Fried K, Morgan‐Daniel J, Snyder A, Bauer R, Lahey S, Addeo R, Houck Z, Perez C, Beneciuk J. PROTOCOL: Fear avoidance model psychological factors as predictors for persistent post-concussion clinical outcomes: An integrative review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1311. [PMID: 37131460 PMCID: PMC10052450 DOI: 10.1002/cl2.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships. The goals of this integrative review are to (1) identify and describe range of evidence that explores relationships between psychological factors and clinical outcomes in patients with PSaC, and (2) develop a comprehensive understanding of FAM-specific psychological factors that have been identified as potential predictors of clinical outcomes in patients with PSaC. Methods This review will be based on principles and stages of an integrative review which will allow for inclusion of diverse methodologies: (1) problem formulation, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation. Methods for reporting this review will be informed by the 2020 PRISMA guidelines for systematic reviews. Discussion The findings from this integrative review will inform healthcare professionals working in post-concussion rehabilitation settings regarding relationships between FAM psychological factors and PSaC-an area that until recently has not been thoroughly explored. Additionally, this review will inform the development of other reviews and clinical studies to further investigate relationships between FAM psychological factors and PSaC. Integrative Review Registration OSF DOI 10.17605/OSF.IO/CNGPW.
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Affiliation(s)
| | - Jane Morgan‐Daniel
- University of Florida Health Science Center LibrariesGainesvilleFloridaUSA
| | - Aliyah Snyder
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Russell Bauer
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Sarah Lahey
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Russell Addeo
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Zachary Houck
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Christopher Perez
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Jason Beneciuk
- Department of Rehabilitation ScienceUniversity of FloridaGainesvilleFloridaUSA
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16
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Aaron RV, McGill LS, Finan PH, Wegener ST, Campbell CM, Mun CJ. Determining Profiles of Pain-Specific and General Emotion Regulation Skills and Their Relation to 12-Month Outcomes Among People With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:667-678. [PMID: 36503109 PMCID: PMC10079591 DOI: 10.1016/j.jpain.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Difficulties with pain-specific emotion regulation (ER; eg, pain catastrophizing, pain acceptance) are associated with poor pain outcomes. Less is known about how general ER relates to pain outcomes, or the extent to which pain-specific and general ER interact. In a sample (N = 1,453) of adults with chronic pain, the current study used latent profile analysis to identify subgroups of people with distinct pain-specific and general ER profiles, and determined how subgroup membership at baseline related to pain severity, pain interference, depression and anxiety symptoms at 12-month follow-up. Four groups were identified: 1) general ER difficulties only (29.6%); 2) pain-specific and general ER difficulties (26.3%); 3) skillful pain-specific and general ER (24.6%); 4) pain-specific ER difficulties only (19.4%). Controlling for auto-correlation and demographic covariates, those with pain-specific and general ER difficulties had the worst outcomes in all domains. Membership to other groups did not differentiate between pain severity or interference outcomes; those skillful in pain-specific and general ER had the lowest depression and anxiety symptoms at 12 months. General ER difficulties are common among adults with chronic pain and raise relative risk when paired with pain-specific ER difficulties. Findings offer potential directions for individualizing pain psychology treatment. PERSPECTIVE: This article shows that people with chronic pain have different sets of strengths and difficulties when it comes to regulating emotions related and/or unrelated to the experience of pain itself. Understanding an individual's unique constellation of emotion regulation skills and difficulties might help personalize the psychological treatment of pain.
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Affiliation(s)
- Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Edson College of Nursing and Health Innovation, Arizona State University, Pheonix, Arizona
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17
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Alinajimi F, Deldar Z, Dehghani M, Khatibi A. Emotion regulation mediates the relationship between family caregivers' pain-related beliefs and patients' coping strategies. Front Behav Neurosci 2023; 17:983350. [PMID: 36824059 PMCID: PMC9941146 DOI: 10.3389/fnbeh.2023.983350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023] Open
Abstract
Background: In order to tailor more effective interventions and minimize the burden of chronic pain, it is critical to identify the interaction and contribution of social and psychological factors in pain. One of the important psychological factors in pain management is related to the choice of pain coping strategies in chronic pain patients. Social resources, including family caregivers' pain attitudes-beliefs, can influence pain coping strategies in chronic pain patients. Moreover, one key factor that may intervene in the relationship between caregivers' pain attitudes-beliefs and the patients' coping strategies is the emotion regulation strategies. Therefore, the present study aimed to investigate the mediating role of emotion regulation strategies of chronic pain patients and their family caregivers on the association between caregivers' pain attitudes-beliefs and pain coping strategies of chronic pain patients. Methods: We recruited 200 chronic musculoskeletal pain patients and their family caregivers. Chronic pain patients responded to measures of pain coping and emotion regulation strategies while family caregivers completed questionnaires related to their attitude toward pain and emotion regulation of themselves. Results: There is an association between caregivers' pain attitudes-beliefs and pain coping strategies in patients with chronic musculoskeletal. Moreover, the structural equation modeling revealed that the emotion regulation of both patients and family caregivers mediate the relationship between the caregivers' pain attitudes-beliefs and pain coping strategies of patients with chronic musculoskeletal. Conclusions: The social context of pain, including the effect of family caregivers' responses to the patient's pain, is a critical pain source that is suggested to affect coping strategies in patients. These findings suggest an association between pain attitudes-beliefs in family caregivers and pain coping strategies in patients. Moreover, these results showed that the emotion regulation of both patients and their family caregivers mediates this association.
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Affiliation(s)
| | - Zoha Deldar
- Department of Psychology, McGill University, Montreal, QC, Canada,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mohsen Dehghani
- Department of Clinical Psychology and Health, Shahid Beheshti University, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom,Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom,*Correspondence: Ali Khatibi
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18
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Chronic pain acceptance: Relations to opioid misuse and pain management motives among individuals with chronic low back pain. Addict Behav 2023; 136:107495. [PMID: 36156453 PMCID: PMC10187546 DOI: 10.1016/j.addbeh.2022.107495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.
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19
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Rice T, Sher L. Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies. Psychol Res Behav Manag 2022; 15:3561-3574. [PMID: 36505667 PMCID: PMC9733630 DOI: 10.2147/prbm.s371832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
Children and adolescents with chronic pain are at an increased risk of suicidality. This narrative review article aims to inform clinical practice in the assessment and management of suicidality in youth with chronic pain. The article begins with a survey of the background and prevalence of youth with chronic pain. A review of the current evidence behind the increased risk of suicidality in youth with chronic pain follows. Contextualization of this data with general tenets of child and adolescent suicide risk and risk assessment is provided. Suicidology theory including the interpersonal theory of suicide is overviewed to help clinicians to conceptualize the reviewed data. Guiding parameters for the suicide risk assessment and management planning is presented. Concluding recommendations are made to guide clinical practice in the assessment and management of suicidality in youth with chronic pain.
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Affiliation(s)
- Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Correspondence: Timothy Rice, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue, 13th Floor, Suite A, Office 5, New York, NY, 10025, USA, Tel +1 212 523 5635, Fax +1 212 523 5650, Email
| | - Leo Sher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Yarns BC, Zhu TA, Najafian Jazi A. Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach. Am J Geriatr Psychiatry 2022; 30:1342-1350. [PMID: 35999127 DOI: 10.1016/j.jagp.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients' pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA.
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
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21
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Maroti D, Lumley MA, Schubiner H, Lilliengren P, Bileviciute-Ljungar I, Ljótsson B, Johansson R. Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial. J Psychosom Res 2022; 163:111068. [PMID: 36327532 DOI: 10.1016/j.jpsychores.2022.111068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/11/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Somatic symptom disorder (SSD) is commonly encountered in health care settings. Cognitive-behavioural treatments have been most extensively studied, but they tend to have small effects of temporary duration. Emotional awareness and expression therapy (EAET) is a newly developed treatment for SSD, targeting emotional processing of trauma and conflict as a mechanism of symptom change. In an earlier uncontrolled study of self-guided, internet-administrated EAET (I-EAET), we found substantial reductions in somatic symptoms, prompting the need for a randomized controlled trial of I-EAET. METHODS We conducted a 2-arm RCT, comparing 10-week I-EAET (n = 37) to a waitlist control (WL; n = 37). Primary outcomes were reductions of somatic symptoms (PHQ-15) and pain intensity (BPI-4) at post-treatment, with a 4-month evaluation of effect duration. We also analysed emotional processing (EPS-25) and depression (PHQ-9) as possible mediators of I-EAET's effects. RESULTS Compared to controls, I-EAET significantly reduced somatic symptoms at both post-treatment and follow-up. I-EAET also reduced pain, depression, insomnia, and anxiety at post-treatment, but these effects were not retained at follow-up. As hypothesized, a facet of emotional processing partially mediated the treatment effect on somatic symptoms, even when controlling for depression. CONCLUSIONS Although treatment effects were smaller than in the previous uncontrolled trial, I-EAET is a promising treatment for SSD, with a minority of patients (around 20%) experiencing substantial clinical improvement. The benefits of I-EAET are partially mediated by improved emotional processing. Future research should identify and target patients who respond best to I-EAET and develop tailored treatment to enhance treatment effects. (Preregistered at clinicaltrials.gov: NCT04751825.).
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA..
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden..
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Robert Johansson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden..
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22
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Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain. THE JOURNAL OF PAIN 2022; 24:655-666. [PMID: 36442816 DOI: 10.1016/j.jpain.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk. PERSPECTIVE: This article identifies reward drive as a potentially important factor increasing the effects of depression-related cognitive mechanisms on risk of prescription opioid misuse in those with CNCP. These findings could assist in personalizing clinical CNCP management to reduce the risks associated with opioid misuse.
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23
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Tuck N, Pollard C, Good C, Williams C, Lewis G, Hames M, Aamir T, Bean D. Active Virtual Reality for Chronic Primary Pain: Mixed Methods Randomized Pilot Study. JMIR Form Res 2022; 6:e38366. [PMID: 35830224 PMCID: PMC9330488 DOI: 10.2196/38366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain. Objective This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting. Methods For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention. Results Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important. Conclusions The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.
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Affiliation(s)
- Natalie Tuck
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Pain Management Unit, Department of Anaesthesiology and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
| | - Catherine Pollard
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Clinton Good
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Caitlin Williams
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn Lewis
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Murray Hames
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Tipu Aamir
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Debbie Bean
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Pain Management Unit, Department of Anaesthesiology and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
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24
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Aaron RV, Mun CJ, McGill LS, Finan PH, Campbell CM. The Longitudinal Relationship Between Emotion Regulation and Pain-Related Outcomes: Results From a Large, Online Prospective Study. THE JOURNAL OF PAIN 2022; 23:981-994. [PMID: 34974172 PMCID: PMC9232929 DOI: 10.1016/j.jpain.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
People with chronic pain engage in various strategies, such as pain catastrophizing and pain acceptance, to regulate the difficult emotional aspects of living with pain. Engagement in these strategies is known to influence pain severity and pain interference. However, less research has examined the extent to which general emotion regulation, the ability to identify emotions and engage in strategies to alter emotions, relates to pain-related outcomes. The current study, a large (N = 1453) online prospective study of adults with chronic pain, employed theory-driven assessment of emotion regulation to determine the extent to which general difficulties with emotion regulation at baseline relate to pain severity and pain interference at three-month follow-up, above and beyond pain catastrophizing and pain acceptance. We conducted a series of path models, controlling for demographic covariates and baseline pain severity and pain interference. Pain catastrophizing and pain acceptance at baseline significantly predicted pain interference at three-month follow-up. However, when indices of general emotion regulation were entered into the model, the associations between pain catastrophizing and pain interference (B = .009, P = .153) were no longer statistically significant. Alexithymia emerged as a significant predictor of pain severity (B = .012, P = .032) and pain interference (B = .026, P < .001). These findings highlight the value of considering the role of general emotion regulation (particularly identifying and describing emotions), in addition to pain-specific experiences, in understanding risk for poor pain-related outcomes. PERSPECTIVE: In addition to pain catastrophizing and pain acceptance, difficulties regulating emotions in general (particularly elevated alexithymia) relates to pain outcomes three months later. These findings shed light on risk for poor pain outcomes and point to general emotion regulation as a potentially important target of chronic pain intervention.
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Affiliation(s)
- Rachel V Aaron
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland.
| | - Chung Jung Mun
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Lakeya S McGill
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland
| | - Patrick H Finan
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Claudia M Campbell
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
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25
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Mun CJ, Weaver KR, Hunt CA, Owens MA, Phillips J, Lerman SF, Buenaver LF, Colloca L, Tennen H, Haythornthwaite JA, Finan PH, Smith MT. Pain Expectancy and Positive Affect Mediate the day-to-day Association Between Objectively Measured Sleep and Pain Severity Among Women With Temporomandibular Disorder. THE JOURNAL OF PAIN 2022; 23:669-679. [PMID: 34839028 DOI: 10.1016/j.jpain.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022]
Abstract
The majority of individuals with temporomandibular disorders (TMD) experience sleep disturbance, which can maintain and exacerbate chronic pain. However, the factors underlying the sleep-pain link have not been fully elucidated, especially beyond the laboratory. Sleep deprivation can induce threat interpretation bias, as well as impairment in positive affective functioning. Using both actigraphy and daily diaries, we examined whether morning pain expectancy and positive affect mediate the association between previous night's sleep disturbance and next-day overall pain severity. Total sleep time (TST) was selected as the primary measure of sleep. The sample included 144 women (mean age = 36 [SD = 11.1]) with TMD who displayed at least subclinical insomnia. Sleep was assessed for 14 days using actigraphy which was validated by concurrent sleep diaries. Daily diary assessments of pain-related experiences and affective states were conducted twice per day (ie, once upon participants' waking and the other prior to going to sleep) for the same 14-day period. Multilevel structural equation modeling revealed that both morning pain expectancy (95% CI: -.0004, -.00003) and positive affect (95% CI: -.0005, -.000001) mediated the association between previous night's TST and next-day's overall pain severity, such that shorter previous night TST was associated with higher next-morning pain expectancy and lower positive affect, which in turn were associated with a greater level of next-day's overall pain severity while controlling for morning pain severity. Reducing exaggerated daily pain expectancy and up-regulating positive affect may be important intervention targets for disengaging the sleep-pain link among individuals with co-occurring TMD and sleep disturbance. PERSPECTIVE: The daily link between previous night sleep duration and next day pain severity is mediated by morning pain expectancy and positive affect among women with temporomandibular disorder and sleep disturbance. Reducing pain expectancy and increasing positive affect may serve an important role in improving self-management of chronic pain.
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Affiliation(s)
- Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Kristen R Weaver
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Maryland
| | - Carly A Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Owens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Phillips
- Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luis F Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Maryland
| | - Howard Tennen
- Department of Public Health Sciences, UConn Health, Farmington, Connecticut
| | - 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
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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26
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Ginsberg JP, Raghunathan K, Bassi G, Ulloa L. Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery. Front Med (Lausanne) 2022; 9:821022. [PMID: 35187004 PMCID: PMC8854756 DOI: 10.3389/fmed.2022.821022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 12/19/2022] Open
Abstract
Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.
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Affiliation(s)
- J. P. Ginsberg
- Departments of Applied Psychophysiology, Psychology and Statistics, Saybrook University, Pasadena, CA, United States
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Gabriel Bassi
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
| | - Luis Ulloa
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
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27
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At the Intersection of Anger, Chronic Pain, and the Brain: A Mini-Review. Neurosci Biobehav Rev 2022; 135:104558. [PMID: 35122780 DOI: 10.1016/j.neubiorev.2022.104558] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 01/30/2023]
Abstract
Chronic pain remains one of the most persistent healthcare challenges in the world. To advance pain treatment, experts have recently introduced research-driven subtypes of chronic pain based on proposed underlying mechanisms. Nociplastic pain (e.g., nonspecific chronic low back or fibromyalgia) is one such subtype which may involve a greater etiologic role for brain plasticity, painful emotions induced by life stress and trauma, and unhealthy emotion regulation. In particular, correlational and behavioral data link anger and the ways anger is regulated with the presence and severity of nociplastic pain. Functional neuroimaging studies also suggest nociplastic pain and healthy anger regulation demonstrate inverse patterns of activity in the medial prefrontal cortex and amygdala; thus, improving anger regulation could normalize activity in these regions. In this Mini-Review, we summarize these findings and propose a unified, biobehavioral model called the Anger, Brain, and Nociplastic Pain (AB-NP) Model, which can be tested in future research and may advance pain care by informing new treatments that address anger, anger regulation, and brain plasticity for nociplastic pain.
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28
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Ji L, Wang J, Zhu B, Qiao X, Jin Y, Si H, Wang W, Bian Y, Wang C. Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients. Geriatr Nurs 2021; 43:293-298. [PMID: 34974398 DOI: 10.1016/j.gerinurse.2021.12.017] [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: 10/20/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation. METHODS Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms. RESULTS Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957). CONCLUSIONS Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.
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Affiliation(s)
- Lili Ji
- School of Nursing, Peking University, 100191 Beijing, China; School of Nursing, Weifang Medical University, 261042 Weifang, China
| | - Jinrong Wang
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Baoqi Zhu
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, 100191 Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
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29
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Lumley MA, Krohner S, Marshall LM, Kitts TC, Schubiner H, Yarns BC. Emotional awareness and other emotional processes: implications for the assessment and treatment of chronic pain. Pain Manag 2021; 11:325-332. [PMID: 33533272 DOI: 10.2217/pmt-2020-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Emotional awareness (EA) is a key emotional process that is related to the presence and severity of chronic pain (CP). In this report, we describe primary and secondary emotions, discuss the distinction between emotional states and emotional regulation/processing, and summarize theory and research highlighting the significance of EA for CP. We describe ways to assess EA and diagnose centrally-mediated CP, for which emotional processes appear most relevant. We review several psychological interventions designed to enhance EA as well as several broader emotional processing treatments developed to address trauma and psychosocial conflicts underlying many patients' pain. We conclude by offering our perspective on how future integration of emotional processing into pain care could promote recovery from CP.
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Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Shoshana Krohner
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Liyah M Marshall
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Torran C Kitts
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI, & Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Southfield, MI 48075, USA
| | - Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, & Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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