Towards a science and practice of resilience in the face of pain

The primary objective of this paper is to discuss how a resilience approach to (chronic) pain may advance our current understanding of (mal)adaptation to pain. Different resilience perspectives are described, and future challenges for research, prevention and treatment of (chronic) pain are discussed. Literature searches were performed in Web of Science and PubMed to identify relevant literature on risk and resilience in the context of pain. Resilience can be best defined as the ability to restore and sustain living a fulfilling life in the presence of pain. The Psychological Flexibility Model, the Broaden-and-Build Theory, and Self-Determination Theory are described as theories that may provide insight into resilience within the context of (chronic) pain. We describe how a resilience paradigm shifts the outcomes to pursue in pain research and intervention and argue the need for including positive outcomes in addition to negative outcomes. Psychological flexibility, positive affect and basic psychological needs satisfaction are described as potentially important resilience mechanisms with the potential to target both sustainability and recovery from pain. A resilience approach to chronic pain may have important implications for the prevention and treatment of chronic pain problems, as it may give specific indications on how to empower patients to continue living a fulfilling life (in the presence of pain).

SIGNIFICANCE

The resilience approach put forward in this review spotlights sustainability of positive outcomes (e.g. engagement in meaningful activities) in the presence of pain as an outcome to pursue beyond recovery of negative outcomes. We illuminate the evidence-base and practical application of promising resilience mechanisms (positive emotions, psychological flexibility, needs satisfaction). For this article, a commentary is available at the Wiley Online Library.

Vicarious pain while observing another in pain: an experimental approach

Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer's characteristics such as hypervigilance for pain and dispositional empathy.

Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous) stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI) upon vicarious pain errors.

Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not.

Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence.

Child's and parents' catastrophizing about pain is associated with procedural fear in children: a study in children with diabetes and their mothers

The contribution of the child's and parents' catastrophizing about pain was explored in explaining procedural pain and fear in children. Procedural fear and pain were investigated in 44 children with Type I diabetes undergoing a finger prick. The relationships between parents' catastrophizing and parents' own fear and estimates of their child's pain were also investigated. The children and their mothers completed questionnaires prior to a routine consultation with the diabetes physician. Children completed a situation-specific measure of the Pain Catastrophizing Scale for Children (PCS-C) and provided ratings of their experienced pain and fear on a 0-10 numerical rating scale (NRS). Parents completed a situation-specific measure of the Pain Catastrophizing Scale For Parents (PCS-P) d provided estimates of their child's pain and their own experienced fear on a 0-10 NRS. Analyses indicated that higher catastrophizing by children was associated with more fear and pain during the finger prick. Scores for parents' catastrophzing about their children's pain were positively related to parents' scores for their own fear, estimates of their children's pain, and child-reported fear, but not the amount of pain reported by the child. The findings attest to the importance of assessing for and targeting child and parents' catastrophizing about pain. Addressing catastrophizing and related fears and concerns of both parents and children may be necessary to assure appropriate self-management. Further investigation of the mechanisms relating catastrophizing to deleterious outcomes is warranted.

The impact of parental gender, catastrophizing and situational threat upon parental behaviour to child pain: a vignette study

BACKGROUND

This study examined which parents report to be solicitous or discouraging in response to their child's pain, and when they do so.

METHODS

Using a vignette methodology, mothers (n = 472) and fathers (n = 271) imagined their child in pain situations varying in duration (1 day or several weeks) and cause of pain (known or unknown biomedical cause).

RESULTS

In general, fathers demonstrated similar tendencies toward solicitousness than mothers, but reported to engage more in discouraging behaviours. In line with expectations, parents who catastrophized about their child's pain reported a higher inclination to engage in solicitous behaviours. Only for fathers, high catastrophizing was also related to a higher report of discouraging behaviours. However, the effects of catastrophizing differed across situations varying in duration and cause of pain. Specifically, the effect of parental catastrophizing upon self-reported solicitous behaviours was particularly strong when imagining their child in pain with unknown biomedical cause. Further, high catastrophizing in fathers only translated in a higher inclination for discouraging responses when imagining their child in pain of short duration.

CONCLUSIONS

The findings of the current study highlight the importance of parental catastrophizing in explaining parental behavioural tendencies in response to their child in pain. Further, reported behaviours were found to vary across pain situations, attesting to the importance of studying parental behaviour 'in context'.

Expressive dimensions of pain catastrophizing: An observational study in adolescents with chronic pain

Investigated was the relationship between pain catastrophizing and pain intensity in adolescents suffering from chronic pain (n = 38) and the extent to which they expressed communicative pain and pain-related protective behaviours. Adolescents were observed on video performing a 2-Min Walk Test (2MWT). Behaviours were coded on videotape. The adolescents' verbalizations about the 2MWT were also rated by their parents. Analyses revealed that higher levels of catastrophic thinking about pain were associated with higher levels of facial pain expressions and verbalizations about their pain experience, beyond the effects of age, gender, pain duration and pain intensity. Pain-related protective behaviours did not vary with the adolescents' level of pain catastrophizing, but varied with pain intensity. The findings corroborate the functional distinctiveness of different types of pain behaviours. The results are discussed in terms of the processes linking (1) catastrophizing to communicative pain behaviours and (2) pain to pain-related protective behaviours.

The relationship between high catastrophizing children's facial display of pain and parental judgment of their child's pain

The present study investigated the effect of the child's pain catastrophizing and self-reported pain upon the child's facial expression of pain and parental inferences of their child's pain. School children (n=62) experienced pain by taking part in a cold water procedure. Analyses revealed that more intense pain was associated with higher levels of facial pain expression in children who reported a low frequency of catastrophizing. In children with high pain catastrophizing, this relationship was not significant. A similar pattern was obtained for the pain inferences by the parent: pain intensity as reported by the child was positively related to pain inferences by the parent in children who reported a low frequency of catastrophizing, but such relationship was not significant for children with high catastrophizers. Further analyses revealed that when pain intensity was low, parents of high catastrophizing children judged the pain of their child to be higher than parents of low catastrophizing children. The implications of the findings are discussed in terms of the importance of assessing different dimensions of pain encoded in expression, different types of pain expression, and its differential effects upon others.

Catastrophizing about their children's pain is related to higher parent-child congruency in pain ratings: an experimental investigation

Little is known about the variables that account for why parents underestimate the pain of their child. In the present experiment, the joint impact of parental catastrophizing about their child's pain and children's facial pain expressions was examined upon pain estimates of their child undergoing a pressure pain test. In line with previous research, parents underestimated their children's pain. Interestingly, it was found that pain was estimated as higher when the child showed more facial pain expressions and when parents catastrophized more about their child's pain. An intriguing finding was that catastrophizing about their child's pain was related to less parent-child incongruence in pain ratings. The discussion addresses the possible functions of catastrophizing of parents about their children's pain, and delineates avenues for future research.

The effects of parental presence upon the facial expression of pain: the moderating role of child pain catastrophizing

This experiment investigated the effects of child catastrophic thinking and parental presence on the facial expressions of children when experiencing pain. School children experienced pressure pain in either one of two conditions: (1) when observed by a parent (n=53 children and their parent), or (2) when observed by an adult stranger (n=31 children). Analyses revealed that children showed more facial pain expression in the presence of their parent than in the presence of the stranger. This effect was, however, only found for children with infrequent catastrophic thoughts about pain. Children who have frequent catastrophic thoughts expressed high pain regardless of who they believed was observing them. Results are discussed in terms of the social consequences of pain catastrophizing, and the variables contributing to the expression or suppression of pain display in children and its impact upon others.

Expressive dimensions of pain catastrophizing: a comparative analysis of school children and children with clinical pain

We investigated the role of the child's pain catastrophizing in explaining (1) children's self-reported tendency to verbally share their pain experience with others and (2) different dimensions of pain expression, as described by the mother and the father, including non-verbal and verbal communicative pain behaviour and protective pain behaviour. Participants were school children, children with chronic or recurrent pain, and their parents. The results showed that: (1) Pain catastrophizing was associated with children's greater self-acknowledged tendency to verbally share their pain experience with others. (2) Mothers and fathers perceived highly catastrophizing children to be more communicative about their pain. (3) The role of pain catastrophizing in the child's verbal sharing of pain experiences and in explaining expressive behaviour as rated by parents did not differ between the school children and children with recurrent and chronic pain. (4) Nevertheless, findings indicated marked differences between school children and the clinical sample. Children of the clinical sample experienced more severe pain, more pain catastrophizing, more protective pain behaviour, but less verbal communications about their pain. These results further corroborate the position that catastrophic thoughts about pain have interpersonal consequences. Findings are discussed in terms of the possible functions and effects upon others of pain catastrophizing and associated categories of pain behaviour.

A randomized open study to assess the efficacy and tolerability of dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Cambodia

OBJECTIVES

To compare the efficacy and tolerability of dihydroartemisinin-piperaquine (DHA-PQP) with that of a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.

METHOD

Randomized open-label non-inferiority study over 64 days.

RESULTS

Four hundred and sixty-four patients were included in the study. The polymerase chain reaction genotyping-adjusted cure rates on day 63 were 97.5% (95% confidence interval, CI, 93.8-99.3) for DHA-PQP and 97.5% (95% CI, 93.8-99.3) for MAS3, P = 1. There were no serious adverse events, but significantly more episodes of vomiting (P = 0.03), dizziness (P = 0.002), palpitations (P = 0.04), and sleep disorders (P = 0.03) reported in the MAS3 treatment group, consistent with the side-effect profile of mefloquine.

CONCLUSIONS

DHA-PQP was as efficacious as MAS3, but much better tolerated, making it more appropriate for use in a routine programme setting. This highly efficacious, safe and more affordable fixed-dose combination could become the treatment of choice for Plasmodium falciparum malaria in Cambodia.

Fear of movement/injury in the general population: factor structure and psychometric properties of an adapted version of the Tampa Scale for Kinesiophobia

In recent years, several studies have pointed out the importance of pain-related fear in the development and maintenance of chronic pain. An important instrument for measuring pain-related fear in the context of low back pain is the Tampa Scale for Kinesiophobia (TSK). Recently, a version of this questionnaire has been developed for administration among the general population (TSK-G). To determine the factor structure of the TSK-G, data from a random sample of the Dutch general population were studied separately for people who had had back complaints in the previous year, and people who had been without back complaints. For both groups the TSK-G appeared to consist of one, internally consistent, factor of 12 items. The one-factor TSK-G also appeared valid after comparison with scores on measures of catastrophizing and general health status.

The Effects of Catastrophic Thinking about Pain on Attentional Interference by Pain: No Mediation of Negative Affectivity in Healthy Volunteers and in Patients with Low Back Pain

BACKGROUND:Previous studies have shown that catastrophic thinking about pain enhances attentional interference in healthy volunteers.

OBJECTIVE:To investigate whether the attentional effects of pain catastrophizing can be accounted for by the more general predisposition of negative affectivity.

METHODS:Sixty-seven pain-free students participated in the first experiment, and 33 patients with chronic low back pain participated in the second experiment. In both experiments, participants performed an auditory reaction time task while being exposed to a series of threatening electrocutaneous stimuli. Retardation in reaction times to auditory probes during pain was taken as an index of the attentional interruption by pain. Participants also completed self-report instruments of negative affectivity and pain catastrophizing.

RESULTS:In both experiments, pain catastrophizing enhanced attentional interference by pain. This effect was most pronounced immediately after the onset of the electrocutaneous stimulus. The effect remained after controlling for the effects of negative affectivity.

CONCLUSIONS:Catastrophic thinking about pain enhances attentional interruption by pain in normal samples, as well as in clinical samples of patients with chronic back pain. This effect is specific to pain catastrophizing and cannot be explained by the more general disposition of negative affectivity.

Identifying malaria control issues: a district hospital-based evaluation

Chuk district hospital is centrally located in a rural malarious region in southern Cambodia. It was the site of a hospital-based evaluation (KAP assessment and in vivo i.v. quinine/oral tetracycline drug study) done to identify relevant issues for establishing a rational malaria control strategy. The KAP assessment identified the young, male forest worker as the highest risk group. Of 112 study patients, 73% were male and 82% reported various forest activities. The primary reason found for patient delay (8.9 days) in seeking hospital care was self-treatment at home (N = 102, 91%) with drugs purchased through private sellers (104/105). Using the 7-day WHO field test methodology, resistance rates were calculated (N = 22); S1/R1, 73%; R1, 9%; R2, 0%; R3, 18%. A modified version of the 7-day test was used to calculate its utility in this particular rural setting. It showed a negative predictive value of 93% and a positive predictive value of 71%. The case fatality rate for the study period was 2.7%. Information from this study, which correlates a confirmed malaria diagnosis with prior patient behavior and response to anti-malarial therapy, is intended for realizing the goals set forth by the national malaria control program.