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Czub M, Serrano-Ibáñez ER, Piskorz J, Esteve R, Lydon HK, López-Martínez AE, Mullen B, Ramírez-Maestre C, Heary C, O'Neill C, Sainero G, Ruiz Escalera JF, Caes L, Morales Murcia S, McDarby V, McGuire BE. Virtual Reality Distraction for Needle-Related Pain and Distress in Children: A Multicenter Randomized Controlled Trial. Cyberpsychol Behav Soc Netw 2024. [PMID: 38624238 DOI: 10.1089/cyber.2023.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
This international multicenter randomized controlled trial aimed to compare the effectiveness of virtual reality (VR) distraction with an identical non-VR game in reducing needle-related pain and anxiety in children undergoing venous blood draw. The study involved 304 children aged 5-9 years undergoing a blood draw procedure, randomly allocated to one of three groups: VR distraction, non-VR distraction, and control group (usual care). The distraction task was based on the Multiple Object Tracking (MOT) paradigm, and the game was identical in design and gameplay for both VR and non-VR distraction groups. The primary outcome was self-reported pain intensity using the Faces Pain Scale-Revised (FPS-R). Secondary outcomes included child distress, attention/distraction to the blood draw, and parent and medical staff satisfaction with procedure. Analyses were conducted using analysis of variance and multivariable linear regression models. The results showed that VR distraction and non-VR distraction performed similarly, showing large effect sizes compared with standard care. There was no significant difference between the two types of distraction. The study's findings suggest that VR and non-VR distraction are similarly effective in reducing needle-related pain and anxiety in children undergoing venous blood draw. This is the first well-powered study comparing modern VR distraction with an identical task displayed on a smartphone or monitor screen. The study's results have important implications for using VR in clinical settings and suggest that investing in expensive VR equipment for acute pain management may not be necessary. The study protocol was pre-registered on Open Science Framework at https://osf.io/frsyc.
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Affiliation(s)
- Marcin Czub
- Institute of Psychology, University of Wrocław, Wrocław, Poland
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Joanna Piskorz
- Institute of Psychology, University of Wrocław, Wrocław, Poland
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Helena K Lydon
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Bertille Mullen
- Haemophilia Department, Children's Health Ireland at Crumlin Hospital, Dublin, Ireland
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Caroline Heary
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Conor O'Neill
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Gloria Sainero
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Vincent McDarby
- Department of Psychology, Children's Health Ireland at Crumlin Hospital, Dublin, Ireland
| | - Brian E McGuire
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
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Esteve R, Barrado-Moreno V, Ramírez-Maestre C, Serrano-Ibáñez ER, de la Vega R, Ruiz-Párraga GT, Sainero-Tirado G, Fernández Baena M, Jensen M, López-Martínez AE. Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain. Eur J Pain 2024. [PMID: 38189159 DOI: 10.1002/ejp.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal. METHODS The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal. RESULTS The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster. CONCLUSIONS These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles. SIGNIFICANCE The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.
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Affiliation(s)
- R Esteve
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - V Barrado-Moreno
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - C Ramírez-Maestre
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - E R Serrano-Ibáñez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - R de la Vega
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - G T Ruiz-Párraga
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - G Sainero-Tirado
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | | | - M Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - A E López-Martínez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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López-Martínez AE, Serrano-Ibáñez ER, Solís-Serrano L, Ramírez-Maestre C, Esteve R. Empathy among health science undergraduates toward the diagnosis of chronic pain: An experimental study. Nurse Educ Today 2023; 130:105922. [PMID: 37562151 DOI: 10.1016/j.nedt.2023.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES To analyse the empathetic response of future health professionals toward people diagnosed with chronic pain differentiated by the degree of visibility and credibility of symptoms. METHODS A total of 203 undergraduates performed an experimental task using vignettes depicting different diagnoses of chronic pain and completed questionnaires measuring dispositional and situational empathy. A MANCOVA analysis was conducted. RESULTS The main effects of chronic pain diagnoses did not significantly affect situational empathy (p = .587, η2 = 0.007, d = 0.229). The dispositional empathy variables perspective-taking and personal distress affected the situational empathy scores (p = .002, η2 = 0.072, d = 0.906, and p = .043, η2 = 0.032, d = 0.547, respectively). CONCLUSIONS It would seem appropriate to foster intra-individual empathy factors among health science undergraduates such that they can more readily understand the process of individual adaptation to chronic pain and thus manage it more effectively. PRACTICE IMPLICATIONS It would be useful for dispositional empathy to form part of the transversal competences of the training programmes of future health professionals from the beginning of their studies.
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Affiliation(s)
- Alicia E López-Martínez
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain; Biomedical Research Institute of Malaga-IBIMA (Spain), C/Dr. Ortiz Ramos, 12.29010 Málaga, Spain.
| | - Elena R Serrano-Ibáñez
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain; Biomedical Research Institute of Malaga-IBIMA (Spain), C/Dr. Ortiz Ramos, 12.29010 Málaga, Spain.
| | - Laura Solís-Serrano
- Biomedical Research Institute of Malaga-IBIMA (Spain), C/Dr. Ortiz Ramos, 12.29010 Málaga, Spain
| | - Carmen Ramírez-Maestre
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain; Biomedical Research Institute of Malaga-IBIMA (Spain), C/Dr. Ortiz Ramos, 12.29010 Málaga, Spain.
| | - Rosa Esteve
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain; Biomedical Research Institute of Malaga-IBIMA (Spain), C/Dr. Ortiz Ramos, 12.29010 Málaga, Spain.
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Galán S, de la Vega R, Esteve R, López-Martínez AE, Fernández Baena M, Ramírez-Maestre C. Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study. Front Pain Res (Lausanne) 2023; 4:1269018. [PMID: 37928367 PMCID: PMC10621745 DOI: 10.3389/fpain.2023.1269018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication. Methods Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse. Results The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11). Conclusions This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted. Significance This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.
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Affiliation(s)
- Santiago Galán
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Málaga, Spain
| | - Rocío de la Vega
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Rosa Esteve
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Alicia E. López-Martínez
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
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Esteve R, Serrano-Ibáñez ER, Castillo-Real S, Ramírez-Maestre C, López-Martínez AE. How do the activity patterns of people with chronic pain influence the empathic response of future health professionals: an experimental study. Adv Health Sci Educ Theory Pract 2023:10.1007/s10459-023-10291-2. [PMID: 37792117 DOI: 10.1007/s10459-023-10291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023]
Abstract
Empathy in healthcare professionals is associated with better treatment outcomes and higher satisfaction among patients with chronic pain. Activity patterns play an essential role in the adjustment of these patients and, as a pain behaviour, may have a communicative function and elicit distinct empathic responses. This study investigated whether the activity pattern profiles characteristic of these patients had differential effects on the empathic response (empathic distress and compassion/sympathy) of future healthcare professionals. Healthcare professionals should improve their knowledge about the role of different activity patterns in the well-being of people with chronic pain and receive specific training in empathic skills. We controlled for several variables that could affect the empathic response (sex, age, academic degree, previous experience of chronic pain, and dispositional empathy).A total of 228 undergraduates performed an experimental task using vignettes depicting four activity pattern profiles displayed by people with chronic pain and completed questionnaires measuring dispositional and situational empathy. We conducted a MANCOVA analysis.Undergraduates showed more compassion/sympathy toward the medium cycler profile than toward the doer profile. Participants' age was associated with empathic distress. Sex, academic degree, and previous experiences with chronic pain were not associated with their empathic response to the vignettes. Dispositional perspective-taking and empathic concern were significantly associated with compassion/sympathy responses, and personal distress was significantly associated with empathic distress.Activity pattern profiles may have a communicative function and elicit different empathic responses toward people with chronic pain. Individual differences in dispositional empathy play an important role on situational empathic responses.
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Affiliation(s)
- Rosa Esteve
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, c/ Dr. Ortiz Ramos, 29010, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Elena R Serrano-Ibáñez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, c/ Dr. Ortiz Ramos, 29010, Málaga, Spain.
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain.
| | - Sheila Castillo-Real
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, c/ Dr. Ortiz Ramos, 29010, Málaga, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, c/ Dr. Ortiz Ramos, 29010, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Andalucía Tech, c/ Dr. Ortiz Ramos, 29010, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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López-Martínez AE, Sainero-Tirado G, Esteve R, Reyes-Pérez Á, Ruiz-Párraga GT, de la Vega R, Serrano-Ibáñez ER, Ramírez-Maestre C. Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain? Psychol Trauma 2023; 15:394-403. [PMID: 35604711 DOI: 10.1037/tra0001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is an ongoing debate on the use of long-term high-dose medically prescribed opioid analgesics for patients with chronic noncancer pain. Such use is elevated when there is comorbid pain and PTSD, which is quite prevalent. Therefore, it is relevant to investigate the psychological variables that may explain opioid misuse in this population. The purpose of this study was to examine the interaction effect of PTSD severity, distress intolerance, and pain catastrophizing on prescribed opioid misuse in chronic noncancer pain patients. METHOD A total of 168 participants (M age = 60 years, 74% women) were assessed regarding opioid medication, pain intensity, traumatic psychological events, PTSD, distress intolerance, pain catastrophizing, and current opioid misuse. RESULTS Groups were formed according to the level of PTSD severity (no symptoms, moderate symptoms, and severe symptoms). Significant differences were found between the groups in pain intensity, catastrophizing, distress intolerance, and opioid misuse. The severe-symptoms group had the highest scores on all variables. There were no between-group differences in the prescribed medication. Mediation analysis showed that the relationship between PTSD severity and opioid misuse was completely and independently mediated by distress intolerance and pain catastrophizing. CONCLUSIONS Distress intciolerance and pain catastrophizing may be theoretically and clinically relevant constructs in understanding the motivation for opioid misuse in people with concurrent chronic noncancer pain and PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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de la Vega R, Serrano-Ibáñez ER, Ruiz-Párraga GT, Palermo TM, Wicksell R, Fernández-Jiménez E, Oliva S, Roldán S, Monfort L, Peláez MJ, Leyva Carmona M, Ramírez-Maestre C, López-Martínez AE, Miró J, Esteve R. Protocol for a multi-phase, multi-center, real-world, hybrid effectiveness-implementation study of a digital intervention for pediatric chronic pain co-designed with patients (Digital SPA). Digit Health 2023; 9:20552076231219490. [PMID: 38130799 PMCID: PMC10734335 DOI: 10.1177/20552076231219490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain. Methods (Phase 1) Focus groups with patients, parents, and clinicians (n = 5-6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness-implementation trial. Participants (n = 195) will be adolescents aged 12-17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation. Discussion This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation. Trial registration number TRN and date of registration ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful.In this study, we expect that assessing users' needs and co-designing an intervention with them will improve adherence.Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts.This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care.
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Affiliation(s)
- Rocío de la Vega
- Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
| | - Elena R. Serrano-Ibáñez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
| | - Gema T. Ruiz-Párraga
- Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
| | - Tonya M. Palermo
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Rikard Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Pain Clinic, Capio St Göran Hospital, Stockholm, Sweden
| | - Eduardo Fernández-Jiménez
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Silvia Oliva
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Hospital Materno Infantil del Hospital Regional Universitario, Málaga, Spain
| | - Susana Roldán
- Hospital Materno Infantil Virgen de las Nieves, Granada, Spain
| | | | - María José Peláez
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Hospital Materno Infantil del Hospital Regional Universitario, Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
| | - Alicia E. López-Martínez
- Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
| | - Jordi Miró
- Universitat Rovira i Virgili, Tarragona, Spain
- Unit for the Study and Treatment of Pain–ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Rosa Esteve
- Hospital Universitario Materno Infantil Torrecárdenas, Almería, Spain
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Sainero-Tirado G, Ramírez-Maestre C, López-Martínez AE, Esteve R. Distress intolerance and pain catastrophizing as mediating variables in PTSD and chronic noncancer pain comorbidity. Scand J Pain 2022; 23:318-325. [PMID: 35858875 DOI: 10.1515/sjpain-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Several studies have demonstrated posttraumatic stress disorder (PTSD) and chronic pain comorbidity. However, there is a lack of research on the psychological variables that might explain their co-occurrence. We investigated the mediating role of distress intolerance and pain catastrophizing in this relationship. METHODS A moderated mediation model was tested. The sample comprised 114 individuals with chronic noncancer pain (90 women and 24 men; mean age, of 60.04 years [SD=9.76]). RESULTS Catastrophizing had a significant effect on PTSD. Distress intolerance mediated catastrophizing and PTSD, and pain intensity moderated this relationship. CONCLUSIONS New insights are provided into the psychological variables that may explain PTSD and chronic noncancer pain comorbidity.
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Affiliation(s)
| | - Carmen Ramírez-Maestre
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alicia E López-Martínez
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Rosa Esteve
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
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Serrano-Ibáñez ER, Ramírez-Maestre C, Ruiz-Párraga GT, Esteve R, López-Martínez AE. Pain Interference, Resilience, and Perceived Well-Being During COVID-19: Differences Between Women With and Without Trauma Exposure Prior to the Pandemic. Int J Public Health 2022; 67:1604443. [PMID: 35928222 PMCID: PMC9344401 DOI: 10.3389/ijph.2022.1604443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The aim of this study was to investigate the consequences of the COVID-19 pandemic in women with non-malignant chronic pain, and to determine whether women exposed to traumatic situations prior to the outbreak would be at a higher risk of negative health impacts. Methods: A total of 365 women were divided into three subgroups according to whether or not they had experienced a traumatic event prior to COVID-19. They completed an online survey. Results: Significant differences were found between groups during lockdown: 1) more psychological abuse was experienced by the group of women who had experienced an interpersonal traumatic event prior to the pandemic than in the other subgroups; 2) physical activity levels were higher and scores on pain interference were lower in women in the non-traumatized subgroup than in the other subgroups; 3) pain interference was predicted by pain intensity, decreased social support, and resilience, whereas perceived well-being was predicted by pain interference. Conclusion: Women who had experienced a traumatic event prior to the pandemic suffered worse consequences of the COVID-19 lockdown, particularly greater pain interference, although resilience was shown to both mitigate pain interference and enhance perceived well-being.
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Affiliation(s)
- Elena R. Serrano-Ibáñez
- Faculty of Psychology and Speech Therapy, University of Málaga, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Carmen Ramírez-Maestre
- Faculty of Psychology and Speech Therapy, University of Málaga, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Gema T. Ruiz-Párraga
- Faculty of Psychology and Speech Therapy, University of Málaga, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology and Speech Therapy, University of Málaga, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Alicia E. López-Martínez
- Faculty of Psychology and Speech Therapy, University of Málaga, Málaga, Spain
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
- *Correspondence: Alicia E. López-Martínez,
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Reyes-Pérez Á, López-Martínez AE, Esteve R, Ramírez-Maestre C. Spanish Validation of the COMM Scale to Assess the Misuse of Prescription Opioids in Patients with Chronic Noncancer Pain. Int J Ment Health Addict 2022; 21:1-15. [PMID: 35342377 PMCID: PMC8936043 DOI: 10.1007/s11469-022-00803-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 02/08/2023] Open
Abstract
The Current Opioid Misuse Measure (COMM) is a questionnaire used to identify and monitor chronic pain patients on opioid therapy who may be misusing their prescription opioids. The aim of the present study was to adapt the questionnaire for its use in Spanish-speaking populations. A total of 171 individuals (131 women and 40 men) with nononcological chronic pain participated in this cross-sectional study. The most frequent pain diagnoses in the sample were fibromyalgia, herniated disc, and rheumatoid arthritis. Systematic sampling was used. All individuals were interviewed at their clinic between March 2018 and February 2020. The dimensionality of the COMM-SV items was evaluated using an optimal implementation of parallel analysis (PA) and an exploratory factor analysis. Internal consistency, test-retest reliability, and criterion and convergent validity were calculated. The COMM-SV comprises five factors: problematic interpersonal behaviour, searching for more medication than prescribed, medication misuse and self-injurious thoughts, emergency use, and memory and attention problems. It has good reliability and adequate test-retest stability. The results support its criterion and convergent validity. Given the increasing use and abuse of opioids, a valid and reliable instrument is needed in Spanish settings to identify patients with chronic pain who present aberrant behaviour related to the use of these medications. The COMM-SV enables Spanish clinicians to do that.
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Affiliation(s)
- Ángela Reyes-Pérez
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Málaga, Spain
| | - Alicia E. López-Martínez
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
| | - Rosa Esteve
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
| | - Carmen Ramírez-Maestre
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
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11
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López-Martínez AE, Ramírez-Maestre C, Serrano-Ibáñez ER, Ruiz-Párraga GT, Esteve R. Intolerance of uncertainty moderates the relationship between catastrophizing, anxiety, and perceived pain in people with chronic nononcological pain. Pain Med 2022; 23:1793-1799. [PMID: 35172006 DOI: 10.1093/pm/pnac030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 02/05/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Substantial empirical evidence has shown that intolerance of uncertainty is a central transdiagnostic feature in psychopathology and it has been suggested to be a pain-related psychological factor contributing to the experience of chronic pain. However, research in this area is virtually nonexistent. The objective of this study was to investigate associations between pain severity, catastrophizing, and anxiety in people with chronic nononcological pain, while assuming that intolerance of uncertainty moderates these relationships. METHODS A convenience sample of 188 individuals with nononcological chronic pain (157 women and 32 men) participated in the study. We investigated the moderated mediation of intolerance of uncertainty between anxiety and catastrophizing and between catastrophizing and pain intensity. RESULTS The full moderated mediation model accounted for significant variance in pain intensity (R2 = .148, P< .001). Intolerance of uncertainty significantly moderated the interaction between anxiety and catastrophizing (B = 0.039, SE = 0.012, CI [0.015, 0.063]) and between catastrophizing and pain intensity (B = -0.034, SE = 0.010, CI [-0.054, -0.014]). Anxiety and intolerance of uncertainty did not interact in predicting catastrophizing, although an interaction effect was found between intolerance of uncertainty and catastrophizing in predicting pain intensity. CONCLUSION This study is the first to address the interrelationship of intolerance of uncertainty, catastrophizing, and anxiety in relation to perceived pain intensity. The current findings support intolerance of uncertainty as a relevant psychological variable that is distinct from other relevant constructs in the setting of pain research and treatment.
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Affiliation(s)
- Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Spain
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Spain
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Spain
| | - Gema T Ruiz-Párraga
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Spain
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Spain
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12
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Esteve R, Bernardes SF, López-Martínez AE, Martín-Delgado CE, Ramírez-Maestre C. The Informal Social Support for Autonomy and Dependence in Pain Inventory Spanish version. Health Soc Care Community 2021; 30:e1991-e2002. [PMID: 34747074 DOI: 10.1111/hsc.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/08/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
Social support plays a crucial role in the quality of life of people with chronic pain. The Informal Social Support for Autonomy and Dependence in Pain Inventory assesses two functions of received social support: the promotion of autonomy and the promotion of dependence. The aim of this cross-sectional study was to adapt this instrument for its use in the Spanish population. The sample comprised 256 individuals with chronic pain. Participants were recruited through two local associations of people with fibromyalgia, a physiotherapy unit and a hospital pain unit. The data were collected in Spain between October 2018 and January 2020. The structure of the questionnaire was analysed using confirmatory factor analysis, average variance extracted, composite reliability and internal consistency indexes, and inter-correlations between the scales. The criterion-related validity of the instrument was analysed by investigating its relationship with pain intensity, positive and negative affect, daily functioning, activity impairment, wellbeing and satisfaction with life. The structure with the best fit had four related factors: emotional social support for the promotion of autonomy; instrumental social support for the promotion of autonomy; emotional social support for the promotion of dependence and instrumental social support for the promotion of dependence. The scales showed adequate internal consistency. An association was found between higher levels of instrumental social support for the promotion of dependence and higher levels of pain-related disability and decreased daily functioning. An association was also found between the promotion of autonomy and increased satisfaction with life. The Spanish version of the inventory shows appropriate psychometric properties. In the setting of disability prevention, this instrument is useful in assessing the support relationships between people with chronic pain and their relatives.
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Affiliation(s)
- Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Sonia F Bernardes
- Department of Social and Organizational Psychology, Centro de Investigação e de Intervenção Social (CIS-IUL), ISCTE-Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Carmen Estela Martín-Delgado
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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13
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Miró J, Jensen MP, Ramírez-Maestre C, Esteve R, López-Martínez AE, de la Vega R. The Silhouettes Fatigue Scale: a validity study with individuals with physical disabilities and chronic pain. Disabil Rehabil 2021; 44:6408-6413. [PMID: 34403273 DOI: 10.1080/09638288.2021.1964621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Fatigue is known to interfere with function in individuals with physical disabilities. In order to monitor changes in fatigue over time and evaluate the efficacy of treatments, psychometrically sound measures of fatigue are needed. The aim of this work was to evaluate the validity of the Silhouettes Fatigue Scale with English instructions (SFS-EN) in a sample of adults with physical disabilities living in the USA. METHODS Individuals with medical conditions associated with physical disabilities responded to an online survey that included the SFS-EN as well as another validated measure of fatigue (PROMIS short form-4a Fatigue Scale), and measures of pain intensity and pain catastrophizing. RESULTS 523 individuals participated (mean age = 59.1 years; SD = 11.4). Most participants were Caucasian (89%), women (59%) and unemployed (71%). Results showed strong positive correlations between both measures of fatigue, supporting the convergent validity of the SFS-EN. In addition, the magnitude of this association was significantly greater than the association between the scores of the SFS-EN and the measures of pain intensity and pain catastrophizing, supporting the former's discriminant validity. CONCLUSIONS The findings extend previous results supporting the SFS as a brief, easy to administer and understand, and valid measure of fatigue.IMPLICATIONS FOR REHABILITATIONFatigue is common in adults with physical disabilities and chronic pain.The Silhouettes Fatigue Scale (SFS) is a new single-item measure of general fatigue.Findings show that the SFS with English instructions (SFS-EN) is an easy to understand measure.Results support the convergent and discriminant validity of the SFS-EN score in adults with physical disabilities and chronic pain.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Carretera de Valls, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Avda. de la Universitat, Reus, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
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14
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Ramírez-Maestre C, Esteve R, López-Martínez AE, Jensen MP, Miró J, de la Vega R. The Impairment and Functioning Inventory Revised-English version: A validation study in individuals with disabilities and bothersome pain. PM R 2021; 14:818-827. [PMID: 34181318 DOI: 10.1002/pmrj.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/14/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the relevance of daily function in individuals with chronic pain, few questionnaires have been designed to assess this domain in individuals with musculoskeletal pain. In addition, the Impairment and Functioning Inventory-Revised (IFI-R) is the only instrument that assesses perceived decreases in levels of daily activity after the onset of pain. OBJECTIVE To evaluate the psychometric properties of the English version of the IFI-R. DESIGN Cross-sectional study. SETTING A database of individuals with medical conditions commonly associated with chronic pain maintained by the University of Washington. PATIENTS A total of 470 individuals with chronic pain. METHODS Factorial validity was analyzed by conducting a confirmatory factor analysis via structural equation modeling. Internal consistency was evaluated by calculating Cronbach's α coefficients. Convergent validity was assessed by calculating Pearson correlation coefficients between the two scales of the IFI-R and the Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference Scale. Criterion validity was analyzed by regression analysis via structural equation modeling. MAIN OUTCOME MEASURES The English version of the IFI-R (IFI-R-EV) for individuals with chronic pain. RESULTS The IFI-R-EV consists of 30 items with two related subscales: The Daily Function subscale (α = .86). and the Impairment subscale (α = .89). A significant correlation was found between these subscales and a measure of pain interference (r's = - .33, and .35 respectively; p's < .01). We also found statistically significant associations (p < .05) between daily function and depression (β = -.14) and pain intensity (β = -.13), between impairment and depression (β = .14) and pain intensity (β = .16), and between daily function and pain acceptance (β = .14). CONCLUSIONS The findings indicate that the IFI-R-EV provides valid and reliable measures of daily function and impairment in English-speaking individuals with a disability and chronic pain. These results are consistent with those obtained with the Spanish version.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain
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Ramírez-Maestre C, López-Martínez AE, Esteve R. Predictive variables of prescription opioid misuse in patients with chronic noncancer pain. Development of a risk detection scale: A registered report protocol. PLoS One 2021; 16:e0251586. [PMID: 33984037 PMCID: PMC8118327 DOI: 10.1371/journal.pone.0251586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Opioid therapy is utilized for a broad range of chronic pain conditions. Several studies have highlighted the adverse effects of opioid medication due to the misuse of these drugs. The gradual increase in the use of opioids has become a global phenomenon and is generating social concern. Several treatment guidelines have strongly recommended assessing the risks and benefits of pharmacological treatment with opioids. These guidelines also recommend the psychological assessment of patients with chronic noncancer pain in order to make informed decisions on the advisability of intervention with opioids. Some authors have emphasized the relevance of assessing the risk of opioid misuse in patients with noncancer chronic pain before initiating treatment. METHODS AND ANALYSIS Two studies will be conducted, each with a different primary objective. The primary objective of the first study (Study 1) will be to conduct a comprehensive investigation to identify the factors most closely associated with subsequent opioid misuse; and based on the results of Study 1, the primary objective of the second study (Study 2) will be to develop a brief, reliable, valid, and useful instrument that would enable health care providers to make decisions on opioid prescription and on the required level of monitoring and follow-up. These decisions would have positive consequences for patient wellbeing. Study 1 will include a logistic regression analysis to test the hypothetical model. Study 2 will have a longitudinal design and include three assessment sessions in order to develop a measure to assess the risk of prescribed opioid misuse and to analyse its reliability and validity. Participants will be individuals with chronic noncancer pain attending three Pain Units. These individuals will either be undergoing pharmacological treatment that includes opioid analgesics (Study 1, N = 400) or are going to commence such treatment (Study 2, N = 250).
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Affiliation(s)
- Carmen Ramírez-Maestre
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Alicia E. López-Martínez
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Rosa Esteve
- Universidad de Málaga, Facultad de Psicología, Andalucía Tech, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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Serrano-Ibáñez ER, Ruiz-Párraga GT, Gómez-Pérez L, Ramírez-Maestre C, Esteve R, López-Martínez AE. The Relationship Between Experiential Avoidance and Posttraumatic Stress Symptoms: A Moderated Mediation Model Involving Dissociation, Guilt, and Gender. J Trauma Dissociation 2021; 22:304-318. [PMID: 33455542 DOI: 10.1080/15299732.2020.1869647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Experiential avoidance, dissociation, and guilt have been shown to be associated with trauma exposure and to play an important role in explaining the development and maintenance of posttraumatic stress symptoms. However, there is a lack of studies that simultaneously address the relationship between these variables, which has never been studied within the framework of emotional processing theory. Furthermore, gender differences in traumatic victimization, posttraumatic stress symptoms, experiential avoidance, dissociation, and guilt have also been reported. Therefore, this study had a double aim: a) to assess the mediating roles of dissociation and guilt in the relationship between experiential avoidance and posttraumatic stress symptoms; and b) to investigate whether gender moderates any such relationship. The final sample comprised 683 undergraduate students (150 men and 533 women) with a history of exposure to traumatic events and with posttraumatic stress symptoms. Mediation and moderated mediation analyses were conducted. Dissociation and guilt independently mediated the association between experiential avoidance and posttraumatic stress symptoms: however, this mediation effect was not moderated by gender. The findings suggest that interventions aimed at controlling psychological variables linked to PTSD (i.e. experiential avoidance, dissociation, and guilt) may be of help to both men and women.
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Affiliation(s)
- Elena R Serrano-Ibáñez
- Departamento de Psicología, Universidad Isabel I (Burgos, Spain), Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Gema T Ruiz-Párraga
- Universidad de Málaga (Spain). Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Lidia Gómez-Pérez
- Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Carmen Ramírez-Maestre
- Universidad de Málaga (Spain). Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Universidad de Málaga (Spain). Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Universidad de Málaga (Spain). Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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17
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López-Martínez AE, Esteve R, Ruiz-Párraga GT, Rueda-Serrano C, Serrano-Ibáñez ER, Ramírez-Maestre C. Psychometric Properties of the Spanish Version of the Pain Anxiety Symptoms Scale-20 (PASS-20-SV). Psicothema 2021; 33:296-303. [PMID: 33879303 DOI: 10.7334/psicothema2020.260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations. METHODS Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23 men). The dimensionality of the PASS-20-SV items was evaluated using Exploratory Factor Analysis and an optimal implementation of Parallel Analysis (robust maximum likelihood). Data from sample 1 was used to analyse internal consistency and convergent validity. Estimated test-retest stability and predictive validity were based on data from the sample 2 participants, who completed the first administration (T1) and a second administration (T2, 6 months later). RESULTS The PASS-20-SV comprises two factors: pain-related anxiety and apprehension, and pain-related fear and avoidance. It has good to excellent reliability and adequate test-retest stability. The results support its convergent and predictive validity. CONCLUSIONS The Spanish Version of the PASS-20 is a valid, reliable measure of pain-related anxiety and pain-related fear in Spanish-speaking patients.
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18
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Ruiz-Párraga GT, Serrano-Ibáñez ER, Gómez-Pérez L, Ramírez-Maestre C, Esteve R, López-Martínez AE. The relevance of psychological strength for physical and psychological well-being in trauma-exposed women. Scand J Psychol 2021; 62:386-392. [PMID: 33547651 DOI: 10.1111/sjop.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 01/04/2021] [Indexed: 02/05/2023]
Abstract
Traumatic experiences have consistently been linked to poor health and well-being, particularly in women. Psychological factors have been theorized to directly affect the reporting of physical symptoms and perceptions of general health. Posttraumatic stress disorder (PTSD) has been proposed as a major pathway through which trauma affects health and emotion dysregulation. Trauma is considered to be a key psychological variable in the pathogenesis of PTSD. Fortunately, not all women who have experienced trauma manifest adverse effects. Resilience acts as a psychological protective variable following trauma. The present study tested a hypothetical model of the contribution of resilience, emotional dysregulation, and PTSD symptoms to physical and psychological well-being in a large sample of trauma-exposed women. A transversal study with 753 female participants is used. Structural modeling was used to test linear associations between variables. After experiencing trauma, resilience was negatively and significantly associated with emotional dysregulation, which, in turn, was positively associated with PTSD symptoms. Both resilience and PTSD symptoms were associated with physical and psychological well-being. The results suggest that resilience and emotional dysregulation are relevant to the health and well-being of women with PTSD symptoms and may help guide the development of psychological treatment in this group. Therefore, these findings may be relevant in promoting health and well-being in such women, and may help to identify individuals who would receive the most benefit from interventions addressing emotional regulation and psychological resilience.
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Affiliation(s)
- Gema T Ruiz-Párraga
- Facultad de Psicología, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga, Málaga, Spain
| | - Elena R Serrano-Ibáñez
- Facultad de Psicología, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga, Málaga, Spain
| | - Lydia Gómez-Pérez
- Facultad de Psicología, Universidad Pontificia Católica de Chile, Santiago de Chile, Chile
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga, Málaga, Spain
| | - Rosa Esteve
- Facultad de Psicología, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga, Málaga, Spain
| | - Alicia E López-Martínez
- Facultad de Psicología, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga, Málaga, Spain
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Serrano-Ibáñez ER, Esteve R, Ramírez-Maestre C, Ruiz-Párraga GT, López-Martínez AE. Chronic pain in the time of COVID-19: Stress aftermath and central sensitization. Br J Health Psychol 2020; 26:544-552. [PMID: 33099793 DOI: 10.1111/bjhp.12483] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/05/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The COVID-19 crisis is a significant stressor worldwide. The physical and emotional condition of individuals with pain sensitization syndromes who are experiencing the pandemic may worsen. This study investigated the contribution of life changes due to the coronavirus to emotional distress in individuals with a diagnosis of chronic central sensitization pain and tested whether the associations between level of pain and sensitization were independent of or mediated by emotional distress. METHODS Spanish individuals with chronic pain (N = 362) completed an online survey on direct or indirect exposure to the consequences of COVID-19, pain intensity, and emotional distress. They also completed central sensitization questionnaires. RESULTS An association was found between changes in daily routines and pain intensity, emotional distress, and sensitization scores. Correlations were found between emotional distress, sensitization, and pain intensity. Significant predictors of emotional distress were age, difficulty in receiving medical care, changes in daily routines, and diminished social support. Emotional distress did not mediate the association between sensitization and pain intensity. CONCLUSION Due to the COVID-19 situation, individuals with central sensitization pain syndromes may be at higher risk of developing psychological distress. Interdisciplinary interventions involving psychologists are urgently needed to provide this population with appropriate health care.
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Affiliation(s)
- Elena R Serrano-Ibáñez
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Facultad de Psicología y Logopedia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología y Logopedia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Gema T Ruiz-Párraga
- Facultad de Psicología y Logopedia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Alicia E López-Martínez
- Facultad de Psicología y Logopedia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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Ramírez-Maestre C, Reyes-Pérez Á, Esteve R, López-Martínez AE, Bernardes S, Jensen MP. Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age. Int J Environ Res Public Health 2020; 17:ijerph17176428. [PMID: 32899359 PMCID: PMC7503487 DOI: 10.3390/ijerph17176428] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023]
Abstract
Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
- Correspondence: ; Tel.: +34-952-13-23-89
| | - Ángela Reyes-Pérez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Alicia E. López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Sonia Bernardes
- Instituto Universitario de Lisboa (ISCTE-IUL), Cis-IUL, Av. das Forças Armadas, 1649-026 Lisboa, Portugal;
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, 325 9th Ave, Seattle, WA 98104, USA;
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21
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Esteve R, López-Martínez AE, Ruíz-Párraga GT, Serrano-Ibáñez ER, Ramírez-Maestre C. Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain. Int J Environ Res Public Health 2020; 17:ijerph17155556. [PMID: 32752085 PMCID: PMC7432233 DOI: 10.3390/ijerph17155556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake.
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Affiliation(s)
- Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Alicia Eva López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Gema Teresa Ruíz-Párraga
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Elena Rocío Serrano-Ibáñez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Facultad de Ciencias de la Salud, Área de Psicología, Universidad Isabel I, 09003 Burgos, Spain
| | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Correspondence: ; Tel.: +34-952-132-389
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22
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Ramírez-Maestre C, Esteve R, López-Martínez AE, Miró J, Jensen MP, de la Vega R. Beyond pain intensity and catastrophizing: The association between self-enhancing humour style and the adaptation of individuals with chronic pain. Eur J Pain 2020; 24:1357-1367. [PMID: 32383261 DOI: 10.1002/ejp.1583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/29/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many questions regarding the process by which self-enhancing humour style has an effect on chronic pain individuals' adjustment remain unanswered. The aim of the present study was to analyse the association of self-enhancing humour style with adjustment in a sample of individuals with chronic pain, over and above the role of catastrophizing and pain intensity. Adjustment was assessed using measures of depression, pain interference and flourishing. We also examined the indirect association between self-enhancing humour style and adjustment via pain acceptance. METHODS The study included 427 patients with heterogeneous chronic pain conditions. The study hypotheses were tested using three multiple linear regression analyses, one for each of the criterion variables. RESULTS Consistent with the study hypothesis, both direct and indirect associations were found between self-enhancing humour style and depressive symptoms, pain interference and flourishing via pain acceptance. CONCLUSIONS Self-enhancing humour style could potentially help individuals with chronic pain to gain perspective and distance themselves from the situation through the acceptance of pain-related negative emotions. SIGNIFICANCE Very few studies have investigated the relationship between humour styles and adjustment in chronic pain samples. The results of the current study support the idea that adaptive dispositional traits, such as patient's self- enhancing humour style, play a role in the adaptation of individuals with chronic pain. Given that the association between self-enhancing humour style and adjustment evidenced an indirect association through pain acceptance, training in the use of humour, as individuals with self-enhancing humour style do, might be a useful addition to ACT treatment.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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García-Encinas A, Ramírez-Maestre C, Esteve R, López-Martínez AE. Predictors of posttraumatic stress symptoms and perceived health after an acute coronary syndrome: the role of experiential avoidance, anxiety sensitivity, and depressive symptoms. Psychol Health 2020; 35:1497-1515. [PMID: 32404010 DOI: 10.1080/08870446.2020.1761974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: The identification of psychological markers of the posttraumatic stress reaction after a cardiac event is relevant in the management of cardiovascular risk factors. The aim of the study to test the contribution of experiential avoidance, anxiety sensitivity, and depressive symptoms to acute coronary syndrome posttraumatic stress symptoms and perceived health (both measured 6 months later), and to determine whether the associations between experiential avoidance, anxiety sensitivity, and depressive symptoms with perceived health were mediated by the posttraumatic stress symptoms.Design: 180 patients with acute coronary syndrome completed a survey over a 6-month period.Results: Anxiety sensitivity and depressive symptoms but not experiential avoidance contributed significantly to posttraumatic stress symptoms. Depressive symptoms and posttraumatic symptoms but neither anxiety sensitivity nor experiential avoidance had a significant association on perceived health. Acute coronary syndrome posttraumatic symptoms significantly mediated the association of depressive symptoms with perceived health. That is, increased depressive symptoms was significantly associated with higher levels of posttraumatic symptoms, which in turn predicted lower levels of perceived health.Conclusions: Understanding the psychological factors that are associated with post-acute coronary syndrome posttraumatic stress symptoms may help to identify patients at risk in order to refer them to the appropriate psychological care service.
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Affiliation(s)
- Angélica García-Encinas
- Departamento de Personalidad, Evaluación y Tratamiento, Facultad de Psicología y Logopedia, Universidad de Málaga, Servicio de salud mental, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Spain
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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Ramírez-Maestre C, Esteve R, Serrano-Ibáñez ER, López-Martínez AE, Ruiz-Párraga GT, Rivas-Moya T. Psychometric characteristics and factorial structures of the Defensive Pessimism Questionnaire-Spanish Version (DPQ-SV). PLoS One 2020; 15:e0229695. [PMID: 32302314 PMCID: PMC7164620 DOI: 10.1371/journal.pone.0229695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to validate the Spanish version of the Defensive Pessimism Questionnaire. A sample of undergraduate students (N = 539) was measured on defensive pessimism using the Defensive Pessimism Questionnaire (DPQ), optimism and pessimism using the Life Orientation Test (LOT), positive and negative affect using the Positive and Negative Affect Schedule, and anxiety using the trait subscale of the State and Trait Anxiety Inventory. A Spanish version of the DPQ (DPQ-SV) is presented. Exploratory and Robust Confirmatory Factor Analysis had a bi-dimensional structure (Reflectivity and Negative Expectation). Omega coefficient showed a high internal consistency and the temporal stability was high in each dimension. Both DPQ-SV subscales (Negative Expectation and Reflectivity) showed adequate convergence with LOT-optimism and LOT-pessimism. Reflectivity showed adequate criterion validity with trait-anxiety and negative affect, but inadequate criterion validity with positive affect. Negative Expectation showed excellent criterion validity with trait-anxiety and negative affect and good criterion validity with positive affect. Finally, mediation analysis showed that Negative Expectation had a significant indirect mediating effect between trait-anxiety and negative affect. Reflectivity had a significant indirect mediating effect between trait-anxiety and negative and positive affect. Analysis of the psychometric properties of the DPQ-SV subscale scores showed that it is a two factor adequate measurement tool for its use in this type of samples.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Facultad de Psicología y Logopedia, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
- * E-mail:
| | - Rosa Esteve
- Facultad de Psicología y Logopedia, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Elena R. Serrano-Ibáñez
- Facultad de Psicología y Logopedia, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Alicia E. López-Martínez
- Facultad de Psicología y Logopedia, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Gema T. Ruiz-Párraga
- Facultad de Psicología y Logopedia, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Teresa Rivas-Moya
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, Málaga, Spain
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López-Martínez AE, Ramírez-Maestre C, Serrano-Ibáñez ER, Ruiz-Párraga GT, Peters ML, Esteve R. Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain. Qual Life Res 2020; 29:2137-2148. [PMID: 32236774 DOI: 10.1007/s11136-020-02487-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily functioning, pain-related impairment, and psychological well-being). METHODS The sample comprised 258 individuals with chronic musculoskeletal pain who completed a series of questionnaires and vignettes. The vignettes presented a short description of a situation in which a person with chronic pain experienced a threat to a valued domain-specific goal and had to choose a possible goal management solution (i.e., goal persistence, flexibility reengagement, and disengagement). Hierarchical regression analyses were used to predict chronic pain adaptation using the selected vignette strategies as predictors. RESULTS After controlling for age, sex, pain intensity, and the responses to the dispositional goal management scales, persistence, reengagement, and disengagement goal strategies presented in the case scenarios predicted daily functioning (p < .001). Persistence, flexibility, disengagement (p < .001), and reengagement (p < .05) predicted pain-related impairment. Persistence, disengagement (p < .001), and flexibility (p < .05) predicted psychological well-being scores. CONCLUSION The use of vignettes could be useful to assess goal adjustment because this methodology enables respondents to provide more context-specific responses. The results of this approach could be used to improve clinical practice aimed at helping people with chronic musculoskeletal pain to better cope with this health condition.
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Affiliation(s)
- Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain.
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Gema T Ruiz-Párraga
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Madelon L Peters
- Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
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López-Martínez AE, Reyes-Pérez Á, Serrano-Ibáñez ER, Esteve R, Ramírez-Maestre C. Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review. World J Clin Cases 2019; 7:4254-4269. [PMID: 31911906 PMCID: PMC6940350 DOI: 10.12998/wjcc.v7.i24.4254] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.
AIM To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).
METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.
RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.
CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
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Affiliation(s)
- Alicia E López-Martínez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Ángela Reyes-Pérez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Elena Rocío Serrano-Ibáñez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Rosa Esteve
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
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Ramírez-Maestre C, de la Vega R, Sturgeon JA, Peters M. Editorial: Resilience Resources in Chronic Pain Patients: The Path to Adaptation. Front Psychol 2019; 10:2848. [PMID: 31920877 PMCID: PMC6933479 DOI: 10.3389/fpsyg.2019.02848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Carmen Ramírez-Maestre
- Andalucía Tech, Facultad de Psicología, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain
| | - Rocío de la Vega
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - John Andrew Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Madelon Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Ramírez-Maestre C, Esteve R, López-Martínez AE, Serrano-Ibáñez ER, Ruiz-Párraga GT, Peters M. Goal Adjustment and Well-Being: The Role of Optimism in Patients with Chronic Pain. Ann Behav Med 2019; 53:597-607. [PMID: 30184082 PMCID: PMC6546937 DOI: 10.1093/abm/kay070] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Chronic pain directly or indirectly interferes with valued personal goals. Goal adjustment plays a central role in patients’ adaptation. Studies on the relationship between optimism and goal regulation have shown that people with high dispositional optimism adjust their goals in a flexible way, and that flexible goal adjustment promotes quality of life. Purpose The aim of this study was to analyze the relationship among optimism, goal adjustment, and adaptation in patients with chronic pain. Methods A sample of 258 patients with chronic musculoskeletal pain completed questionnaires on optimism, reengagement, disengagement, flexibility, tenacity, rumination, purpose in life, well-being, pain intensity, daily functioning, and impairment. Results Structural equation modeling analysis showed that optimism had a positive association with reengagement, flexibility, and tenacity, and a negative association with disengagement. Disengagement was positively associated with rumination, whereas reengagement, flexibility, and tenacity were associated with higher levels of purpose in life, which were strongly associated with adaptation in patients with chronic pain. Conclusions This study supports the conclusions of previous research on the role of goal adjustment as a mediator variable between optimism and well-being.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Alicia E López-Martínez
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Elena R Serrano-Ibáñez
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Gema T Ruiz-Párraga
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Madelon Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, MD Maastricht, Netherlands
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Vega RDL, Miró J, Esteve R, Ramírez-Maestre C, López-Martínez AE, Jensen MP. Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical, emotional and cognitive factors. Disabil Health J 2019; 12:588-593. [PMID: 31076226 DOI: 10.1016/j.dhjo.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. OBJECTIVE The aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities. METHODS Participants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (Mage = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses. RESULTS After controlling for age and sex, the predictors explained an additional 7-16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%. CONCLUSIONS Consistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.
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Affiliation(s)
- Rocío de la Vega
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS and Research Center for Behavior Assessment (CRAMC), Department of Psychology and Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | | | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Serrano-Ibáñez ER, López-Martínez AE, Ramírez-Maestre C, Esteve R, Jensen MP. The behavioral inhibition and activation systems and function in patients with chronic pain. Personality and Individual Differences 2019. [DOI: 10.1016/j.paid.2018.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Serrano-Ibáñez ER, Ramírez-Maestre C, Esteve R, López-Martínez AE. The behavioural inhibition system, behavioural activation system and experiential avoidance as explanatory variables of comorbid chronic pain and posttraumatic stress symptoms. Eur J Psychotraumatol 2019; 10:1581013. [PMID: 30891160 PMCID: PMC6419650 DOI: 10.1080/20008198.2019.1581013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background: The variables that underlie comorbid chronic pain and posttraumatic stress symptoms (PTSS) are not yet clearly established. Objective: The aim of the present study was to analyse the role of the behavioural inhibition system (BIS), behavioural approach system (BAS) and experiential avoidance (EA) in pain adjustment (i.e. pain intensity, daily functioning and pain-related impairment) in patients with chronic pain and PTSS. Methods: A battery of instruments was administered to 388 chronic pain patients. The sample was divided into those with PTSS (n = 194) and those without PTSS (n =194). Results: Significant differences were found between groups in the BIS, EA, impairment and daily functioning. No differences were found between groups in the BAS. Structural equation modelling showed that the BIS and EA were associated with worse adjustment in the 194 patients with both chronic pain and PTSS. The BAS was associated with a lower level of pain and greater daily functioning. Conclusion: The findings provide evidence that BIS and BAS activation and EA play a role in adjustment to chronic pain in patients with concurrent PTSS. These results may help guide the development of psychological treatments for patients with both conditions.
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Affiliation(s)
- Elena R Serrano-Ibáñez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Rosa Esteve
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Alicia E López-Martínez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga, Spain
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Pérez-Aranda A, Hofmann J, Feliu-Soler A, Ramírez-Maestre C, Andrés-Rodríguez L, Ruch W, Luciano JV. Laughing away the pain: A narrative review of humour, sense of humour and pain. Eur J Pain 2018; 23:220-233. [PMID: 30176100 DOI: 10.1002/ejp.1309] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The link between humour and sense of humour with pain has been a topic of research for decades. The purpose of the present article was to review the different studies that have been conducted to date on the association between humour and sense of humour with pain. DATABASES AND DATA TREATMENT The literature search was conducted using the PubMed, Science Direct and ProQuest databases. Forty-one studies were reviewed, and the results are summarized and structured into three sections: experimental pain, chronic pain and pain in children. RESULTS For experimental pain, the findings support the idea that humorous distractions, such as watching a comedy clip, increase pain tolerance, although most of the studies indicate that other non-humorous distractions produce similar effects. Regarding chronic pain, humour has been studied as a way of coping with pain and the emotional distress produced by chronic pain conditions. The results of correlational studies show significant associations between the use of humour and main variables such as anxiety and catastrophizing. Finally, concerning pain in children, similar findings to those described for the previous sections have been reported, with a notable presence of studies on clinic clown interventions, which promote emotional well-being among children and their parents, although their effectiveness in pain reduction is controversial. CONCLUSIONS The study of the link between humour and pain is still on an early stage, and overcoming the limitations of previous studies is required to strengthen the promising results that have been observed up to date. SIGNIFICANCE This review summarizes all main findings regarding humour, sense of humour and pain up until the first half of 2018 and offers a list of aspects to be considered in further studies regarding the link of humour and pain to contribute to a more systematic research.
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Affiliation(s)
- Adrián Pérez-Aranda
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Jennifer Hofmann
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Personality and Assessment, University of Zurich, Zurich, Switzerland
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Carmen Ramírez-Maestre
- Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Malaga, Spain
| | - Laura Andrés-Rodríguez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Willibald Ruch
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Personality and Assessment, University of Zurich, Zurich, Switzerland
| | - Juan V Luciano
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
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Serrano-Ibáñez ER, Ruiz-Párraga GT, Esteve R, Ramírez-Maestre C, López-Martínez AE. Validation of the Child PTSD Symptom Scale (CPSS) in Spanish adolescents. Psicothema 2018; 30:130-135. [PMID: 29363482 DOI: 10.7334/psicothema2017.144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. OBJECTIVE To provide data on the psychometric properties of the CPSS in a sample of Spanish adolescents, to establish the internal consistency of the measure, and to examine its criterion validity. METHOD The participants were 339 adolescents (172 boys and 167 girls, mean age 13.95) exposed to peer violence during the previous year. RESULTS Confirmatory factor analysis demonstrated a good fit to the four-factor dysphoria model. The alpha reliabilities for the overall measure and its subscales were suitable. DISCUSSION The Spanish version of the scale has sound psychometric properties with good reliability and validity. Moreover, it integrates the four-factor structure corresponding to the dimensions of PTSD described in the DSM-V.
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Serrano-Ibáñez ER, Ramírez-Maestre C, López-Martínez AE, Esteve R, Ruiz-Párraga GT, Jensen MP. Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain. Front Psychiatry 2018; 9:394. [PMID: 30250434 PMCID: PMC6139336 DOI: 10.3389/fpsyt.2018.00394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023] Open
Abstract
Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ2/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.
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Affiliation(s)
- Elena R Serrano-Ibáñez
- Facultad de Psicología, Andalucía Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Andalucía Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Alicia E López-Martínez
- Facultad de Psicología, Andalucía Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Rosa Esteve
- Facultad de Psicología, Andalucía Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Gema T Ruiz-Párraga
- Facultad de Psicología, Andalucía Tech, Universidad de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, Gómez-Pérez L, López-Martínez AE. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain. Int J Behav Med 2017; 24:239-248. [PMID: 27757840 DOI: 10.1007/s12529-016-9600-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. METHOD Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability. RESULTS A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability. CONCLUSION Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.
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Affiliation(s)
- C Ramírez-Maestre
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain.
| | - R Esteve
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - G Ruiz-Párraga
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - L Gómez-Pérez
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - A E López-Martínez
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
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Esteve R, Bendayan R, López-Martínez AE, Ramírez-Maestre C. Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study. Pain Med 2017; 18:2116-2125. [PMID: 28505357 DOI: 10.1093/pm/pnx053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the predictive power of resilience and vulnerability factors in relation to pain-related disability. DESIGN A two-year prospective study investigated whether back pain-related disability was predicted by the following variables, measured when pain was acute: 1) pain-related disability, 2) pain intensity, 3) depression, 4) fear avoidance beliefs, 5) anxiety sensitivity, and 6) resilience. METHODS Two hundred thirty-two patients treated in five primary care centers participated in this study. They were assessed at baseline during an acute back pain episode and at six, 12, 18, and 24 months. Ninety-nine patients completed all the assessment sessions. Linear mixed models were used to examine the trajectory of disability across the measurement occasions and its association with the predictors. RESULTS Individuals who had higher scores of disability and pain intensity when pain was acute also had higher scores of disability six months later; moreover, the increase in disability was greater over time in comparison with individuals with lower scores in disability and pain intensity when pain was acute. Individuals who had reported greater levels of fear avoidance beliefs when pain was acute also reported greater scores of disability six months later; however, no differences were found in the rate of change in disability. No associations were found between initial disability or rate of change and resilience, anxiety sensitivity, or depression. CONCLUSIONS Patients with acute back pain who show high levels of pain-related disability, pain intensity, and fear avoidance beliefs are at risk of developing back pain-related disability and should be the target of a preventive intervention.
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Affiliation(s)
- Rosa Esteve
- Departments of Personality, Assessment and Psychological Treatment
| | - Rebeca Bendayan
- Psychobiology and Methodology of Behavioural Sciences, Universidad de Málaga, Málaga, Spain
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Ramírez-Maestre C, Correa M, Rivas T, López-Martínez AE, Serrano-Ibáñez ER, Esteve R. Psychometric characteristics of the Flourishing Scale-Spanish Version (FS-SV). The factorial structure in two samples: Students and patients with chronic pain. Personality and Individual Differences 2017. [DOI: 10.1016/j.paid.2017.05.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bendayan R, Ramírez-Maestre C, Ferrer E, López A, Esteve R. From acute to chronic back pain: Using linear mixed models to explore changes in pain intensity, disability, and depression. Scand J Pain 2017; 16:45-51. [PMID: 28850411 DOI: 10.1016/j.sjpain.2017.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/03/2017] [Accepted: 02/21/2017] [Indexed: 02/05/2023]
Abstract
Abstract
Background/aims
This longitudinal study investigated the pattern of change in pain intensity, disability, and depression in 232 chronic pain patients who were followed up for 2 years since pain onset. Most studies that have investigated changes in these variables over time have used participants who had already been in pain for more than 3 months. Few studies have followed up individuals from the acute phase onward and such studies used traditional statistical methods that cannot identify transition points over time or measure inter-individual variability.
Methods
We followed up individuals with chronic pain from pain onset up to 18 months and we examined their pain intensity, disability and depression trajectories using a modelling approach that allows to account for between and within-individual variability. We compared three patterns of change based on theoretical criterions: a simple linear growth model; a spline model with a 3-month transition point; and a spline model with a 6-month transition point. Time with pain was selected as time metric to characterise the change in these variables in the transition from acute to chronic pain. Sex and age differences were also examined.
Results
The results showed that the pain intensity trajectory was best represented by the spline model with a 3-month transition point, whereas disability and depression were best explained by linear growth models. There were sex differences at intercept level in all the models. There were age differences at baseline for pain intensity. No sex or age differences were found for the slope.
Conclusions
Pain intensity decreased in the first 3 months but underwent no further change. Disability and depression slightly but constantly decreased over time. Although women and older individuals are more likely to report higher pain intensity or pain-related disability in the first three months with pain, no differences by sex or age appear to be associated with the changes in pain intensity, depression and disability through the process of chronification.
Implications
Our findings suggest that pain chronification could be considered a continuous process and contribute to the ongoing discussion on the utility of standard classifications of pain as acute or chronic from a clinical point of view. Clinical and intervention decisions based in these standard classifications should consider the differences in the trajectories of pain related variables over time. In addition, this article illustrates a statistical procedure that can be of utility to pain researchers.
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Affiliation(s)
- Rebecca Bendayan
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain; MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, United Kingdom.
| | - Carmen Ramírez-Maestre
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis, One Shields Ave., Davis, CA 95616-8686, United States
| | - Alicia López
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
| | - Rosa Esteve
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
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Esteve R, López-Martínez AE, Peters ML, Serrano-Ibáñez ER, Ruíz-Párraga GT, González-Gómez H, Ramírez-Maestre C. Activity Pattern Profiles: Relationship With Affect, Daily Functioning, Impairment, and Variables Related to Life Goals. J Pain 2017; 18:546-555. [PMID: 28063959 DOI: 10.1016/j.jpain.2016.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/20/2016] [Accepted: 12/18/2016] [Indexed: 02/05/2023]
Abstract
The aim of this cross-sectional study was to identify subgroups of patients on the basis of their activity patterns and to investigate their relationship with life goals, optimism, affect, and functioning. The sample was comprised of 276 patients with chronic musculoskeletal pain. Hierarchical cluster analysis was performed on the activity pattern variables and the resulting clusters were compared using 1-way analysis of variance. The 4-cluster was the optimal solution. The 4 clusters comprised: 1) avoiders: patients with high levels of avoidance and low levels of persistence, who use pacing to reduce pain, 2) doers: patients with high levels of persistence and low levels of pacing and avoidance, 3) extreme cyclers: patients with high levels of avoidance and persistence and low levels of pacing, and 4) medium cyclers: patients with moderately high levels of avoidance and persistence and high levels of pacing. Comparison of the clusters showed that doers had the most adaptive profile, whereas avoiders, followed by extreme cyclers, had unhealthy profiles. Doers showed a high level of optimism and a good balance between goal value, expectancy, and conflict. PERSPECTIVE It is useful to distinguish profiles on the basis of various activity patterns. In contrast to profiles characterized by avoidance, profiles characterized by high persistence and low avoidance were associated with adaptive results. Patients with this profile also showed a high level of optimism and a good balance between goal value, expectancy, and conflict.
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Affiliation(s)
- Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain.
| | | | - Madelon L Peters
- Maastricht University, Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, The Netherlands
| | | | - Gema T Ruíz-Párraga
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | - Henar González-Gómez
- Unidad de Rehabilitación de la Unidad de Gestión Clínica Carihuela, Torremolinos, Málaga, Spain
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Serrano-Ibáñez ER, López-Martínez AE, Ramírez-Maestre C, Ruiz-Párraga GT, Esteve Zarazaga R. El papel de los sistemas de aproximación e inhibición conductual (SAC/SIC) en la adaptación psicológica al dolor crónico. Rev Soc Esp Dolor 2017. [DOI: 10.20986/resed.2017.3602/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Peters ML, Esteve R, Ramírez-Maestre C, López-Martínez AE. Response to Andrews and Deen on Defining Activity Pacing. J Pain 2016; 17:1363-1364. [PMID: 27890166 DOI: 10.1016/j.jpain.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/07/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Madelon L Peters
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Rosa Esteve
- Faculty of Psychology, University of Málaga, Málaga, Spain
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López-Martínez AE, Serrano-Ibáñez ER, Ruiz-Párraga GT, Gómez-Pérez L, Ramírez-Maestre C, Esteve R. Physical Health Consequences of Interpersonal Trauma: A Systematic Review of the Role of Psychological Variables. Trauma Violence Abuse 2016; 19:305-322. [PMID: 27456113 DOI: 10.1177/1524838016659488] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Interpersonal forms of trauma are among the most commonly reported traumas. These types of traumas are more damaging to well-being than noninterpersonal forms. They have also been strongly associated with somatic symptoms and more general physical health problems. Nevertheless, the results of trauma studies are mixed and suggest that pathways may vary according to the stressors, mediators, and health outcomes investigated. This article presents a systematic qualitative review of published studies that have investigated interpersonal trauma, its association with physical health, and the potential role of intervening psychological variables. A systematic search was made of four psychology and health electronic databases. Of the 863 studies reviewed, 50 were preselected, 11 of which met the inclusion and methodological quality criteria. All but one study had a cross-sectional design. The findings showed that childhood trauma exposure was the most common category of interpersonal trauma addressed in the reviewed studies and that the physical health variables investigated were diverse. The psychological variables most frequently investigated in the studies were posttraumatic stress disorder, depression, dissociation, and substance abuse. Overall, the results suggest that interpersonal trauma exposure is associated with poorer physical health; however, the role of intervening psychological variables remains unclear. The limitations of the reviewed literature are discussed, and methodological recommendations are made for future research.
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Affiliation(s)
- Alicia E López-Martínez
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Elena R Serrano-Ibáñez
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Gema T Ruiz-Párraga
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Rosa Esteve
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
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Esteve R, Ramírez-Maestre C, Peters ML, Serrano-Ibáñez ER, Ruíz-Párraga GT, López-Martínez AE. Development and Initial Validation of the Activity Patterns Scale in Patients With Chronic Pain. J Pain 2015; 17:451-61. [PMID: 26724275 DOI: 10.1016/j.jpain.2015.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/05/2015] [Accepted: 12/05/2015] [Indexed: 02/05/2023]
Abstract
UNLABELLED Several self-report measures were used to identify 6 activity patterns in chronic pain patients: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. Instruments for assessing pacing should include 3 pacing behaviors (breaking tasks into smaller tasks, taking frequent short rests, slowing down), each of which relate to a single goal (increasing activity levels, conserving energy for valued activities, and reducing pain). This article presents the Activity Patterns Scale (APS), which assesses these 6 activity patterns. Study 1 included 291 participants with chronic pain, and tested 3 structures using confirmatory factor analyses. The structure with the best fit had 8 factors corresponding to the hypothesized scales. High correlations in the expected direction were found between the APS subscales and the "Patterns of Activity Measure-Pain." Study 2 included 111 patients with chronic pain, and aimed at examining the association between the APS subscales and adjustment to pain. It was found that that activity avoidance was associated with daily functioning and impairment. Negative affect was positively associated with activity avoidance and excessive persistence, and negatively associated with task-contingent persistence, which was also positively associated with positive affect. This study showed that the APS is a valid and reliable instrument for clinical practice and research. PERSPECTIVE This article presents a valid and reliable instrument to assess activity patterns in patients with chronic pain. The findings suggest that avoidance, persistence, and pacing are multidimensional constructs. Distinguishing between these dimensions sheds light on previous contradictory results and has direct clinical implications regarding recommending the most advisable activity patterns.
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Affiliation(s)
- Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain.
| | | | - Madelon L Peters
- Maastricht University, Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, Maastricht, The Netherlands
| | | | - Gema T Ruíz-Párraga
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
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Ruiz-Párraga GT, López-Martínez AE, Esteve R, Ramírez-Maestre C, Wagnild G. A confirmatory factor analysis of the Resilience Scale adapted to chronic pain (RS-18): new empirical evidence of the protective role of resilience on pain adjustment. Qual Life Res 2014; 24:1245-53. [PMID: 25377350 DOI: 10.1007/s11136-014-0852-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Recent attention has focused on resilience as an important process in the experience and management of chronic pain. In this context, resilience is considered as a psychological factor that promotes adaptive responses to pain and pain-related life adversities. Current research suggests that it is a relevant variable in the prediction of pain adjustment among chronic pain patients. Recently, it was adapted the Resilience Scale to patients suffering chronic musculoskeletal pain (RS-18). The aims of this study were to confirm the internal structure of the RS-18 and to present new empirical evidence regarding its validity. METHODS A sample of 592 patients with chronic musculoskeletal back pain completed a battery of instruments to assess resilience, anxiety sensitivity, catastrophizing, fear-avoidance beliefs, hypervigilance, pain acceptance, and pain adjustment variables (pain intensity, emotional distress, functional impairment, and daily functioning). RESULTS Confirmatory factor analysis supported the validity of the RS-18 and a single-factor solution. A series of moderated multiple regression analysis showed that resilience is a relevant psychological variable that not only independently predicts better pain adjustment, but also moderates the relationships between several psychological pain-related variables and pain adjustment variables. CONCLUSIONS These findings give empirical support to the consideration of resilience as a protective variable in chronic pain adjustment and highlight the consideration that improving resilient behaviour could be an important target for the treatment of pain patients.
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Affiliation(s)
- Gema T Ruiz-Párraga
- Universidad de Málaga, Department of Personality, Assessment and Psychological Treatment, Málaga, Spain
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Ramírez-Maestre C, Esteve R. The Role of Sex/Gender in the Experience of Pain: Resilience, Fear, and Acceptance as Central Variables in the Adjustment of Men and Women With Chronic Pain. The Journal of Pain 2014; 15:608-618.e1. [DOI: 10.1016/j.jpain.2014.02.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/09/2014] [Accepted: 02/19/2014] [Indexed: 12/26/2022]
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Ramírez-Maestre C, Esteve R, López-Martínez A. Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain. Ann Behav Med 2014; 48:402-10. [PMID: 24722965 DOI: 10.1007/s12160-014-9619-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain,
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López-Martínez AE, Ramírez-Maestre C, Esteve R. An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models. Eur J Pain 2014; 18:1129-38. [PMID: 24677331 DOI: 10.1002/j.1532-2149.2014.00459.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models. METHODS Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale. RESULTS Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance. CONCLUSIONS This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.
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Affiliation(s)
- A E López-Martínez
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, University of Málaga, Spain
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Esteve R, Marquina-Aponte V, Ramírez-Maestre C. Postoperative Pain in Children: Association Between Anxiety Sensitivity, Pain Catastrophizing, and Female Caregivers' Responses to Children's Pain. The Journal of Pain 2014; 15:157-68.e1. [DOI: 10.1016/j.jpain.2013.10.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/12/2013] [Accepted: 10/06/2013] [Indexed: 01/27/2023]
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Esteve R, Ramírez-Maestre C. Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients. Ann Behav Med 2013; 46:169-80. [DOI: 10.1007/s12160-013-9499-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071 Málaga, Spain.
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