Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study

VULNERABILITY FACTORS, ADJUSTMENT, AND OPIOID MISUSE IN CHRONIC NON-CANCER PAIN INDIVIDUALS

There are several person variables that pre-date injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of two diathesis variables (impulsiveness and anxiety sensitivity) in the adjustment of individuals with chronic noncancer pain and in the opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modelling analyses. The results show a significant association between impulsiveness and anxiety sensitivity and all the maladjustment variables, and between impulsiveness and anxiety sensitivity and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the SEM analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and anxiety sensitivity are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including anxiety sensitivity and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and to opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.

Chronic Pain Resilience Across Clinical Populations: A Concept Analysis

BACKGROUND

Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain.

AIMS

To uncover and clarify the unique characteristics of the concept of chronic pain resilience.

DESIGN

A concept analysis using Rodgers' evolutionary method.

METHODS

Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences.

RESULTS

The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.

Transition from Acute to Chronic Low Back Pain in a Community-Based Cohort

The transition from acute to chronic low back pain (LBP) in community settings has yet to be well understood. We recruited n=131 participants with acute LBP from the community and followed them for 3 and 6-month outcomes. Acute LBP was defined by a duration of < 4 weeks, and participants must have reported a 30-day LBP-free period before the current acute episode. Chronic LBP was defined as pain most or every day over the past 3 months. Baseline psychological, social, and demographic factors were examined as predictors of transition to chronic LBP at 3 months or continuation of chronic LBP at 6 months. The transition from acute to chronic LBP at 3 months was 32.2% ( 38/118). At 6 months, 80.7% (25/111) of participants who transitioned at 3 months continued to have chronic LBP. At 6 months, participants who identified as Black or African American were more likely than white participants to transition to chronic LBP (RR=1.76, 95% CI 1.05, 2.95) and more likely to continue to have chronic LBP (RR=2.19, 95% CI 1.14, 4.21). Those classified at baseline by both LBP most or every day and intensity of at least 30/100 were more likely to transition to chronic LBP (RR=3.13, 95% CI 1.84, 5.30) and continue to have chronic LBP at 6 months (RR=2.58, 95% CI 1.43, 4.16). The STarT Back Screening Tool and the OSPRO-YF were associated with the transition to chronic LBP at 3 months and continuation at 6 months. Participants with higher PROMIS General Health and PROMIS Physical Health scores were less likely to transition to chronic LBP or continue to have chronic LBP at 6 months. These findings identify factors of acute LBP in the community that may predict the transition to chronic LBP. Larger studies are needed to confirm these findings and better understand the mechanisms driving the transition to chronic LBP.

Efficacy of cognitive behavioral therapy for reducing pain susceptibility and increasing social engagement in patients with chronic low back pain: A systematic review and meta-analysis

BACKGROUND

The objective of this study was to evaluate the efficacy of cognitive behavioral therapy in improving social engagement and pain susceptibility in patients with chronic low back pain (≥6 months duration).

METHODS

From the initial to January 2023, 5 databases were searched for randomized controlled trials, literature screening, quality evaluation, and data extraction were performed by 2 independent researchers throughout, Meta-analysis was performed using RevMan 5.4 software, standardized mean difference (SMD) was calculated for different indicators, and the combined experimental and control groups were calculated using random-effects models or fixed-effects models effect sizes, and forest plots were drawn to present the results.

RESULTS

A total of 16 studies containing 2527 patients with chronic nonspecific low back pain, all of whom had pain lasting longer than 6 months, were included, and after treatment, cognitive behavioral therapy (CBT) was superior to other treatments in improving social participation [SMD = -0.30, 95%CI (-0.60, -0.01), Z = 2.02, P = .04]. There was no significant difference from other treatments in improving patient depression [SMD = -0.07, 95%CI (-0.19, 0.05), Z = 1.11, P = .27] and anxiety [SMD = -0.07, 95%CI (-0.30, 0.16), Z = 0.52, P = .57]. Three papers describe the superiority of CBT over other treatments in improving sleep quality, but the metrics could not be combined due to too little literature.

CONCLUSION

CBT can improve patients' social participation and pain susceptibility to some extent, but it does not show advantages for managing negative emotions (depression, anxiety). Due to the limited number and low quality of included literature, the above findings still need to be validated by conducting a large sample of high-quality RCTs.

Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.

Reconsidering the Conceptualization of Resilience: The Experiences of Refugee and Immigrant Youth in Montreal

Over the last two decades, immigrant and refugee integration service agencies in Canada have been incorporating a focus on resiliency in their work and hold "fostering resilience" as a primary goal of services. These agencies focus on helping their clients enhance resilience in response to their integration challenges. Refugee and immigrant youth (RIY) face intersectional vulnerabilities during their resettlement process. These challenges make the concept of resilience vital to their success. However, resettlement service providers associate RIY's resilience with their assimilation into the Western culture such as integrating into the dominant culture. This definition is insensitive to cultural and social factors that contextualize RIY's definition of resilience. Drawing from in-depth interviews of Refugees and Immigrant youths in Montreal, and using Resilience as a conceptual framework, the research study investigated the barriers to the integration of RIY and their conceptualization of resilience. The study found social isolation, cultural differences between the host and home communities, racism, hostility, aggression, and language to be barriers to RIY's integration. The youth conceptualized resilience as a form of adaptability to any situation; as the ability to integrate into a new society while remaining deeply rooted in one's culture and past experiences; and overcoming marginalization. The paper contributes to a nuanced critical understanding in the field of refugee and migration studies and further throws light on a growing triangular interrelationship between social and economic integration of refugees, cultural factors of host communities, and resilience.

A scoping review on the methods of assessment and role of resilience on function and movement-evoked pain when experiencing a musculoskeletal injury

BACKGROUND

Resilience refers to an individual's ability to maintain effective functioning, by resisting, withstanding or recovering from stressors or adversity, including pain associated with physical injury (J Clin Psychol Med Settings 28:518-28, 2021). The aim of this scoping review is to determine the role of resilience in the experience of movement-evoked pain (MEP) and return to functional activity following a musculoskeletal injury.

METHODS

This review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the scoping review protocol of the Joanna Briggs Institute (JBI). Five databases and one grey literature database were searched using predetermined key words and index terms to capture published and unpublished records on the topic. Two authors independently screened the title and abstract of each record, with the full-text of eligible records being reviewed. Papers were eligible for inclusion if they examined the population, concept and context of interest, were written in English and the full text was available. Data were extracted from each eligible record to guide discussion of the available literature on this topic.

RESULTS

Of 4771 records, 2695 articles underwent screening based on their title and abstract. After title and abstract screening 132 articles were eligible for full text review, with 24 articles included in the final analysis. This review identified that psychological resilience has primarily been investigated in the context of a range of age-related pathologies. The choice of functional and movement-evoked pain assessments in the included studies were often guided by the pathology of interest, with some being general or injury specific.

CONCLUSION

This scoping review identified inconsistent conclusions regarding the role of resilience in the experience of MEP and the ability to return to function for older adults with a musculoskeletal injury. This scoping review highlights the need for longitudinal research to be conducted that allows a broader age range, including younger adults, to determine if multidimensional resilience may promote recovery form musculoskeletal injury.

Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study

OBJECTIVE

The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication.

METHODS

This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ2 test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed.

RESULTS

Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores.

CONCLUSION

Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.

Prognostic factors for pain chronicity in low back pain: a systematic review

Supplemental Digital Content is Available in the Text.

Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention.

Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

OBJECTIVE

Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy.

METHODS

A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain.

RESULTS

Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain.

CONCLUSIONS

The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.

Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain

Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake.

Clinical and Psychosocial Factors Over Time Following an Acute Low Back Pain Episode

BACKGROUND

Low back pain (LBP) is a prevalent condition with overwhelming healthcare costs and high disability rates. Characterization of clinical and psychosocial variables over time in patients experiencing an episode of acute LBP and the identification of factors that differ between those who develop chronic LBP and those who do not could aid in the development of improved targeted treatment.

PURPOSE

The purpose of this study was to evaluate the trajectory of depression, pain catastrophizing, life purpose, pain sensitivity, and disability in persons presenting with an acute/subacute episode of LBP, evaluating whether there are changes over time and differences in these variables between those who developed chronic LBP and those who did not.

METHODS

Prospective analysis (baseline, 2.5 months, 6 months, and weekly diaries) of 42 patients experiencing an acute LBP episode was performed. Descriptive statistics, repeated-measures mixed modeling, and Fisher's least significant differences method were used during data analysis.

RESULTS

Depressive symptoms vary over time. There was no difference over time in pain catastrophizing, life purpose, pain sensitivity, or disability. Those who met the criteria for chronic LBP at 6 months had increased pain catastrophizing scores and higher disability scores compared with those who do not meet the criteria for chronic LBP. Depressive symptoms, life purpose, and pain sensitivity were not different between those who met the criteria for chronic LBP and those who did not.

CONCLUSION

Findings from this study characterize factors potentially contributory to the development of chronic LBP over time. Those participants who developed chronic LBP had higher pain catastrophizing scores averaged across all time points in this study, suggesting it could be an interesting factor to target to improve LBP chronicity.

Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: Findings from the Netherlands obsessive compulsive disorder study

INTRODUCTION

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators.

METHODS

We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments.

RESULTS

Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome.

LIMITATIONS

The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias.

CONCLUSION

Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed.

Pain-Related Fear-Dissociable Neural Sources of Different Fear Constructs

Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia,” “fear avoidance beliefs,” or “pain anxiety,” pain-related fear constructs plausibly differ while it is unclear how specific the questionnaires are in assessing these different constructs. Furthermore, the relationship of pain-related fear to other anxiety measures such as state or trait anxiety remains ambiguous. Advances in neuroimaging such as machine learning on brain activity patterns recorded by functional magnetic resonance imaging might help to dissect commonalities or differences across pain-related fear constructs. We applied a pattern regression approach in 20 human patients with nonspecific chronic low back pain to reveal predictive relationships between fear-related neural pattern information and different pain-related fear questionnaires. More specifically, the applied multiple kernel learning approach allowed the generation of models to predict the questionnaire scores based on a hierarchical ranking of fear-related neural patterns induced by viewing videos of activities potentially harmful for the back. We sought to find evidence for or against overlapping pain-related fear constructs by comparing the questionnaire prediction models according to their predictive abilities and associated neural contributors. By demonstrating evidence of nonoverlapping neural predictors within fear-processing regions, the results underpin the diversity of pain-related fear constructs. This neuroscientific approach might ultimately help to further understand and dissect psychological pain-related fear constructs.