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Smakowski A, Hüsing P, Völcker S, Löwe B, Rosmalen JGM, Shedden-Mora M, Toussaint A. Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies. J Psychosom Res 2024; 181:111608. [PMID: 38365462 DOI: 10.1016/j.jpsychores.2024.111608] [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] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment. METHODS Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included. RESULTS Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning. CONCLUSION This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.
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Affiliation(s)
- Abigail Smakowski
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Paul Hüsing
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Sophia Völcker
- Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Bernd Löwe
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Netherlands
| | - Meike Shedden-Mora
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany; Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Anne Toussaint
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
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2
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Wang J, Liu M, Tian C, Gu J, Chen S, Huang Q, Lv P, Zhang Y, Li W. Elaboration and validation of a novelty nomogram for the prognostication of anxiety susceptibility in individuals suffering from low back pain. J Clin Neurosci 2024; 122:35-43. [PMID: 38461740 DOI: 10.1016/j.jocn.2024.03.003] [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: 12/18/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
Low back pain (LBP) constitutes a distressing emotional ordeal and serves as a potent catalyst for adverse emotional states, notably anxiety. We dedicated to discerning methodologies for identifying patients who are predisposed to heightened levels of anxiety and pain. A self-assessment questionnaire was administered to patients afflicted with LBP. The pain scores were subjected to analysis in conjunction with anxiety scores, and a clustering procedure was executed using the scientific k-means methodology. Subsequently, six machine learning algorithms, including Logistics Regression (LR), K-Nearest Neighbor (KNN), Decision Tree (DT), Support Vector Machine (SVM), Random Forest (RF), and Extreme Gradient Boosting (XGB), were employed. Next, five pertinent variables were identified, namely Age, Course, Body Mass Index (BMI), Education, and Marital status. Furthermore, a LR model was utilized to construct a nomogram, which was subsequently subjected to assessment for discrimination, calibration, and evaluation of its clinical utility. As a result, 599 questionnaires were valid (effective rate: 99 %). The correlation analysis revealed a significant association between anxiety and pain scores (r = 0.31, P < 0.001). LBP patients could be divided into two clusters, Cluster1 had higher pain scores (P < 0.05) and SAS scores (P < 0.001). The proposed nomogram demonstrated an area under the receiver operating characteristics curve (ROC) of 0.841 (95 %CI: 0.804-0.878) and 0.800 (95 %CI: 0.733-0.867) in the training and test groups, respectively. Briefly, the established nomogram has demonstrated remarkable proficiency in discerning individuals afflicted with LBP who are at a heightened risk of experiencing anxiety.
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Affiliation(s)
- Jian Wang
- Department of Neurosurgery, Tangdu Hospital, Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Miaomiao Liu
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Chao Tian
- Department of Rehabilitation, Southeast Hospital, Affiliated Hospital of Xiamen University, Xiamen, China
| | - Junxiang Gu
- Department of Neurosurgery, the Second Affiliated Hospital of the Xi'an Jiaotong University, Xi'an, China
| | - Sihai Chen
- Department of Psychiatry, Xiaogan Mental Health Center, Xiaogan, China
| | - Qiujuan Huang
- Department of Rehabilitation, Southeast Hospital, Affiliated Hospital of Xiamen University, Xiamen, China
| | - Peiyuan Lv
- Department of Neurosurgery, Tangdu Hospital, Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Yuhai Zhang
- Department of Health Statistics and Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational, China.
| | - Weixin Li
- Department of Neurosurgery, Tangdu Hospital, Affiliated Hospital of the Air Force Medical University, Xi'an, China.
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3
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Ghoussoub K, Côté CI, Fortier M, Nauche B, Rainville P, Pagé MG. Investigating the Impact of Stress on Pain: A Scoping Review on Sense of Control, Social-Evaluative Threat, Unpredictability, and Novelty (STUN Model). J Pain Res 2024; 17:737-751. [PMID: 38405686 PMCID: PMC10893892 DOI: 10.2147/jpr.s450977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
Background Stress can have paradoxical effects on pain, namely hyperalgesia and hypoalgesia. Four situational characteristics activate the hypothalamic-pituitary-adrenal axis, leading to a physiological stress response: lacking Sense of control, social-evaluative Threat, Unpredictability and Novelty (STUN). This scoping review reports on the types of evidence published on the effects of STUN characteristics on pain outcomes. Databases/Data Treatment Searches of primary electronic databases were performed to identify articles published on adults between 1990 and 2021 that contained search terms on pain and stress/STUN characteristics. A total of 329 articles were included in the analysis. Results Only 3.3% of studies examined simultaneously >1 STUN component. Almost all observational studies (177/180) examined the association between perceived stress and pain without measuring physiological stress responses. Of the 130 experimental studies, 78 (60.0%) manipulated stressful characteristics through nociception, and only 38.5% assessed if/how stress manipulation impacted perceived stress. Conclusion There is a clear lack of integration of the characteristics that trigger a physiological stress response in the pain field. Only 3.3% of studies examined simultaneously more than one STUN component and there is an unequal attention given to individual components of the STUN framework. Recommendations for future research include selection of stress manipulations/measurements that are more precisely inducing/reflecting neurobiological mechanisms of stress responses to insure valid integration of scientific knowledge.
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Affiliation(s)
- Karen Ghoussoub
- Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, Canada
- Research Center of the Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Catherine Isadora Côté
- Research Center of the Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Maude Fortier
- Research Center of the Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Bénédicte Nauche
- CHUM Library, Centre hospitalier de l’Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pierre Rainville
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de l’île de Montréal, Montreal, Quebec, Canada
- Department of Stomatology, Université de Montréal, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, Canada
- Research Center of the Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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4
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Valenzuela B. Landau model for illustrating the learning and unlearning process of nociplastic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1307532. [PMID: 38444432 PMCID: PMC10913031 DOI: 10.3389/fpain.2024.1307532] [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: 10/25/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Recent advancements in understanding the consolidation of nociplastic pain point to a complex, non-conscious learned process of threat perception. Neurobiological pain education is emerging as a promising approach to unlearn nociplastic pain, supported by biopsychosocial tools such as exposure to movement, mindfulness, and group sharing formats. However, this approach is still not well-known among clinicians and the society at large, creating a communication problem that unfortunately perpetuates the suffering of patients. Herein, we propose a Landau model to describe the learning and unlearning process of nociplastic pain, aiming to clarify this complex situation and facilitate communication across different sectors of the society. Nociplastic pain corresponds to a first-order transition, with attention more likely in the alert-protection state than in the trust-explore state. Two appealing results of the model are that the perception of the critical context depends on personal history regarding the symptom and that biopsychosocial loops are formed when there is alarming learned historical information about the symptom, along with confused and contradictory expert information, as seen in nocebo messages. Learning and unlearning in the model correspond to a chang in control parametrs that can weigh more on the alert-protection state, trust-explore state, uncertain state or neutral state. This description clarifies why neurobiological education is the foundational therapy from which others must be built to embody the accessible, clear, and trustworthy information.
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Affiliation(s)
- Belén Valenzuela
- Department of Theory and Simulation of Materials, Instituto de Ciencia de Materiales de Madrid, ICMM-CSIC, Madrid, Spain
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5
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Ecija C, Gutierrez L, Catala P, Peñacoba C. Preference for Hedonic Goals in Fibromyalgia; Is It Always an Avoidance Mechanism? Looking the Relationship with Pain Acceptance from a Positive Psychology Perspective. Pain Manag Nurs 2024; 25:80-87. [PMID: 38129209 DOI: 10.1016/j.pmn.2023.11.006] [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: 02/02/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
The aim of this study was to analyze the effect of openness to experience on pain acceptance through positive affect (PA) considering the moderating role of preference for mood management goals in women with fibromyalgia (FM). A cross-sectional study (n = 231) was carried out. A simple mediation model and a moderate mediation model were conducted by SPSS macro-PROCESS. Results showed that PA mediated positively the effect of openness to experience on acceptance (B = 0.46, SE = 0.80, t = 5,59; 95% CI = [0.3016, 0.6298], p < .001) and that the contribution of openness to experience to PA varied at different values of mood management goals (medium: - .04; ß = .40, p < .001; high: .95; ß = .61, p<.001). Findings may serve as a foundation for tailored interventions to promote activity through acceptance focusing on PA and mood management goals among women with medium to high level of hedonic goals.
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Affiliation(s)
- Carmen Ecija
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lorena Gutierrez
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Cecilia Peñacoba
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
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6
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Lv SS, Lv XJ, Cai YQ, Hou XY, Zhang ZZ, Wang GH, Chen LQ, Lv N, Zhang YQ. Corticotropin-releasing hormone neurons control trigeminal neuralgia-induced anxiodepression via a hippocampus-to-prefrontal circuit. SCIENCE ADVANCES 2024; 10:eadj4196. [PMID: 38241377 PMCID: PMC10798562 DOI: 10.1126/sciadv.adj4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Anxiety and depression are frequently observed in patients suffering from trigeminal neuralgia (TN), but neural circuits and mechanisms underlying this association are poorly understood. Here, we identified a dedicated neural circuit from the ventral hippocampus (vHPC) to the medial prefrontal cortex (mPFC) that mediates TN-related anxiodepression. We found that TN caused an increase in excitatory synaptic transmission from vHPCCaMK2A neurons to mPFC inhibitory neurons marked by the expression of corticotropin-releasing hormone (CRH). Activation of CRH+ neurons subsequently led to feed-forward inhibition of layer V pyramidal neurons in the mPFC via activation of the CRH receptor 1 (CRHR1). Inhibition of the vHPCCaMK2A-mPFCCRH circuit ameliorated TN-induced anxiodepression, whereas activating this pathway sufficiently produced anxiodepressive-like behaviors. Thus, our studies identified a neural pathway driving pain-related anxiodepression and a molecular target for treating pain-related psychiatric disorders.
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Affiliation(s)
- Su-Su Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xue-Jing Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ya-Qi Cai
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xin-Yu Hou
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Zhi-Zhe Zhang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Guo-Hong Wang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Li-Qiang Chen
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ning Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
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7
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Munneke W, Demoulin C, Roussel N, Leysen M, Van Wilgen CP, Pitance L, Reezigt RR, Voogt LP, Dankaerts W, Danneels L, Köke AJA, Cools W, De Kooning M, Nijs J. Comparing physical therapy students' attitudes and beliefs regarding chronic low back pain and knee osteoarthritis: an international multi-institutional comparison between 2013 and 2020 academic years. Braz J Phys Ther 2024; 28:100592. [PMID: 38368840 PMCID: PMC10883834 DOI: 10.1016/j.bjpt.2024.100592] [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] [Received: 03/23/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. OBJECTIVES To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. METHODS In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. RESULTS In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. CONCLUSIONS Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.
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Affiliation(s)
- Wouter Munneke
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nathalie Roussel
- Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Antwerp, Belgium
| | - Marijke Leysen
- Pain in Motion International Research Group (PiM), Belgium; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - C Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Transcare, Transdisciplinary Pain Management Center, the Netherlands
| | - Laurent Pitance
- Neuro-musculoskeletal Lab (NMSK), UCLouvain, Brussels, Belgium; Oral and Maxillofacial Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Roland R Reezigt
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Lennard P Voogt
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, the Netherlands
| | - Wim Dankaerts
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physical Therapy, Universiteit Gent, Ghent, Belgium
| | - Albère J A Köke
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherland; Department of Physical Therapy Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Wilfried Cools
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel, Brussels, Belgium
| | - Margot De Kooning
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sweden.
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8
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van den Broeke EN, Crombez G, Vlaeyen JW. Reconceptualizing sensitization in pain: back to basics. Pain Rep 2024; 9:e1125. [PMID: 38239565 PMCID: PMC10796139 DOI: 10.1097/pr9.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/26/2023] [Accepted: 10/29/2023] [Indexed: 01/22/2024] Open
Abstract
Fillingim RB. Redefining sensitization could be a sensitive issue. PAIN Rep 2024;9:e1126.
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Affiliation(s)
- Emanuel N. van den Broeke
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical & Health Psychology, Ghent University, Gent, Belgium
| | - Johan W.S. Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
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9
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Crombez G, Veirman E, Van Ryckeghem D, Scott W, De Paepe A. The effect of psychological factors on pain outcomes: lessons learned for the next generation of research. Pain Rep 2023; 8:e1112. [PMID: 38027466 PMCID: PMC10631620 DOI: 10.1097/pr9.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/10/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Big data and machine learning techniques offer opportunities to investigate the effects of psychological factors on pain outcomes. Nevertheless, these advances can only deliver when the quality of the data is high and the underpinning causal assumptions are considered. We argue that there is room for improvement and identify some challenges in the evidence base concerning the effect of psychological factors on the development and maintenance of chronic pain. As a starting point, 3 basic tenets of causality are taken: (1) cause and effect differ from each other, (2) the cause precedes the effect within reasonable time, and (3) alternative explanations are ruled out. Building on these tenets, potential problems and some lessons learned are provided that the next generation of research should take into account. In particular, there is a need to be more explicit and transparent about causal assumptions in research. This will lead to better research designs, more appropriate statistical analyses, and constructive discussions and productive tensions that improve our science.
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Affiliation(s)
- Geert Crombez
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Elke Veirman
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Van Ryckeghem
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Whitney Scott
- Health Psychology Section, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Annick De Paepe
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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10
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Dillon M, Olson R, Mescouto K, Costa N, Setchell J. How physiotherapists attend to the human aspects of care when working with people with low back pain: a thematic analysis. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:277-293. [PMID: 36632019 DOI: 10.1080/14461242.2022.2161927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Pain is a multidimensional experience. Physiotherapy has attempted to enhance earlier biomedical approaches to patient care through approaches like the 'biopsychosocial' model. Nevertheless, physiotherapy continues to focus on biomedical and/or behavioural aspects of care. We critically investigated how physiotherapists attend to human (psychosocial, emotional, existential, and moral) aspects of low back pain care. We co-analysed ethnographic data with researchers, patients, and physiotherapists using concepts of conforming, tinkering and abandoning 'scripts'. Data included observations of 28 physiotherapy interactions between 26 patients and 10 physiotherapists and 7 researcher-clinician dialogues. Analysis suggests when conforming to scripts, clinicians have difficulty recognising and responding to emotions; time pressure limited clinicians focus, and a biological focus often distracted from psychosocial aspects of people's back pain experiences. In contrast, tinkering with or abandoning scripts allowed space to broaden the focus. Drawing from theorists such as Butler (1999) and Gibson et al. (2020) our analysis contributes to health sociology, arguing that 'tinkering' with or 'abandoning' scripts can foster more humanistic, flexible and reflexive approaches to care. Although health sociologists have explored tinkering, abandoning is new; within physiotherapy, it encapsulates being able to respond with agility to non-physical elements of care without constraint from traditional ways of thinking and doing.
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Affiliation(s)
- M Dillon
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R Olson
- School of Social Science, The University of Queensland, Brisbane, Australia
| | - K Mescouto
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - N Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - J Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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11
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Kang S, Van Ryckeghem DML, Vlaeyen JWS, De Paepe AL, Crombez G. In search of conditioned pain: an experimental analysis. Pain 2023; 164:2596-2605. [PMID: 37288937 DOI: 10.1097/j.pain.0000000000002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
ABSTRACT There is an ongoing debate about whether pain can be classically conditioned, but surprisingly, evidence is scarce. Here, we report 3 experiments investigating this idea. In a virtual reality task, healthy participants were approached and touched near or on their hand with a coloured pen (blue or yellow). During acquisition, participants learned that one of the colours of the pen (CS+) was predictive of a painful electrocutaneous stimulus (ECS) whereas the other coloured pen (CS-) was not. During the test phase, more frequent reports of experiencing an US when none was delivered ("false alarm") for the CS+ vs CS- qualified as evidence of conditioned pain. Notable differences between experiments were that the US was delivered when the pen touched a spot between the thumb and index finger (experiment 1; n = 23), when it virtually touched the hand (experiment 2; n = 28) and when participants were informed that the pen caused pain rather than simply predicting something (experiment 3; n = 21). The conditioning procedure proved successful in all 3 experiments: Self-reported fear, attention, pain, fear, and US expectancy were higher ( P < 0.0005) for the CS+ than the CS-. There was no evidence for conditioned pain in experiment 1, but there was some evidence in experiments 2 and 3. Our findings indicate that conditioned pain may exist, albeit most likely in rare cases or under specific situations. More research is needed to understand the specific conditions under which conditioned pain exists and the underlying processes (eg, response bias).
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Affiliation(s)
- Sahaj Kang
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Annick L De Paepe
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Flores-Cortes M, Guerra-Armas J, Pineda-Galan C, La Touche R, Luque-Suarez A. Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review. Brain Sci 2023; 13:1461. [PMID: 37891829 PMCID: PMC10604973 DOI: 10.3390/brainsci13101461] [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: 09/14/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Decision making and action execution both rely on sensory information, and their primary objective is to minimise uncertainty. Virtual reality (VR) introduces uncertainty due to the imprecision of perceptual information. The concept of "sensorimotor uncertainty" is a pivotal element in the interplay between perception and action within the VR environment. The role of immersive VR in the four stages of motor behaviour decision making in people with pain has been previously discussed. These four processing levels are the basis to understand the uncertainty that a patient experiences when using VR: sensory information, current state, transition rules, and the outcome obtained. METHODS This review examines the different types of uncertainty that a patient may experience when they are immersed in a virtual reality environment in a context of pain. Randomised clinical trials, a secondary analysis of randomised clinical trials, and pilot randomised clinical trials related to the scope of Sensorimotor Uncertainty in Immersive Virtual Reality were included after searching. RESULTS Fifty studies were included in this review. They were divided into four categories regarding the type of uncertainty the intervention created and the stage of the decision-making model. CONCLUSIONS Immersive virtual reality makes it possible to alter sensorimotor uncertainty, but studies of higher methodological quality are needed on this topic, as well as an exploration into the patient profile for pain management using immersive VR.
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Affiliation(s)
- Mar Flores-Cortes
- Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
| | | | | | - Roy La Touche
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Alejandro Luque-Suarez
- Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Instituto de Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
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Kegel JL, Kazman JB, Clifton DR, Emanuele P, Nelson DA, Deuster PA. The combined effects of coping and pain interference on army readiness. FRONTIERS IN PAIN RESEARCH 2023; 4:1175574. [PMID: 37654909 PMCID: PMC10465792 DOI: 10.3389/fpain.2023.1175574] [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: 03/07/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Chronic pain and associated interference with daily activities are common in the military and impact Force readiness. Chronic pain affects one-third of service members and is a leading cause of medical non-readiness (MNR) in the military. Research suggests that underlying psychological mechanisms related to trait coping styles and pain interference (PI) affect functional outcomes, but little research exists examining this relationship within an Army population. The purpose of this study was to examine the combined effects of PI and coping on U.S. Army soldier readiness by using annual well-being data from the Global Assessment Tool (GAT) and medical non-readiness (MNR) based on duty restriction records. Methods The sample comprised 866,379 soldiers who completed the GAT between 2014 and 2017 with no duty restrictions at the time of baseline GAT completion; subjects were observed through 2018 for duty restrictions. Parametric survival regression models with a Weibull distribution predicted demographic-adjusted hazards of MNR by dichotomized PI (no PI/PI) and beneficial/non-beneficial use of GAT coping components (good coping, bad coping, catastrophizing-flexibility, and catastrophizing-hopelessness). Incident MNR was evaluated for all duty restrictions, and stratified by selected body systems (upper extremity, lower extremity, psychiatric). Results Among soldiers with PI, hazards were higher in those reporting non-beneficial coping styles (bad coping, hopelessness) and lower in those reporting beneficial coping styles (good coping, flexibility). Across all coping styles, PI/coping interactions were particularly strong for catastrophizing-hopelessness and when examining MNR from psychiatric conditions. Discussion These findings suggest some synergistic associations between pain and coping that may impact pain-related occupational disability. Coping skills may be an effective interventional target for chronic pain reduction/prevention within military programs, such as the Master Resilience Training Course offered to soldiers in the Army. Further research should assess whether early coping style interventions can reduce pain-related outcomes.
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Affiliation(s)
- Jessica L. Kegel
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Josh B. Kazman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Daniel R. Clifton
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Peter Emanuele
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - D. Alan Nelson
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States
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Boselie JJLM, Peters ML. Shifting the perspective: how positive thinking can help diminish the negative effects of pain. Scand J Pain 2023; 23:452-463. [PMID: 36803855 DOI: 10.1515/sjpain-2022-0129] [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: 09/01/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES The field of pain psychology has taken significant steps forward during the last decades and the way we think about how to treat chronic pain has radically shifted from a biomedical perspective to a biopsychosocial model. This change in perspective has led to a surge of accumulating research showing the importance of psychological factors as determinants for debilitating pain. Vulnerability factors, such as pain-related fear, pain catastrophizing and escape/avoidant behaviours may increase the risk of disability. As a result, psychological treatment that has emerged from this line of thinking has mainly focused on preventing and decreasing the adverse impact of chronic pain by reducing these negative vulnerability factors. Recently, another shift in thinking has emerged due to the field of positive psychology, which aims to have a more complete and balanced scientific understanding of the human experience, by abandoning the exclusive focus on vulnerability factors towards including protective factors. METHODS The authors have summarised and reflected on the current state-of-the-art of pain psychology from a positive psychology perspective. RESULTS Optimism is an important factor that may in fact buffer and protect against pain chronicity and disability. Resulting treatment approaches from a positive psychology perspective are aimed at increasing protective factors, such as optimism, to increase resilience towards the negative effects of pain. CONCLUSIONS We propose that the way forward in pain research and treatment is the inclusion of both vulnerability and protective factors. Both have unique roles in modulating the experience of pain, a finding that had been neglected for too long. Positive thinking and pursuing valued goals can make one's life gratifying and fulfilling, despite experiencing chronic pain.
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Affiliation(s)
| | - Madelon L Peters
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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15
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Chen S, Jackson T, He Y. Effects of False Feedback on Pain Tolerability Among Young Healthy Adults: Predictive Roles of Intentional Effort Investment and Perceived Pain Intensity. J Pain Res 2023; 16:2257-2268. [PMID: 37425222 PMCID: PMC10329439 DOI: 10.2147/jpr.s412994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Expectations and modification gained through critical learning influence pain perception. We tested how pain tolerability was influenced by the effects of orally delivered false feedback and participant status immediately prior to performing tasks. Patients and Methods A total of 125 healthy college students (69 females and 56 males) were randomly assigned to 3 groups (positive, negative, and control) to participate in two formal cold pressor tests (CPTs). Participants completed the same series of task-related questionnaires (perceived importance, intended effort, current affect, and self-efficacy) before each CPT. False performance feedback was delivered after completion of the baseline level CPT. After completion of each CPT, both pain intensity and pain tolerability (duration in ice water) were recorded. Results The results of linear mixed models revealed significant condition × time interactions on pain tolerability and task self-efficacy after controlling for individual variance as a random effect. Participants who received negative feedback exhibited increased pain tolerability without decreasing their self-efficacy, whereas participants who received positive feedback showed increased self-efficacy with no change in pain tolerability. A longer pain tolerance duration was also predicted by a more intentional investment of effort and a lower intensity of experienced pain as well as the effect of false feedback. Conclusion The research highlights the effect of powerful situational influences on laboratory-induced pain tolerance.
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Affiliation(s)
- Shuanghong Chen
- Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University, Chongqing, People’s Republic of China
- Faculty of Psychology, Southwest University, Chongqing, People’s Republic of China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, Macau, People’s Republic of China
| | - Ying He
- Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University, Chongqing, People’s Republic of China
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16
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Toonders SAJ, van Westrienen PE, de Wit NJ, van Dongen JM, Gerrits M, Pisters MF, Veenhof C. The cost-effectiveness of an indicated blended care intervention in primary care compared to usual care in patients with moderate persistent somatic symptoms. J Psychosom Res 2023; 171:111387. [PMID: 37270910 DOI: 10.1016/j.jpsychores.2023.111387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Appropriate treatment for people with an increased risk for developing chronic Persistent Somatic Symptoms (PSS) is of great importance at an early stage to improve quality of life and prevent high costs for society. OBJECTIVE To evaluate the cost-effectiveness of an integrated blended care intervention compared to usual care for QALYs, subjective symptom impact and physical and mental health status in patients with moderate PSS. METHODS This economic evaluation was conducted alongside a 12-month prospective, multicenter cluster randomized controlled trial in Dutch primary care. 80 participants received the intervention and 80 participants received usual care. Seemingly unrelated regression analyzes were performed to estimate cost and effect differences. Missing data were imputed using multiple imputation. Bootstrapping techniques were used to estimate uncertainty. RESULTS We found no significant difference in total societal costs. Intervention, primary and secondary healthcare and absenteeism costs were higher for the intervention group. The ICER for QALYs demonstrated the intervention was on average less costly and less effective compared to usual care. For the subjective symptom impact and physical health, the ICER indicated that the intervention group was on average less costly and more effective. For mental health, the intervention was on average more costly and less effective. CONCLUSION We didn't find an integrated blended primary care intervention to be cost-effective compared to usual care. However, when looking on relevant, but specific outcome measures (subjective symptom impact and physical health) for this population, average costs are found to be lower and the effectiveness found to be higher.
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Affiliation(s)
- S A J Toonders
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - P E van Westrienen
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - N J de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - M Gerrits
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M F Pisters
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Guerra-Armas J, Flores-Cortes M, Pineda-Galan C, Luque-Suarez A, La Touche R. Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients. Brain Sci 2023; 13:brainsci13040617. [PMID: 37190582 DOI: 10.3390/brainsci13040617] [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: 03/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.
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Affiliation(s)
- Javier Guerra-Armas
- Faculty of Health Sciences, Universidad Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas, Spain
| | - Mar Flores-Cortes
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
| | | | - Alejandro Luque-Suarez
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
- Instituto de la Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
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Schemer L, Hess CW, Van Orden AR, Birnie KA, Harrison LE, Glombiewski JA, Simons LE. Enhancing Exposure Treatment for Youths With Chronic Pain: Co-design and Qualitative Approach. J Particip Med 2023; 15:e41292. [PMID: 36892929 PMCID: PMC10037174 DOI: 10.2196/41292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Increasing the access to and improving the impact of pain treatments is of utmost importance, especially among youths with chronic pain. The engagement of patients as research partners (in contrast to research participants) provides valuable expertise to collaboratively improve treatment delivery. OBJECTIVE This study looked at a multidisciplinary exposure treatment for youths with chronic pain through the lens of patients and caregivers with the aim to explore and validate treatment change processes, prioritize and develop ideas for improvement, and identify particularly helpful treatment elements. METHODS Qualitative exit interviews were conducted with patients and caregivers at their discharge from 2 clinical trials (ClinicalTrials.gov NCT01974791 and NCT03699007). Six independent co-design meetings were held with patients and caregivers as research partners to establish a consensus within and between groups. The results were validated in a wrap-up meeting. RESULTS Patients and caregivers described that exposure treatment helped them better process pain-related emotions, feel empowered, and improve their relationship with each other. The research partners developed and agreed upon 12 ideas for improvement. Major recommendations include that pain exposure treatment should be disseminated more not only among patients and caregivers but also among primary care providers and the general public to facilitate an early referral for treatment. Exposure treatment should allow flexibility in terms of duration, frequency, and delivery mode. The research partners prioritized 13 helpful treatment elements. Most of the research partners agreed that future exposure treatments should continue to empower patients to choose meaningful exposure activities, break long-term goals into smaller steps, and discuss realistic expectations at discharge. CONCLUSIONS The results of this study have the potential to contribute to the refinement of pain treatments more broadly. At their core, they suggest that pain treatments should be disseminated more, flexible, and transparent.
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Affiliation(s)
- Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Department of Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Reply to Manhapra. Pain 2023; 164:e175. [PMID: 36779561 DOI: 10.1097/j.pain.0000000000002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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20
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Better Together. Group versus individual Cognitive-Behavioral Therapy for tinnitus: A Multiple-Baseline Single-Case Experimental Design. Ear Hear 2023; 44:167-178. [PMID: 36117259 DOI: 10.1097/aud.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Chronic tinnitus is effectively treated through cognitive-behavioral therapy (CBT). Both group and individual CBT for tinnitus are effective, but no study has directly compared the two. The current study explores group versus individual CBT for tinnitus. DESIGN A multiple-baseline single-case experimental design was employed to observe changes within/between individual and group treatments. Six participants started a 10-week CBT protocol and were equally divided into individual or group treatment. Participants were exchanged between treatments at random time points. Diary data included 14 variables on tinnitus experience (e.g. annoyance and distraction) and wellbeing (e.g. happiness and stress). Five male participants (59- to 67-year-old) completed treatment. RESULTS Randomization tests comparing means between individual and group treatments did not reveal significant differences. Analysis of data overlap and trend (Tau-U) revealed minor significant improvements for seven variables (50%) in group treatment as compared to individual treatment. Diminished happiness and activity levels were observed in participants who went from group to individual treatment. CONCLUSIONS Low effect sizes and homogeneity of sample restrict the generalizability of data. Group CBT indicated potential benefits when compared to individual CBT. Social learning may be an underlying process in group delivery boosting tinnitus recovery. Findings are limited to male patients with chronic disabling tinnitus.
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Ucero-Lozano R, Pérez-Llanes R, López-Pina JA, Cuesta-Barriuso R. 180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy. Haemophilia 2023; 29:282-289. [PMID: 36261396 PMCID: PMC10092164 DOI: 10.1111/hae.14683] [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: 04/28/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. AIM To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. METHODS Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73 ± 12.36 years). The intervention lasted 4 weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). RESULTS No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F = 51.38; η2 p = .63), pressure pain threshold of the lateral malleolus (F = 12.34; η2 p = .29) and range of motion (F = 11.7; η2 p = .28). CONCLUSIONS Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.
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Affiliation(s)
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | - Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain.,Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Garbusow M, Ebrahimi C, Riemerschmid C, Daldrup L, Rothkirch M, Chen K, Chen H, Belanger MJ, Hentschel A, Smolka MN, Heinz A, Pilhatsch M, Rapp MA. Pavlovian-to-Instrumental Transfer across Mental Disorders: A Review. Neuropsychobiology 2022; 81:418-437. [PMID: 35843212 DOI: 10.1159/000525579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
A mechanism known as Pavlovian-to-instrumental transfer (PIT) describes a phenomenon by which the values of environmental cues acquired through Pavlovian conditioning can motivate instrumental behavior. PIT may be one basic mechanism of action control that can characterize mental disorders on a dimensional level beyond current classification systems. Therefore, we review human PIT studies investigating subclinical and clinical mental syndromes. The literature prevails an inhomogeneous picture concerning PIT. While enhanced PIT effects seem to be present in non-substance-related disorders, overweight people, and most studies with AUD patients, no altered PIT effects were reported in tobacco use disorder and obesity. Regarding AUD and relapsing alcohol-dependent patients, there is mixed evidence of enhanced or no PIT effects. Additionally, there is evidence for aberrant corticostriatal activation and genetic risk, e.g., in association with high-risk alcohol consumption and relapse after alcohol detoxification. In patients with anorexia nervosa, stronger PIT effects elicited by low caloric stimuli were associated with increased disease severity. In patients with depression, enhanced aversive PIT effects and a loss of action-specificity associated with poorer treatment outcomes were reported. Schizophrenic patients showed disrupted specific but intact general PIT effects. Patients with chronic back pain showed reduced PIT effects. We provide possible reasons to understand heterogeneity in PIT effects within and across mental disorders. Further, we strengthen the importance of reliable experimental tasks and provide test-retest data of a PIT task showing moderate to good reliability. Finally, we point toward stress as a possible underlying factor that may explain stronger PIT effects in mental disorders, as there is some evidence that stress per se interacts with the impact of environmental cues on behavior by selectively increasing cue-triggered wanting. To conclude, we discuss the results of the literature review in the light of Research Domain Criteria, suggesting future studies that comprehensively assess PIT across psychopathological dimensions.
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Affiliation(s)
- Maria Garbusow
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Carlotta Riemerschmid
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Luisa Daldrup
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Marcus Rothkirch
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ke Chen
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Hao Chen
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Matthew J Belanger
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Angela Hentschel
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Maximilan Pilhatsch
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Elblandklinikum, Radebeul, Germany
| | - Michael A Rapp
- Area of Excellence Cognitive Sciences, University of Potsdam, Potsdam, Germany
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Fujii R, Imai R, Shigetoh H, Tanaka S, Morioka S. Changes in task-specific fear of movement and impaired trunk motor control by pain neuroscience education and exercise: A preliminary single-case study of a worker with low back pain. SAGE Open Med Case Rep 2022; 10:2050313X221131162. [PMID: 36313268 PMCID: PMC9608066 DOI: 10.1177/2050313x221131162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
We report a case (a worker with low back pain) who was provided patient education and therapeutic exercise, and we performed a detailed kinematic analysis of his work-related activity over time. The subjects were one 28-year-old male worker with low back pain. In addition, to clearly identify impaired trunk movement during work-related activity in the low back pain subject, 20 age-matched healthy males (control group) were also included as a comparison subject. He received pain neurophysiology education and exercise instruction. We analyzed the subject's trunk movement pattern during a lifting task examined by a three-dimensional-motion capture system. In addition, task-specific fear that occurred during the task was assessed by the numerical rating scale. The assessment was performed at the baseline phase (4 data points), the intervention phase (8 data points), and the follow-up phase (8 data points), and finally at 3 and 8 months after the follow-up phase. No intervention was performed in the control group; they underwent only one kinematic evaluation at baseline. As a result, compared to the control group, the low back pain subject had slower trunk movement velocity (peak trunk flexion velocity = 50.21 deg/s, extension velocity = -47.61 deg/s), and his upper-lower trunk segments indicated an in-phase motion pattern (mean absolute relative phase = 15.59 deg) at baseline. The interventions reduced his pain intensity, fear of movement, and low back pain-related disability; in addition, his trunk velocity was increased (peak trunk flexion velocity = 82.89 deg/s, extension velocity = -77.17 deg/s). However, the in-phase motion pattern of his trunk motor control remained unchanged (mean absolute relative phase = 16.00 deg). At 8 months after the end of the follow-up, the subject's in-phase motion pattern remained (mean absolute relative phase = 13.34 deg) and his pain intensity had increased. This report suggests that if impaired trunk motor control remains unchanged after intervention, as in the course of the low back pain subject, it may eventually be related to a recurrence of low back pain symptoms.
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Affiliation(s)
- Ren Fujii
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Koryo-cho, Japan,Department of Rehabilitation Medicine, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto-shi, Japan,Ren Fujii, Department of Neurorehabilitation, Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-gun, Koryo-cho 635-0832, Nara, Japan.
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka-shi, Japan
| | - Hayato Shigetoh
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto-shi, Japan,Neurorehabilitation Research Center, Kio University, Koryo-cho, Japan
| | - Shinichiro Tanaka
- Department of Rehabilitation Medicine, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto-shi, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Koryo-cho, Japan,Neurorehabilitation Research Center, Kio University, Koryo-cho, Japan
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24
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Peñacoba C, Ecija C, Velasco L, Catala P, Suso-Ribera C. The paradox of wellbeing: what happens among women with fibromyalgia? The effect of cognitive fusion. Aging Ment Health 2022; 26:1829-1836. [PMID: 34524947 DOI: 10.1080/13607863.2021.1977238] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our study examined the 'paradox of wellbeing' among women with fibromyalgia and the role of cognitive fusion on wellbeing in relation to age. METHODS A total of 228 women diagnosed with fibromyalgia according to the American College of Rheumatology criteria were included. In order to explore the conditional effects of age in the moderation analyzes, as recommended in the PROCESS Macro, the 16th, 50th, and 84th percentiles were calculated. These percentiles define three age groups that we will call younger (from 30 to 53 years), middle-aged (from 54 to 60 years) and older women (from 61 to 78 years). RESULTS We found a 'paradox of wellbeing' among fibromyalgia patients which has not yet been reported: the older the patients, the higher scores on hedonic (positive affect) and eudaimonic (activities engagement) wellbeing. A moderation effect of age was found in the relationship between cognitive fusion and wellbeing (cognitive fusion showed negative associations with positive affect and activities engagement but not among older patients). CONCLUSION Our study underscores the need of personalized interventions for fibromyalgia patients to improve their wellbeing. Especially in younger and middle-aged patients, it would be of interest interventions in cognitive defusion through Acceptance and Commitment Therapy (ACT).
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Affiliation(s)
- Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
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25
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26
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Krypotos AM, Alves M, Crombez G, Vlaeyen JWS. The role of intolerance of uncertainty when solving the exploration-exploitation dilemma. Int J Psychophysiol 2022; 181:33-39. [PMID: 36007711 DOI: 10.1016/j.ijpsycho.2022.08.001] [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: 01/31/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022]
Abstract
When making behavioral decisions, individuals need to balance between exploiting known options or exploring new ones. How individuals solve this exploration-exploitation dilemma (EED) is a key research question across psychology, leading to attempting to disentangle the cognitive mechanisms behind it. A potential predictive factor of performance in an EED is intolerance of uncertainty (IU), an individual difference factor referring to the extent to which uncertain situations are reported to be aversive. Here, we present the results of a series of exploratory analyses in which we tested the relationship between IU and performance in an EED task. For this, we compiled data from 3 experiments, in which participants received the opportunity to exploit different movements in order to avoid a painful stimulus and approach rewards. For decomposing performance in this task, we used different computational models previously employed in studies on the EED. Then, the parameters of the winning model were correlated with the scores of participants in the IU scale. Correlational and cluster analyses, within both frequentists and Bayesian frameworks, did not provide strong evidence for a relation between EED and IU, apart from the decay rate and the subscale "tendency to become paralyzed in the face of uncertainty". Given the theoretical relation between EED and IU, we propose research with different experimental paradigms.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Department of Clinical Psychology, Utrecht University, the Netherlands; Research Group Health Psychology, KU Leuven, Belgium.
| | - Maryna Alves
- Research Group Health Psychology, KU Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Heath Psychology, Ghent University, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Belgium; Experimental Health Psychology, Maastricht University, the Netherlands
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27
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Falling CL, Siegel CA, Salwen-Deremer JK. Inflammatory Bowel Disease and Pain Interference: A Conceptual Model for the Role of Insomnia, Fatigue, and Pain Catastrophizing. CROHN'S & COLITIS 360 2022; 4:otac028. [PMID: 36777421 PMCID: PMC9802206 DOI: 10.1093/crocol/otac028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background People with inflammatory bowel disease (IBD) commonly experience pain influenced by complex interactions among factors, including disease activity, sleep, psychopathology, and changes in pain processing pathways. Treatments for pain in IBD are limited, highlighting the need for research that explores modifiable factors linked to pain. The aim of this study was to investigate relationships among multiple patient factors and to construct a conceptual model for pain interference in IBD. Methods A cross-sectional survey of adults with IBD. Study domains included demographic, comorbidity, psychological, IBD, insomnia, fatigue, and pain features. Structural equation modeling (SEM) was used to examine relationships and interactions among active IBD, insomnia, fatigue, pain experiences (severity, catastrophizing, and interference), and additional patient factors (demographics and psychological). Results One hundred and seventy-four participants, aged 18-85 years, reported the presence of pain. Combining the questionnaire data using SEM resulted in a final model with an excellent fit (χ 2(8) = 9.579, P = .297, χ 2/N = 1.197, CFIN = 0.997, TLI = 0.987, RMSEA = 0.034). The presence of anxiety and depression was the additional patient factors to be retained in the path analysis. SEM results indicated that greater pain interference was directly influenced by greater fatigue, worse pain catastrophizing, and worse pain severity. Pain interference was indirectly impacted by IBD activity, worse insomnia, and the presence of depression and anxiety. Conclusions The proposed conceptual model highlights the role of multiple potentially modifiable factors, including insomnia, pain catastrophizing, and fatigue, contributing to worse pain interference in people with IBD.
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Affiliation(s)
- Carrie L Falling
- Address correspondence to: Carrie L. Falling, PhD, 325 Great King Street, Dunedin 9016, New Zealand ()
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine and Psychiatry, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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28
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Löffler M, Levine SM, Usai K, Desch S, Kandić M, Nees F, Flor H. Corticostriatal circuits in the transition to chronic back pain: The predictive role of reward learning. CELL REPORTS MEDICINE 2022; 3:100677. [PMID: 35798001 PMCID: PMC9381385 DOI: 10.1016/j.xcrm.2022.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/08/2022] [Accepted: 06/13/2022] [Indexed: 10/26/2022]
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29
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Zhang LB, Hu L. Reward learning in the development and maintenance of chronic back pain. Cell Rep Med 2022; 3:100688. [PMID: 35858587 PMCID: PMC9381408 DOI: 10.1016/j.xcrm.2022.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Treating and preventing chronic pain require our understanding of how it develops and maintains. Löffler et al. (2022)1 demonstrate that distinct operant learning signals in the vmPFC-NAc pathway predict the development and maintenance of chronic back pain.
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Affiliation(s)
- Li-Bo Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 100101 Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 100101 Beijing, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 100101 Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 100101 Beijing, China.
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30
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Kube T, Körfer K, Riecke J, Glombiewski JA. How expectancy violations facilitate learning to cope with pain - An experimental approach. J Psychosom Res 2022; 157:110807. [PMID: 35390722 DOI: 10.1016/j.jpsychores.2022.110807] [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: 06/21/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Expectations of painful sensations constitute a core feature of chronic pain. An important clinical question is whether such expectations are revised when disconfirming experiences are made (e.g., less pain than expected). This study examined how people adjust their pain expectations when the experience of decreasing pain is expected vs. unexpected. METHODS In a novel randomized between-subjects design, a subclinical sample of people who frequently experience pain was provided with painful thermal stimulations. Unbeknownst to participants, the temperature applied was decreased from trial to trial. Based on the experimental instructions provided, this experience of decreasing pain was expected in one condition (expectation-confirmation; n = 34), whereas it was unexpected in another (expectation-disconfirmation; n = 39). RESULTS Perceived pain intensity was lower in the expectation-confirmation condition than in the expectation-disconfirmation condition (p = .014, ηp2 = 0.083). The expectation-confirmation condition also showed a greater adjustment of their pain expectations than the expectation-disconfirmation condition (p = .046, ηp2 = 0.047). Across groups, large expectation violations (i.e., less pain than expected) were associated with increases in pain tolerance and the ability to cope with pain at a one-week follow-up. CONCLUSIONS In terms of assimilation, perceived pain intensity was shaped in the direction of pain expectations. The greater adjustment of expectations in the expectation-confirming condition is consistent with a confirmation bias in pain perception. Though participants who experienced large discrepancies between expected and experienced pain were hesitant to adjust their pain expectations immediately, expectation violations increased their ability to cope with pain one week later, suggesting some beneficial longer-term effects of expectation violations.
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Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany.
| | - Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Julia A Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany
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31
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Murillo C, Vo TT, Vansteelandt S, Harrison LE, Cagnie B, Coppieters I, Chys M, Timmers I, Meeus M. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev 2022; 94:102160. [PMID: 35561510 PMCID: PMC11146991 DOI: 10.1016/j.cpr.2022.102160] [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: 06/10/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium
| | - Tat-Thang Vo
- Department of Statistics, The Wharton School, University of Pennsylvania, Pennsylvania, United States; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Marjolein Chys
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States; Department of Rehabilitation Medicine, Maastricht University, Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium.
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Ballantyne JC, Sullivan MD. Is Chronic Pain a Disease? THE JOURNAL OF PAIN 2022; 23:1651-1665. [PMID: 35577236 DOI: 10.1016/j.jpain.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
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Affiliation(s)
- Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Sanromán L, Catalá P, Écija C, Suso-Ribera C, San Román J, Peñacoba C. The Role of Walking in the Relationship between Catastrophizing and Fatigue in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4198. [PMID: 35409880 PMCID: PMC8998906 DOI: 10.3390/ijerph19074198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
Walking is one of the most beneficial treatments for fibromyalgia patients. However, adherence to walking behavior is low due to the initially associated symptoms (including pain and fatigue). Although the association of catastrophism with greater symptoms is known, the results regarding fatigue have not always been consistent. Nevertheless, it is unknown whether the association between catastrophism and fatigue could, in turn, be conditioned by whether the patients walk or not. Therefore, our goal was to explore the moderating effect of walking on the association between catastrophizing and fatigue in patients with fibromyalgia. A cross-sectional study was carried out with 203 women with fibromyalgia. We used the Multidimensional Fatigue Inventory to assess fatigue and the Pain Catastrophizing Scale to assess pain catastrophizing (differentiating between its three dimensions). An ad hoc item was used to evaluate walking (moderator). Lower scores for fatigue and pain catastrophizing were found among patients who walked versus those who did not. Walking moderated the relationship between rumination and fatigue (Beta = 0.16, t = 1.96, p = 0.049) and between magnification and fatigue (Beta = 0.22, t = 21.83, p = 0.047). Helplessness showed no direct or interaction effect for fatigue. Nevertheless, higher rumination and magnification were associated with higher fatigue only in patients who walked. Therefore, to promote adherence to walking and reduce the effects of catastrophizing on fatigue, it seems necessary to manage rumination and magnification among patients who walk.
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Affiliation(s)
- Lucía Sanromán
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Carmen Écija
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, 12006 Castellón de la Plana, Spain;
| | - Jesús San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, 28922 Alcorcón, Spain;
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
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34
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Ma Q. A functional subdivision within the somatosensory system and its implications for pain research. Neuron 2022; 110:749-769. [PMID: 35016037 PMCID: PMC8897275 DOI: 10.1016/j.neuron.2021.12.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/07/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
Somatosensory afferents are traditionally classified by soma size, myelination, and their response specificity to external and internal stimuli. Here, we propose the functional subdivision of the nociceptive somatosensory system into two branches. The exteroceptive branch detects external threats and drives reflexive-defensive reactions to prevent or limit injury. The interoceptive branch senses the disruption of body integrity, produces tonic pain with strong aversive emotional components, and drives self-caring responses toward to the injured region to reduce suffering. The central thesis behind this functional subdivision comes from a reflection on the dilemma faced by the pain research field, namely, the use of reflexive-defensive behaviors as surrogate assays for interoceptive tonic pain. The interpretation of these assays is now being challenged by the discovery of distinct but interwoven circuits that drive exteroceptive versus interoceptive types of behaviors, with the conflation of these two components contributing partially to the poor translation of therapies from preclinical studies.
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Affiliation(s)
- Qiufu Ma
- Dana-Farber Cancer Institute and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.
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35
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Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain. J Clin Med 2022; 11:jcm11051360. [PMID: 35268453 PMCID: PMC8911417 DOI: 10.3390/jcm11051360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Exposure in vivo (EXP) is an effective treatment to reduce pain-related fear and disability in chronic pain populations. Yet, it remains unclear how reductions in fear and pain relate to each other. This single-case experimental design study attempted to identify patterns in the individual responses to EXP and to unravel temporal trajectories of fear and pain. Daily diaries were completed before, during and after EXP. Multilevel modelling analyses were performed to evaluate the overall effect. Temporal effects were scrutinized by individual regression analyses and determination of the time to reach a minimal clinically important difference. Furthermore, individual graphs were visually inspected for potential patterns. Twenty patients with chronic low back pain and complex regional pain syndrome type I were included. On a group level, both fear and pain were reduced following EXP. Individually, fear was significantly reduced in 65% of the patients, while pain in only 20%. A decrease in fear was seen mostly in the first weeks, while pain levels reduced later or remained unchanged. Daily measurements provided rich data on temporal trajectories of reductions in fear and pain. Overall, reductions in fear preceded pain relief and seemed to be essential to achieve pain reductions.
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36
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Neuroscientific evidence for pain being a classically conditioned response to trauma- and pain-related cues in humans. Pain 2022; 163:2118-2137. [PMID: 35239544 DOI: 10.1097/j.pain.0000000000002621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Psychological trauma is typically accompanied by physical pain, and posttraumatic stress disorder (PTSD) often co-occurs with chronic pain. Clinical reports suggest that pain after trauma may be part of a re-experiencing symptomatology. Classical conditioning can underlie visual re-experiencing since intrusions can occur as conditioned responses (CRs) to trauma-related cues. If individuals also experience pain to cues previously paired with, but not anymore inflicting nociceptive stimulation (CSs), conditioning could also explain re-experiencing of pain. Sixty-five participants underwent classical conditioning, where painful electrocutaneous stimulation and aversive film-clips served as unconditioned stimuli (USs) in a 2(pain/no pain)×2(aversive/neutral film) design. CSs were neutral pictures depicting contextual details from the films. One day later, participants were re-exposed to CSs during a memory-triggering-task (MTT). We assessed pain-CRs by self-report and an fMRI-based marker of nociceptive pain, the neurologic pain signature (NPS); and recorded spontaneous daily-life pain-intrusions with an e-diary. During conditioning, pain-signaling CSs elicited more self-reported-pain and NPS-responses than no-pain-signaling CSs. Possibly because the aversive-film masked differences in participants' responses to pain-signaling vs. no-pain-signaling CSs, pain-CRs during acquisition only emerged within the neutral-film condition. When participants were re-exposed to CSs during MTT, self-reported-pain-CRs during the neutral-film condition and, though more uncertain, NPS-CRs during the aversive-film condition persisted. Importantly, participants with stronger pain-CRs showed a greater probability and severity of experiencing spontaneous pain intrusions during daily-life. Our data support that pain can emerge as a CR with emotional and sensory components. Classical conditioning presents a possible mechanism explaining pain-intrusions, and more broadly, pain experienced without nociceptive input.
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Alba G, Vila J, Miranda JGV, Montoya P, Muñoz MA. Tonic pain reduces autonomic responses and EEG functional connectivity elicited by affective stimuli. Psychophysiology 2022; 59:e14018. [PMID: 35128683 PMCID: PMC9285073 DOI: 10.1111/psyp.14018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/23/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Guzmán Alba
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC‐UGR) Spain
| | - Jaime Vila
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC‐UGR) Spain
| | - José G. V. Miranda
- Institute of Physics, Laboratory of Biosystems Federal University of Bahia Salvador Brazil
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS) University of Balearic Islands Palma Spain
| | - Miguel A. Muñoz
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC‐UGR) Spain
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Krypotos AM, Crombez G, Alves M, Claes N, Vlaeyen JWS. The exploration-exploitation dilemma in pain: an experimental investigation. Pain 2022; 163:e215-e233. [PMID: 34108434 DOI: 10.1097/j.pain.0000000000002352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Daily life consists of a chain of decisions. Typically, individuals may choose to pursue what they already know (exploitation) or to search for other options (exploration). This exploration-exploitation dilemma is a topic of interest across multiple scientific fields. Here we propose that investigating how individuals solve this dilemma may improve our understanding of how individuals make behavioral decisions (eg, avoidance) when facing pain. To this end, we present the data of 3 experiments in which healthy individuals were given the opportunity to choose between 4 different movements, with each movement being associated with different probabilities of receiving a painful outcome only (experiment 1) or pain and/or a reward (experiment 2). We also investigated whether participants stuck to their decisions when the contingencies between each movement and the painful/rewarding outcome changed during the task (experiment 3). The key findings across all experiments are the following: First, after initial exploration, participants most often exploited the safest option. Second, participants weighted rewards more heavily than receiving pain. Finally, after receiving a painful outcome, participants were more inclined to explore than to exploit a rewarding movement. We argue that by focusing more on how individuals in pain solve the exploration-exploitation dilemma is helpful in understanding behavioral decision making in pain.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Department of Clinical Psychology, Utrecht University
| | - Geert Crombez
- Department of Experimental-Clinical and Heath Psychology, Ghent University, Ghent, Belgium
| | - Maryna Alves
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
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Taft TH, Guadagnoli L, Carlson DA, Kou W, Keefer L, Pandolfino J. Validation of the Short-Form Esophageal Hypervigilance and Anxiety Scale. Clin Gastroenterol Hepatol 2022; 20:e64-e73. [PMID: 33348046 PMCID: PMC8275671 DOI: 10.1016/j.cgh.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Esophageal hypervigilance and anxiety are emerging as important drivers of dysphagia symptoms and reduced quality of life across esophageal diagnoses. The esophageal hypervigilance and anxiety scale (EHAS) is a validated measure of these cognitive-affective processes. However, its length may preclude it from use in clinical practice. We aimed to create a short form version of the EHAS using established psychometric practices. METHODS A retrospective review of a registry of patients who visited a university-based esophageal motility clinic for diagnostic testing was conducted. Patients were included if they completed the 15-item EHAS and questionnaires assessing dysphagia severity and health-related quality of life (HRQOL) at the time of motility testing. Principle components factor analysis identified items for possible removal. Tests for reliability and concurrent validity were performed on the full EHAS and short-form version (EHAS-7). RESULTS 3,976 adult patients with confirmed esophageal disease were included: 30% with achalasia or EGJOO, 13% with EoE, 13% with GERD, 39% normal motility. Eight items were removed from the scale based on a factor loading of > 0.70, resulting in a single scale 7-item EHAS-7 scored from 0 to 28. The EHAS-7 demonstrated excellent internal consistency (α = 0.91) and split-half reliability (0.88) as was found in the full EHAS in the current study and prior validation. Concurrent validity existed between the EHAS-7 and measures of dysphagia (r = 0.33) and HRQOL (r = -0.73, both P < .001). CONCLUSIONS The EHAS-7 is a 7-item scale to assess esophageal hypervigilance and symptom-specific anxiety that performs as well as the original 15-item version. Shorter questionnaires allow for implementation in clinical practice. The EHAS-7 is a useful tool for clinicians to quickly assess how hypervigilance and anxiety may be contributing to their patients' clinical presentations.
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Affiliation(s)
- Tiffany H. Taft
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | - Dustin A. Carlson
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Walter Kou
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Laurie Keefer
- Mount Sinai Icahn School of Medicine, New York, NY USA
| | - John Pandolfino
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, Carlisle J, Polisky L, Geuter S, Flood TF, Kragel PA, Dimidjian S, Lumley MA, Wager TD. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:13-23. [PMID: 34586357 PMCID: PMC8482298 DOI: 10.1001/jamapsychiatry.2021.2669] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Chronic back pain (CBP) is a leading cause of disability, and treatment is often ineffective. Approximately 85% of cases are primary CBP, for which peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury. OBJECTIVE To test whether a psychological treatment (pain reprocessing therapy [PRT]) aiming to shift patients' beliefs about the causes and threat value of pain provides substantial and durable pain relief from primary CBP and to investigate treatment mechanisms. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial with longitudinal functional magnetic resonance imaging (fMRI) and 1-year follow-up assessment was conducted in a university research setting from November 2017 to August 2018, with 1-year follow-up completed by November 2019. Clinical and fMRI data were analyzed from January 2019 to August 2020. The study compared PRT with an open-label placebo treatment and with usual care in a community sample. INTERVENTIONS Participants randomized to PRT participated in 1 telehealth session with a physician and 8 psychological treatment sessions over 4 weeks. Treatment aimed to help patients reconceptualize their pain as due to nondangerous brain activity rather than peripheral tissue injury, using a combination of cognitive, somatic, and exposure-based techniques. Participants randomized to placebo received an open-label subcutaneous saline injection in the back; participants randomized to usual care continued their routine, ongoing care. MAIN OUTCOMES AND MEASURES One-week mean back pain intensity score (0 to 10) at posttreatment, pain beliefs, and fMRI measures of evoked pain and resting connectivity. RESULTS At baseline, 151 adults (54% female; mean [SD] age, 41.1 [15.6] years) reported mean (SD) pain of low to moderate severity (mean [SD] pain intensity, 4.10 [1.26] of 10; mean [SD] disability, 23.34 [10.12] of 100) and mean (SD) pain duration of 10.0 (8.9) years. Large group differences in pain were observed at posttreatment, with a mean (SD) pain score of 1.18 (1.24) in the PRT group, 2.84 (1.64) in the placebo group, and 3.13 (1.45) in the usual care group. Hedges g was -1.14 for PRT vs placebo and -1.74 for PRT vs usual care (P < .001). Of 151 total participants, 33 of 50 participants (66%) randomized to PRT were pain-free or nearly pain-free at posttreatment (reporting a pain intensity score of 0 or 1 of 10), compared with 10 of 51 participants (20%) randomized to placebo and 5 of 50 participants (10%) randomized to usual care. Treatment effects were maintained at 1-year follow-up, with a mean (SD) pain score of 1.51 (1.59) in the PRT group, 2.79 (1.78) in the placebo group, and 3.00 (1.77) in the usual care group. Hedges g was -0.70 for PRT vs placebo (P = .001) and -1.05 for PRT vs usual care (P < .001) at 1-year follow-up. Longitudinal fMRI showed (1) reduced responses to evoked back pain in the anterior midcingulate and the anterior prefrontal cortex for PRT vs placebo; (2) reduced responses in the anterior insula for PRT vs usual care; (3) increased resting connectivity from the anterior prefrontal cortex and the anterior insula to the primary somatosensory cortex for PRT vs both control groups; and (4) increased connectivity from the anterior midcingulate to the precuneus for PRT vs usual care. CONCLUSIONS AND RELEVANCE Psychological treatment centered on changing patients' beliefs about the causes and threat value of pain may provide substantial and durable pain relief for people with CBP. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03294148.
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Affiliation(s)
- Yoni K. Ashar
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York,Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder
| | - Alan Gordon
- Pain Psychology Center, Los Angeles, California
| | - Howard Schubiner
- Ascension Providence Hospital, Southfield, Michigan,Michigan State University College of Human Medicine, East Lansing
| | | | - Karen Knight
- Panorama Orthopedics and Spine Center, Golden, Colorado
| | - Zachary Anderson
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder,Department of Psychology, Northwestern University, Evanston, Illinois
| | - Judith Carlisle
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder,Department of Philosophy, Washington University in Saint Louis, Saint Louis, Missouri
| | - Laurie Polisky
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder
| | - Stephan Geuter
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder,Johns Hopkins University Department of Biostatistics, Baltimore, Maryland
| | - Thomas F. Flood
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Philip A. Kragel
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder,Department of Psychology, Emory University, Atlanta, Georgia
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Renée Crown Wellness Institute, University of Colorado, Boulder
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Tor D. Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder,Institute of Cognitive Science, University of Colorado, Boulder,Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
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Labrenz F, Woud ML, Elsenbruch S, Icenhour A. The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine. Front Psychiatry 2022; 13:841734. [PMID: 35250678 PMCID: PMC8894646 DOI: 10.3389/fpsyt.2022.841734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022] Open
Abstract
Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.
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Affiliation(s)
- Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.,Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
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López-Roig S, Peñacoba C, Martínez-Zaragoza F, Abad E, Catalá P, Suso-Ribera C, Pastor-Mira MÁ. The Activity Patterns Scale: An Analysis of its Construct Validity in Women With Fibromyalgia. Clin J Pain 2021; 37:887-897. [PMID: 34483231 DOI: 10.1097/ajp.0000000000000980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. MATERIALS AND METHODS The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. RESULTS A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). DISCUSSION Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.
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Affiliation(s)
- Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche
| | | | | | - Esther Abad
- Fibromyalgia Unit, Hospital of San Vicente del Raspeig, Alicante
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I, University, Castellon, Spain
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Kloos T, van Vliet C, Riecke J, Meulders A. Indoor or outdoor? Generalization of costly pain-related avoidance behavior to conceptually related contexts. THE JOURNAL OF PAIN 2021; 23:657-668. [PMID: 34793960 DOI: 10.1016/j.jpain.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022]
Abstract
When pain persists beyond healing time and becomes a "false alarm" of bodily threat, protective strategies, such as avoidance, are no longer adaptive. More specifically, generalization of avoidance based on conceptual knowledge may contribute to chronic pain disability. Using an operant robotic-arm avoidance paradigm, healthy participants (N=50), could perform more effortful movements in the threat context (e.g. pictures of outdoor scenes) to avoid painful stimuli, whereas no pain occured in the safe context (e.g. pictures of indoor scenes). Next, we investigated avoidance generalization to conceptually related contexts (i.e. novel outdoor/indoor scenes). As expected, participants avoided more when presented with novel contexts conceptually related to the threat context than in novel exemplars of the safe context. Yet, exemplars belonging to one category (outdoor/indoor scenes) were not interchangeable; there was a generalization decrement. Posthoc analyses revealed that contingency-aware participants (n=27), but not non-aware participants (n=23), showed the avoidance generalization effect and also generalized their differential pain-expectancy and pain-related fear more to novel background scenes conceptually related to the original threat context. In contrast, the fear-potentiated startle response was not modulated by context.
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Affiliation(s)
- Tabea Kloos
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Christine van Vliet
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Jenny Riecke
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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Batho A, Kneale D, Sutcliffe K, Williams ACDC. Sufficient conditions for effective psychological treatment of chronic pain: a qualitative comparative analysis. Pain 2021; 162:2472-2485. [PMID: 34534175 DOI: 10.1097/j.pain.0000000000002242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain (CP) is the leading cause of years lived with disability globally. Treatment within Western medicine is often multicomponent; the psychological element of treatment varies, yet the optimal conditions for effective reduction of pain-related outcomes remain unclear. This study used qualitative comparative analysis, a relatively new form of evidence synthesis in the field based on set theory to ascertain configurations of intervention components and processes of psychological treatment of chronic pain in adults that lead to more effective interventions. Data were extracted from 38 studies identified in a concurrent Cochrane review and were then subjected to qualitative comparative analysis. Two analyses were conducted: one to examine what is most effective for reducing disability and one to examine what is most effective for reducing distress. Analysis and comparison of the 10 treatments with best outcomes with the 10 treatments with poorest outcomes showed that interventions using graded exposure, graded exercise or behavioural rehearsal (exposure/activity), and interventions aiming to modify reinforcement contingencies (social/operant) reduced disability levels when either approach was applied but not both. Exposure/activity can improve distress levels when combined with cognitive restructuring, as long as social/operant methods are not included in treatment. Clinical implications of this study suggest that treatment components should not be assumed to be synergistic and provided in a single package.
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Affiliation(s)
- Anna Batho
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Dylan Kneale
- IOE-Social Research Institute UCL Institute of Education, University College London, London, United Kingdom
| | - Katy Sutcliffe
- IOE-Social Research Institute UCL Institute of Education, University College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
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Catala P, Suso-Ribera C, Gutierrez L, Perez S, Lopez-Roig S, Peñacoba C. Is Thought Management a Resource for Functioning in Women with Fibromyalgia Irrespective of Pain Levels? PAIN MEDICINE 2021; 22:1827-1836. [PMID: 33595650 DOI: 10.1093/pm/pnab073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by patients with fibromyalgia across different levels of pain severity (i.e., moderation). METHODS The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (standard deviation = 8.94; range = 30 to 78 years). RESULTS Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all P < 0.001). A moderation effect was also found in the relationship between cognitive fusion and fibromyalgia impact on functioning (B = -0.12, t = -2.42, P = 0.016, 95% confidence interval: -0.22 to -0.02) and between magnification and fibromyalgia impact (B = -0.37, t = -2.21, P = 0.028, 95% confidence interval: -0.69 to -0.04). This moderation was not observed for rumination and helplessness. CONCLUSIONS The results suggest that in interventions to improve functioning in people with fibromyalgia, some maladaptive forms of thought management (i.e., cognitive fusion and magnification) preferably should be challenged at milder levels of pain severity. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity; therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions in patients with fibromyalgia experiencing more severe pain levels.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Lorena Gutierrez
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Soledad Perez
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Sofia Lopez-Roig
- Department of Behavioral Sciences and Health, Miguel Hernandez University, Alicante, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
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Zale EL, Powers JM, Ditre JW. Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain. Alcohol Res 2021; 41:08. [PMID: 34306903 PMCID: PMC8289456 DOI: 10.35946/arcr.v41.1.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.
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Affiliation(s)
- Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York
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47
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Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet 2021; 398:78-92. [PMID: 34115979 DOI: 10.1016/s0140-6736(21)00733-9] [Citation(s) in RCA: 383] [Impact Index Per Article: 127.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/23/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. The biopsychosocial model posits low back pain to be a dynamic interaction between social, psychological, and biological factors that can both predispose to and result from injury, and should be considered when devising interdisciplinary treatment plans. Prevention of low back pain is recognised as a pivotal challenge in high-risk populations to help tackle high health-care costs related to therapy and rehabilitation. To a large extent, therapy depends on pain classification, and usually starts with self-care and pharmacotherapy in combination with non-pharmacological methods, such as physical therapies and psychological treatments in appropriate patients. For refractory low back pain, a wide range of non-surgical (eg, epidural steroid injections and spinal cord stimulation for neuropathic pain, and radiofrequency ablation and intra-articular steroid injections for mechanical pain) and surgical (eg, decompression for neuropathic pain, disc replacement, and fusion for mechanical causes) treatment options are available in carefully selected patients. Most treatment options address only single, solitary causes and given the complex nature of low back pain, a multimodal interdisciplinary approach is necessary. Although globally recognised as an important health and socioeconomic challenge with an expected increase in prevalence, low back pain continues to have tremendous potential for improvement in both diagnostic and therapeutic aspects. Future research on low back pain should focus on improving the accuracy and objectivity of diagnostic assessments, and devising treatment algorithms that consider unique biological, psychological, and social factors. High-quality comparative-effectiveness and randomised controlled trials with longer follow-up periods that aim to establish the efficacy and cost-effectiveness of low back pain management are warranted.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Research Group Experimental Health Psychology, Maastricht University, Maastricht, Netherlands; TRACE Center for Translational Health Research, KU, Leuven-Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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48
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Flink IK, Reme S, Jacobsen HB, Glombiewski J, Vlaeyen JWS, Nicholas MK, Main CJ, Peters M, Williams ACDC, Schrooten MGS, Shaw W, Boersma K. Pain psychology in the 21st century: lessons learned and moving forward. Scand J Pain 2021; 20:229-238. [PMID: 32242835 DOI: 10.1515/sjpain-2019-0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/13/2020] [Indexed: 01/10/2023]
Abstract
Background and aims In the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled "Pain in the 21st century: Where do we come from and where are we going?", which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century. Methods Several collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology. Results The topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health. Conclusions There have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context. Implications Professor Steven J. Linton has been at the forefront of pain psychology research during the last decades, and inspired by his work this journey will continue into the 21st century, with the ultimate goal of enhancing the understanding and treatment for all people suffering from persistent and disabling pain.
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Affiliation(s)
- Ida K Flink
- The Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Silje Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Julia Glombiewski
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz Landau, Mainz, Germany
| | - Johan W S Vlaeyen
- Health Psychology Research Group, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Michael K Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Chris J Main
- Research Institute for Primary Care Sciences, Keele University, Keele, Staffordshire, UK
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martien G S Schrooten
- The Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - William Shaw
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Katja Boersma
- The Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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49
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Reed B, Rea KE, Claar RL, van Tilburg MAL, Levy RL. Passive Coping Associations With Self-Esteem and Health-Related Quality of Life in Youth With Inflammatory Bowel Disease. Front Psychol 2021; 12:670902. [PMID: 34248766 PMCID: PMC8263929 DOI: 10.3389/fpsyg.2021.670902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Pediatric patients with inflammatory bowel disease (IBD) may experience chronic stress related to disease symptoms and treatment, with negative consequences to their health-related quality of life (HRQOL). Lower HRQOL among pediatric patients with IBD has been associated with worse disease-related symptoms and psychological functioning, while higher HRQOL has been associated with more adaptive coping with disease symptoms and treatment. In addition, patients’ self-esteem may impact the selection and use of coping strategies through global cognitions about their abilities and perceived competence. The current study seeks to extend existing research on HRQOL in youth with IBD by examining cross-sectional associations among self-esteem and passive coping strategies. Youth ages 9–18 with IBD (n = 147) rated their HRQOL using a disease-specific measure, typical strategies used to cope with pain or GI symptoms, and their general self-esteem. Mediation analyses were performed using regression-based techniques and bootstrapping. Results indicated that greater self-esteem was positively associated with HRQOL but negatively associated with passive coping. Controlling for disease activity, age, and gender, significant indirect effects were found in the relation between self-esteem and HRQOL through passive coping. Multiple mediation analyses using the three passive coping subscales found that self-esteem was indirectly associated with HRQOL through its effects specifically on catastrophizing as a passive coping strategy. Results suggest that pediatric patients’ general self-esteem can impact their HRQOL through passive coping and specifically, maladaptive cognitions (e.g., catastrophizing). Interventions aimed at addressing both self-esteem and catastrophizing as a passive coping strategy may offer promise for improving HRQOL in youth with IBD.
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Affiliation(s)
- Bonney Reed
- Department of Pediatrics, Emory & Children's Pediatric Institute, Atlanta, GA, United States
| | - Kelly E Rea
- Department of Psychology, University of Georgia, Athens, GA, United States
| | - Robyn Lewis Claar
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Miranda A L van Tilburg
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States
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50
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Timmers I, van de Ven VG, Vlaeyen JW, Smeets RJ, Verbunt JA, de Jong JR, Kaas AL. Corticolimbic Circuitry in Chronic Pain Tracks Pain Intensity Relief Following Exposure In Vivo. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:28-36. [PMID: 36324433 PMCID: PMC9616294 DOI: 10.1016/j.bpsgos.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Background A subset of patients with chronic pain who receive exposure in vivo (EXP) treatment experience clinically relevant relief of pain intensity. Although pain relief is not an explicit therapeutic target, it is important to understand how and why this concomitant effect occurs in some patients but not others. This longitudinal study therefore aimed to characterize brain plasticity as well as to explore pretreatment factors related to pain relief. Methods Resting-state functional magnetic resonance imaging data were acquired in 30 patients with chronic pain. Twenty-three patients completed EXP, and 6-month follow-up data were available in 20 patients (magnetic resonance imaging data in 17 patients). Pain-free control data were acquired at two time points (n = 29, n = 21). Seed-based resting-state functional connectivity (rsFC) analyses were performed, with seeds in the amygdala, hippocampus, and nucleus accumbens. Results Pain relief after EXP was highly variable, with 60% of patients reporting a clinically relevant improvement. Amygdala rsFC with the middle frontal gyrus decreased significantly over time in patients but was not associated with pain relief. In contrast, greater pain relief was associated with greater decreases over time in hippocampus rsFC with the precuneus, which was related to reductions in catastrophizing (EXP therapeutic target) as well. Greater pain relief was also associated with lower pretreatment rsFC between nucleus accumbens and postcentral gyrus. Conclusions While changes in hippocampus rsFC were associated with pain relief after EXP, pretreatment nucleus accumbens rsFC showed potential prognostic value. Our findings further support the importance of corticolimbic circuitry in chronic pain, emphasizing its relation to pain relief and identifying potential underlying mechanisms and prognostic factors, warranting further testing in independent samples.
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