Do FIQR Severity Categories and Symptoms, Differentiate Between Continuous, Intermittent and Non-Opioid Users in the Treatment of Fibromyalgia?

BACKGROUND

Many fibromyalgia patients utilize opioids to treat symptoms. It is important to better understand nuances regarding this treatment option and any stigma associated with this treatment modality.

AIM

This study: (1) assessed the prevalence of opioid use among continuous, intermittent, and non-opioid users in fibromyalgia patients; (2) determined whether the Revised Fibromyalgia Impact Questionnaire (FIQR) was useful in distinguishing opioid use and symptom burden; and (3) assessed whether fibromyalgia patients encountered stigma and/or invalidation.

DESIGN

A cross-sectional, observational study of 1,105 participants' responses to validated fibromyalgia and invalidation scales and demographic questions.

METHODS

The study employed online survey methodology.

RESULTS

A total of 45% of patients reported utilizing opioids (27% continuous, 18% intermittent, 55% non-users). FIQR disease categories (mild to most severe) strongly distinguished between opioid and non-opioid users with 59% of users falling in the most severe category and 68% of non-users falling in mild disease category (p < .0001). Interestingly, intermittent users were similar to non-users on FIQR severity (65.9 versus 65.7; p <0.60, 0-100) while continuous users reported greater severity than the former (73.9, p < .0001). Continuous users particularly reported more problems with daily activities (p < .0001), being overwhelmed (p < .0001), and being unable to accomplish goals (p < .0001). Stigma related to being 'drug seeking' and being 'judged'. Invalidation was infrequent.

CONCLUSIONS

Opioid use is common in fibromyalgia and increases monotonically with FIQR severity. Multidisciplinary approaches which help patients perform daily activities, decrease feelings of overwhelm, accomplish goals, and reduce stigma may be beneficial.

Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain

Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.

Experiences of communication in women with endometriosis: perceived validation and invalidation in different contexts, and associations with health-related quality of life

Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis.

Social Verification Theory: A New Way to Conceptualize Validation, Dissonance, and Belonging

ACADEMIC ABSTRACT

In the present review, we propose a theory that seeks to recontextualize various existing theories as functions of people's perceptions of their consistency with those around them. This theory posits that people seek social consistency for both epistemic and relational needs and that social inconsistency is both negative and aversive, similar to the experience of cognitive dissonance. We further posit that the aversive nature of perceiving social inconsistency leads people to engage in various behaviors to mitigate or avoid these inconsistencies. When these behaviors fail, however, people experience chronic social inconsistency, which, much like chronic rejection, is associated with physical and mental health and well-being outcomes. Finally, we describe how mitigation and avoidance of social inconsistency underlie many seemingly unrelated theories, and we provide directions for how future research may expand on this theory.

PUBLIC ABSTRACT

In the present review, we propose that people find inconsistency with those around them to be an unpleasant experience, as it threatens people's core need to belong. Because the threat of reduced belongingness evokes negative feelings, people are motivated to avoid inconsistency with others and to mitigate the negative feelings that are produced when it inevitably does arise. We outline several types of behaviors that can be implemented to avoid or mitigate these inconsistencies (e.g., validation, affirmation, distancing, etc.). When these behaviors cannot be implemented successfully, people experience chronic invalidation, which is associated with reduced physical and mental health and well-being outcomes. We discuss how invalidation may disproportionately affect individuals with minoritized identities. Furthermore, we discuss how belongingness could play a key role in radicalization into extremist groups.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Defining pain-validation: The importance of validation in reducing the stresses of chronic pain

Purpose

To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain.

Methods

The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context.

Results

We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity.

Implications

The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.

Facing Invalidation: A Further Challenge when Living with Chronic Widespread Pain

OBJECTIVE

The concept of "invalidation" refers to the patient's perception that the social environment does not recognize their medical condition. This study explores and describes invalidation experiences among Swedish patients with chronic widespread pain with regard to sociodemographic and pain characteristics, impact of pain, self-reported health, and symptoms of anxiety and depressive.

METHODS

A cross-sectional design using questionnaires, including sociodemographic and pain variables, the Illness Invalidation Inventory (Likert scale items regarding 5 sources), the Hospital Anxiety and Depression Scale, and the Short-Form General Health Survey. Descriptive and univariate analyses were applied.

RESULTS

Of the 152 respondents, 91% were women. Swedish patients with chronic widespread pain experienced invalidation to a large extent from all sources. The highest scores for invalidation were reported from contacts with social services (68%), and the lowest from spouses (30%). Being younger (p < 0.006), having periodic pain (p = 0.011), and having had more frequent visits to a doctor in the previous year (p = 0.007) were characteristics associated with higher invalidation scores. Experiences of invalidation were associated with worse selfreported mental health scores (r = -0.29 to -0.46).

CONCLUSION

Since patients with chronic widespread pain frequently experience invalidation from the social environment, this further challenge in daily life must be taken into consideration in pain management within multimodal pain rehabilitation.

Alternatives to Laboratory Animals: Trends in Replacement and the Three Rs

The significance of contributions in volumes 11-46 (1983 to 2018) of Alternatives to Laboratory Animals in relation to the reduction, refinement and replacement of animal experimentation in biomedical research and testing is reviewed and discussed by the journal's former editor-in-chief, with particular emphasis on the development and production of the journal itself, FRAME, the European Centre for the Validation of Alternative Methods and other organisations. The role of the journal in promoting the principles of humane research (as spelled out by William Russell and Rex Burch) and highlighting a range of important issues and focus topics is explored. These include: botulinum toxin potency testing; ethical issues; the use of human volunteers, and human cells and tissues; the use of non-human primates (especially chimpanzees) and dogs as laboratory animals; toxicity testing in relation to cosmetics, pharmaceuticals and chemicals; UK and EU politics and legislation; and test validation and invalidation. The review concludes by identifying some of the issues that still need to be discussed and some of the questions that urgently need to be addressed.

Invalidation in fibromyalgia and rheumatoid arthritis and its effect on quality of life in Indian patients

AIM

Fibromyalgia (FM) and rheumatoid arthritis (RA) patients face invalidation in the form of "discounting" and "lack of understanding". Invalidation can have effects on the quality of life (QoL) in these patients. We planned this study to look for invalidation in FM and RA Indian patients and see the correlation between invalidation and QoL.

METHODS

Invalidation was measured by the Illness Invalidation Inventory (3*I) to look for "discounting" and "lack of understanding" across sources, that is, spouse, family, medical professionals, work environment. QoL was measured using the World Health Organization QoL-BREF (WHOQoL). It covers mental, physical, psychological, and environmental domains.

RESULTS

Fifty-five FM and 102 RA patients were included in the study. Compared to RA, FM patients had significantly higher discounting by spouse, family and medical professionals (P < .001). FM patients suffered more lack of understanding from spouse and medical professionals as compared to RA patients (P < .001). In RA patients discounting by spouse had weak to moderate negative correlation with psychological, social and environmental domains of WHOQoL (r -.26 to -.48). Lack of understanding by spouse had moderate negative correlation with all the domains of WHOQoL (r -.30 to -.40) and a weak correlation with disease duration (r .23) in RA. In FM discounting by spouse and medical professionals had weak to moderate negative correlation with the physical health domain of WHOQoL (r -.26 to -.30).

CONCLUSION

FM patients faced more invalidation as compared to RA patients. Invalidation from spouse leads to poor QoL in RA and FM patients.

Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.

Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders

OBJECTIVES

Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI.

METHOD

The sample included 171 outpatients (94.2% female; M_age  = 28.78, SD_age  = 11.19).

RESULTS

Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year.

CONCLUSIONS

Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.

Invalidation of chronic pain: a thematic analysis of pain narratives

PURPOSE

Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain.

METHOD

A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain.

FINDINGS

Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation.

CONCLUSION

Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.

Solicitous and invalidating responses are associated with health-care visits in fibromyalgia

Objectives

Health-care use in FM is substantial. Besides the severity of the disease and psychological factors, previous research suggests that the social environment can influence patients’ health-care use. In this study, we describe health-care use in patients with FM and investigate the relationship of social responses of the partner and family with health-care use.

Methods

Cross-sectional data of 280 patients with FM were analysed. Sociodemographic variables, health-status variables, health-care use, partner’s solicitous and punishing responses, and invalidation (i.e. discounting and lack of understanding) by family were assessed. Heath-care use was defined as the number of visits to physicians and health professionals. Associations of independent variables with health-care use were examined using univariate and hierarchical regression analyses.

Results

In the preceding 6 months, 99% of the patients visited at least one physician and 66% visited at least one health professional. The mean (s.d.) total health-care visits and the number of different disciplines consulted were 18.5 (17.7) and 3.6 (1.7), respectively. Being female, paid employment, having a co-morbid condition, a higher severity of FM, more partner’s solicitous responses and more invalidating responses by family were univariately associated with visits to a physician. Having a co-morbid condition, severity of FM and invalidation by family were uniquely associated with visits to a physician. No other associations were found.

Conclusion

Therapeutic attention to patients’ close social environment might be a useful approach to improve health-related outcomes, including health-care use, in patients with FM.

The Perceived Invalidation of Emotion Scale (PIES): Development and psychometric properties of a novel measure of current emotion invalidation

Emotion invalidation is theoretically and empirically associated with mental and physical health problems. However, existing measures of invalidation focus on past (e.g., childhood) invalidation and/or do not specifically emphasize invalidation of emotion. In this article, the authors articulate a clarified operational definition of emotion invalidation and use that definition as the foundation for development of a new measure of current perceived emotion invalidation across a series of five studies. Study 1 was a qualitative investigation of people's experiences with emotional invalidation from which we generated items. An initial item pool was vetted by expert reviewers in Study 2 and examined via exploratory factor analysis in Study 3 within both college student and online samples. The scale was reduced to 10 items via confirmatory factor analysis in Study 4, resulting in a brief but psychometrically promising measure, the Perceived Invalidation of Emotion Scale (PIES). A short-term longitudinal investigation (Study 5) revealed that PIES scores had strong test-retest reliability, and that greater perceived emotion invalidation was associated with greater emotion dysregulation, borderline features and symptoms of emotional distress. In addition, the PIES predicted changes in relational health and psychological health over a 1-month period. The current set of studies thus presents a psychometrically promising and practical measure of perceived emotion invalidation that can provide a foundation for future research in this burgeoning area. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Emotional, cognitive and behavioral reactions to paranoid symptoms in clinical and nonclinical populations

Background: Paranoia is a disruptive belief that can vary across a continuum, ranging from persecutory delusions presented in clinical settings to paranoid cognitions that are highly prevalent in the general population. The literature suggests that paranoid thoughts derive from the activation of a paranoid schema or information processing biases that can be sensitive to socially ambiguous stimuli and influence the processing of threatening situations. Method: Four groups (Schizophrenic participants in active psychotic phases, n=6; stable participants in remission, n=30; participants' relatives, n=32; and healthy controls, n=64) were assessed with self-report questionnaires to determine how the reactions to paranoia of clinical patients differ from healthy individuals. Cognitive, emotional and behavioral dimensions of their reactions to these paranoid thoughts were examined. Results: Paranoid individuals were present in all groups. Most participants referred the rejection by others as an important trigger of paranoid ideations, while active psychotic were unable to identify triggering situations to their thoughts and reactions. This may be determinant to the different reactions and the different degree of invalidation caused by paranoid thoughts observed across groups. Conclusion: Clinical and non-clinical expressions of paranoid ideations differ in terms of their cognitive, emotional and behavioral components. It is suggested that, in socially ambiguous situations, paranoid participants (presenting lower thresholds of paranoid schema activation) lose the opportunity to disconfirm their paranoid beliefs by resourcing to more maladaptive coping strategies. Consequently, by dwelling on these thoughts, the amount of time spent thinking about their condition and the disability related to the disease increases.