Predictors of psychological distress in chronic pain patients

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.     

Subjective future as a mediating factor in the relation between pain,pain-related distress and depression

The coincidence of chronic pain, psychological distress and depression has been well documented in several studies. However, there is still debate about the type of causality linking these factors and whether psychological distress and depression precede or are a consequence of pain. This study contributes to this debate through an analysis of the latent structure behind these complex concepts. To test the hypothesis that subjective future (i.e. how the pain patient perceives the future) has an impact on pain, data were analysed from 660 chronic pain patients who were tested with The Multidimensional Pain Inventory (MPI), The Symptom Distress Checklist (SCL-90) and a Future Scale, which was constructed from items of the Sense of coherence-scale. By use of path analysis and structural equation modeling (S.E.M.) four latent constructs were tested: Pain, Interference, Distress and Subjective future. The results indicated that Subjective future has a strong impact on Distress, is a mediating variable, which contributes to conceptually explaining and practically nullifying the relationship between Pain and Distress, and finally that Pain is a concept, that changes with increasing duration.     

The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain

BackgroundMusculoskeletal pain (MSP) is the largest contributor to chronic pain and frequently occurs alongside other medical comorbidities.ObjectiveExplore the relationships between the presence of pain-related comorbidities, pain intensity, and pain-related psychological distress in patients with MSP.MethodsA longitudinal assessment of individuals 18–90 years old in the Midwestern United States beginning a new episode of physical therapy for MSP. Electronic medical records were assessed the full year prior for care-seeking of diagnoses for pain-related comorbidities (anxiety, metabolic disorder, chronic pain, depression, nicotine dependence, post-traumatic stress disorder, sleep apnea, and sleep insomnia). Pain intensity and pain-related psychological distress (Optimal Screening for Prediction of Referral and Outcome - Yellow Flags tool) were captured during the physical therapy evaluation. Generalized linear models were used to assess the association between pain intensity, psychological distress, and pain-related co-morbidities. Models were adjusted for variables shown in the literature to influence pain.Results532 participants were included in the cohort (56.4% female; median age of 59 years, Interquartile Range [IQR]:47, 69). Comorbid depression (beta coefficient (β) = 0.7; 95%CI: 0.2, 1.2), spine versus lower extremity pain ((β = 0.6; 95%CI: 0.1, 1.1), and prior surgery (β = 0.8, 95%CI: 0.3, 1.4) were associated with higher pain intensity scores. No pain-related comorbidities were associated with pain-related psychological distress (yellow flag count or number of domains). Female sex was associated with less pain-related psychological distress (β = −0.2, 95%CI: −0.3, −0.02).ConclusionsDepression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.     

Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients.

This study aimed to determine whether self-efficacy beliefs mediated the relation between pain-related fear and pain, and between pain-related fear and disability in CLBP patients who exhibited high pain-related fear. In a cross-sectional design, 102 chronic low back pain (CLBP) patients completed measures for pain, disability, self-efficacy and pain-related fear (fear of movement and catastrophizing). Multistep regression analyses were performed to determine whether self-efficacy mediated the relation between pain-related fear and outcome (pain and/or disability). Self-efficacy was found to mediate the relation between pain-related fear and pain intensity, and between pain-related fear and disability. Therefore, this study suggests that when self-efficacy is high, elevated pain-related fear might not lead to greater pain and disability. However, in instances where self-efficacy is low, elevated pain-related fear is likely to lead to greater pain and disability. In view of these findings, we conclude that it is imperative to assess both pain-related fear and self-efficacy when treating CLBP patients with high pain-related fear.     

Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members

The impact of pain beliefs on coping and adjustment is well established. However, less is known about how beliefs unrelated to pain might impact upon this experience. In particular, just world beliefs could impact upon and be influenced by chronic pain, given that pain is not experienced in a vacuum but instead is experienced in a social context where justice issues are potentially salient. The focus of this study was the ability of personal and general just world beliefs to moderate the relationships psychological distress held with pain intensity and disability in chronic pain. The sample (N = 95) was recruited from members of arthritis and fibromyalgia support groups to investigate these social beliefs in a controlled community pain context. A cross‐sectional, questionnaire design was adopted. The personal just world belief was endorsed significantly more than the general just world belief, and endorsement of the personal just world belief was negatively correlated with pain intensity, disability and psychological distress, while the general just world belief was unrelated to these variables. When interaction terms relating to personal and general just world beliefs were entered simultaneously into regression analyses, the personal just world belief did not predict psychological distress. However, pain intensity positively predicted psychological distress at low but not high levels of the general just world belief, while disability predicted psychological distress at low and high levels of this belief. This suggests that a strong general just world belief has implications for psychological well‐being in chronic pain, and as such this belief may occupy a potential coping function in this context.     

景观疗养对改善心理痛苦的作用

目的了解景观疗养对心理痛苦的缓解作用。方法使用ＳＣＬ—９０为疗效评价标准，对来院疗养的１０２例疗养员作疗养前后的对照研究，疗养期间维持原有治疗，仅加景观疗养。结果疗养员经景观疗养后心理痛苦较疗养前明显改善（Ｐ＜０．００１），高分组较低分组疗效更明显（Ｐ＜００１）。结论景观疗养能改善心理痛苦，且心理痛苦越大，疗养效果越明显。     

Lymphedema complicated by pain and psychological distress: A case with complex treatment needs

One complication of breast cancer treatment is lymphedema of the ipsilateral arm. The one-third of lymphedema patients who experience pain report more functional interference, psychiatric symptoms, and distress related to intrusive and avoidant thoughts than patients without pain. Lymphedema patients with pain also report higher levels of body image disturbance and decreased sexual drive. We present a case example illustrating how pain can undermine rehabilitative efforts and detract from quality of life. In addition, the most common causes of pain in patients with upper extremity lymphedema are discussed. Pain related to lymphedema is a neglected aspect of this often overlooked problem in breast cancer survivorship.     

Effects of pain-related catastrophic thinking,anxiety, and depression on pain intensity and quality of life in patients with knee and low back pain

[Purpose] We aimed to examine the effects of pain-related catastrophic thoughts and anxiety/depression on pain intensity and quality of life (QOL), and how these effects (relationships) vary with pain location, in outpatients with chronic pain. [Participants and Methods] We recruited 14 participants with low back pain (2 males and 12 females) and 14 with knee joint pain (3 males and 11 females). We used the following evaluation tools: the visual analog scale (to evaluate pain intensity), pain catastrophizing scale (in which scores are categorized into helplessness, rumination, and magnification), Hospital Anxiety and Depression Scale (for psychodynamic evaluation), and a questionnaire for QOL evaluation. [Results] There was no difference in pain intensity between the groups. The “low back pain” group showed a positive correlation between pain intensity and anxiety, while the “knee pain” group showed a positive correlation between pain intensity and helplessness. The “low back pain” group showed a negative correlation between health in QOL assessment items and helplessness, and between health and magnification. However, in the “knee pain” group, there was a negative correlation between health and rumination, between health and anxiety, and between positive mental attitude and magnification. [Conclusion] Mental status varied depending on the pain location, regardless of the intensity of the pain. This suggests that a psychological approach dependent on pain location is needed during physical therapy.     

Decline in physical activity, disability and pain-related fear in sub-acute low back pain.

AIM OF INVESTIGATION: To evaluate whether a perceived decline in the level of physical activity after the onset of pain (PAD) is more appropriate in the explanation of disability as compared to the actual level of physical activity (PAL) in patients with sub-acute back pain. METHODS: Patients with 4-7 weeks of non-specific low back pain (LBP) participated in this study. Their habitual physical activity level before the back pain started (H-PAL), their actual level of physical activity (PAL) and their perceived decline in the level of physical activity after the onset of pain (PAD) were assessed. The association between these physical activity related variables and perceived disability (QBPDS), fear of movement/(re)injury (TSK), pain catastrophizing (PCS) and pain intensity (VAS) was examined. The role of PAD as a mediator in the association between fear of movement/(re)injury and disability was examined by three linear regression analyses. RESULTS: 123 patients (66 male and 57 female) with a mean age of 44.1 years (SD=10.3) participated in this study. PAD was significantly correlated with disability, fear of movement/(re)injury, pain catastrophizing and pain intensity. PAD and PAL appeared more important in the explanation of disability in the subgroup of patients who were physically active before their back pain started. Generally, PAD indeed mediated the association between fear of movement/(re)injury and disability. CONCLUSIONS: The perceived decline in physical activity, rather than the current physical activity itself is important in the evaluation of the impact of activity related changes on disability in low back pain.     

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Introduction: The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test–retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion: The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables.

Implications for Rehabilitation

• Psychological distress is a relevant problem in rheumatoid arthritis patients and should be recognized early in the disease as it might reflect a lack of social resources which can be crucial in the further course of the disease.

• Special attention should be paid to different types of social support in relation to psychological distress, which might improve targeting psychosocial interventions.

     

Sleep patterns and psychological distress in women living in an inner city

Psychological distress, including symptoms of anxiety, depression, and psychological trauma, is common in women living in inner cities and can be associated with disturbed sleep. The purposes of the study of 115 women were to examine: (a) objective and subjective sleep patterns; (b) extent of psychological distress; and (c) the relationship between objective and subjective sleep patterns and psychological distress. Wrist actigraphs were worn. High levels of life stress, sleep pattern disturbance, and psychological distress were common. Self‐reported sleep patterns, but not objective sleep pattern variables, explained 12.5% to 44% of the variance in psychological distress, suggesting the importance of screening for sleep and psychological distress. These findings suggest that interventions focusing on sleep or psychological distress may reduce symptoms. © 2008 Wiley Periodicals, Inc. Res Nurs Health 32:177–190, 2009     

The assessment of psychological distress.

This paper describes the assessment of psychological distress symptoms in the hospitalized physically ill elderly using a screening instrument known as the Comprehensive Psychopathological Rating Scale (CPRS) (Asberg et al. 1978). The methodological properties of this scale and a subscale known as the Montgomery Asberg Depression Scale (MADRS) (Montgomery-Asberg 1979) are discussed. It is suggested that the introduction of these scales into routine nursing practice would facilitate the identification and collection of psychological distress symptoms in this population and serve as a basis for nursing intervention and evaluation.     

Catastrophizing is associated with pain intensity,psychological distress,and pain-related disability among individuals with chronic pain after spinal cord injury

Little research has examined the role of patient cognitive and behavioral responses, including catastrophizing, in adjustment to chronic pain associated with spinal cord injury (SCI). The objective of this study was to examine the associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain and SCI, after controlling for important demographic and SCI-related variables that might affect outcomes. Participants in this study were 174 community residents with SCI and chronic pain who completed a mailed questionnaire that included the SF-36 Mental Health scale, Coping Strategies Questionnaire, and Graded Chronic Pain Scale. The pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables (P<0.001). The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress (P<0.001) and 11% of the variance in pain-related disability (P<0.001), after controlling for pain intensity and demographic and SCI variables. Catastrophizing, but not any other single pain coping strategy, was consistently strongly and independently associated with the outcome measures. Potentially, the assessment and treatment of catastrophizing may reduce psychological distress and pain-related disability among individuals with chronic pain and SCI.     

正念减压疗法在癌症患者心理困扰中的应用进展

癌症患者普遍存在心理困扰,正念减压疗法(mindfulness-based stress reduction,MBSR)因具备诸多优势而被广泛用于肺癌患者心理困扰的干预。本文介绍了癌症患者心理困扰及MBSR的相关知识、MBSR在癌症患者心理困扰中的应用以及MBSR用于癌症患者心理困扰的机制。     

脑卒中患者心理困扰现状研究进展

心理困扰在脑卒中患者中普遍存在,在卒中后急性期和恢复期均可发生,并可长期存在,严重影响了患者的康复进程及生活质量,甚至增加卒中复发及死亡的风险.因此,尽早进行脑卒中患者心理困扰的评估,确定心理问题并实施有效的干预是预防疾病恶化及改善不良结局的关键.笔者从脑卒中患者心理困扰的现状、影响因素、测量工具及干预措施等方面进行综...