Empirical evidence of the validity of the Spanish version of the pain vigilance awareness questionnaire

Background

The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated.

Purpose

The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity.

Method

A sample of 468 chronic back pain patients completed a battery of instruments to assess fear-avoidance beliefs, pain anxiety, pain catastrophizing, pain vigilance and awareness, pain acceptance, depression, anxiety, disability, and pain intensity.

Results

Confirmatory factor analysis supported the validity of a nine-item version with two subscales: Active Vigilance and Passive Awareness. Both subscales and the total score were positively and significantly correlated with other fear-related constructs: fear-avoidance beliefs, pain anxiety, and pain catastrophizing. Regression analyses showed that Active Vigilance and the two subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with higher anxiety and that the Acceptance Activity Engagement subscale was significantly associated with lower anxiety. The Fear-Avoidance Beliefs Questionnaire–Physical subscale was associated with higher disability and the Acceptance Pain Willingness subscale was associated with lower disability. The Fear-Avoidance Beliefs Questionnaire–Work subscale was significantly associated with higher pain intensity and depression; the Acceptance Activity Engagement and Pain Willingness subscales were significantly associated with lower pain intensity and depression.

Conclusion

The Spanish version of the Pain Vigilance and Awareness Questionnaire is a reliable and valid instrument. Pain Acceptance and Fear Avoidance beliefs are better predictors of adjustment to pain than pain hypervigilance.     

Chronic pain,impact of pain and pain severity with physical disability in older people—Is there a gender difference?

ObjectiveTo establish if there is any gender difference in associations between chronic pain, impact of pain and pain severity with physical disability.MethodsData from the New South Wales Older People's Health Survey (OPHS), a population based survey of 8881 older people aged 65 years and above were used in the analysis. Chronic pain, pain with interference and pain severity and outcome variable of physical disability were all measured and determined by self report.ResultsPhysical disability were more frequent in respondents reporting chronic pain, pain that interferes with activities and pain that was of moderate and strong to severe severity. Chronic pain was significantly associated with physical disability among men with adjusted prevalence ratio (PR) 1.31 (95% CI 1.19, 1.43) and women with adjusted prevalence ratio (PR) 1.34 (95% CI 1.28, 1.42). The relationships between pain with interference and pain severity with physical disability were similar in older men and older women. However, adjustment for psychological distress and self-rated health led to greater reductions in prevalence ratios for older men than women for all associations.ConclusionThere is no gender difference in associations between pain and physical disability among older people. However, psychological distress accounted for more pain-related physical disability in men than in women.     

Prevalence and correlates of clinical insomnia co-occurring with chronic back pain

Given the suggestion of a reciprocal relationship between sleep and pain and the recognition of sleep as an important parameter in determining quality of life, there is increasing research interest in sleep disturbance linked to chronic pain. The present study aimed to provide an estimate of the prevalence of 'clinical insomnia' in patients attending a specialist pain clinic and identify factors associated with it. Seventy chronic back pain patients and 70 gender- and age-matched pain-free controls completed a set of questionnaires measuring sleep (Insomnia Severity Index; ISI), pain (Short-Form McGill Pain Questionnaire) and a selection of general and specific psychological variables (Hospital Anxiety and Depression Scale, Short Health Anxiety Inventory). Scores suggestive of clinical insomnia (ISI > or = 15) were noted in 53% of chronic pain patients, when compared with only 3% in pain-free controls. Significant positive correlations with insomnia severity were detected for all six variables of interest (pain intensity, sensory pain ratings, affective pain ratings, general anxiety, general depression and health anxiety). Affective pain ratings and health anxiety were the best predictors of insomnia severity in this sample, accounting for 30% of the total variance, even when present pain intensity was controlled for. Affective pain remained as a significant predictor of insomnia severity when both the effect of pain intensity and the effects of anxiety and depression were controlled for. Future research should consider investigating the role of pain appraisal and health anxiety in the development and manifestation of insomnia concomitant to chronic pain.     

Chronic low back pain and depression

It is not clear whether the psychological disturbances associated with chronic low back pain are the cause or the result of the chronicity. It is also not clear whether increasing duration of low back pain is associated with depression. Three groups of patients (N = 148), with recent (0-6 months), relatively longstanding (6-24 months) and chronic (more than 24 months) low back pain were given the MMPI, Multiple Affect Adjective Check List (MAACL), State Trait Anxiety Inventory (STAI) and Low Back Pain Questionnaire (LBPQ). Increasing chronicity is associated with significant increases on MMPI Hs, D, HY, PT and MA scales, and on STAI Trait Anxiety scale. These results suggest that chronicity leads to the development of psychopathological characteristics and that these characteristics include a heightened awareness of somatic functioning and the vegetative aspects of the depressive syndrome, but that there is no increase in depressive mood or in the perception of the pain itself.     

Acute and chronic pain: pain dimensions and psychological status

One hundred and ten outpatients with either acute or chronic low-back pain completed the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, and Life Experiences Survey. Acutes and chronics did not differ on dimensions of pain, but significant correlations between pain dimensions and depression and state anxiety were found for chronics. Both groups showed elevated state anxiety; chronics also evidenced mild depression. Combined scores on depression, anxiety, and negative life change predicted sensory and affective pain for the pooled sample. These results confirm the role of psychological variables in the experience of clinical pain and underscore the highly affective nature of chronic pain.     

Depressed mood,anxiety, and the use of labor analgesia

Relatively little is known about mental health and labor pain. The aim of this study was to assess if self-rated antenatal depressed mood and anxiety are associated with pain-related behaviors and self-reported labor pain. We also wanted to replicate our previous finding of altered labor pain behavior in carriers of a specific guanosine triphosphate cyclohydrolase 1 gene (GCH1) haplotype. Ninety-nine women in gestational weeks 37 to 40 filled out questionnaires on depression and anxiety symptoms and later rated their labor pain by use of visual analog scales. Each subject was also genotyped for GCH1. Following adjustment for relevant confounders, women who arrived early to the delivery unit (cervical dilation <5 cm) had a significantly higher antenatal Montgomery-Åsberg Depression Rating Scale (MADRS-S) score, p?<?0.05, than late arrivers (cervical dilation >5 cm). Women with increased Spielberger State-Trait Anxiety Inventory (STAI-T) scores reported higher self-rated pain prior to labor analgesia, p?<?0.05, than women with low STAI-T scores. No association between the GCH1 pain-protective haplotype and cervical dilation was found, but a previously demonstrated association with increased use of second-line analgesia was confirmed. Depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.     

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain

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.

     

A comparison of economic and social reward in patients with chronic nonmalignant back pain.

OBJECTIVE: Patients with chronic nonmalignant back pain are often exposed to multiple sources of economic and social reward. At issue in the present study was whether these rewards are 1) correlated with similar or dissimilar outcome variables and 2) able to account for unique variance in regression models of illness behavior. METHODS: A 2 x 2 factorial design was used in which patients were retrospectively assigned to one of four independent groups: low economic/low social reward, low economic/high social reward, high economic/low social reward, and high economic/high social reward. Of 265 consecutive patients enrolled at a tertiary pain service, 75 met eligibility criteria and had chronic nonmalignant back pain. RESULTS: Preexisting differences in health status were not associated with differences in illness behavior or pain ratings. With social reward held constant, patients in the high economic reward group missed more days from work (p < .005), had more domestic disability (p < .05), and were more depressed (p < .05) than patients in the low economic reward group. With economic reward held constant, patients in the high social reward group missed more days from work (p < .05), had more domestic disability (p < .01), and were more depressed (p < .01) than patients in the low social reward group. Unlike patients in the high economic reward group, however, patients in the high social reward group had higher levels of pain (p < .05) and more nonspecific medical complaints (p < .01). CONCLUSIONS: Economic and social rewards were both associated with increased disability and depression, but only social rewards were associated with increased symptom reporting. Exposure to economic and social rewards may account for unique variance in illness behavior that cannot be explained by differences in medical diagnosis, symptom duration, pain intensity, depression, or somatization.     

Racial differences in the physical and psychosocial health among black and white women with chronic pain

Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.     

Depressive symptoms and disability in acute and chronic back pain patients

Depression and level of disability are evaluated in acute and chronic low back pain (LBP) patients. To assess the possibility that some somatic symptoms are confounded with pain, the items of the Beck Depression Inventory arc divided into a cognitive-affective and somatic subscale. The sample consisted of 37 chronic LBP patients. 41 acute LBP patients, and 28 healthy participants. The level of disability was assessed by the Oswestry Low Back Pain Disability Questionnaire. Chronic LBP patients, but not acute LBP patients, have more depressive symptoms than controls. Additionally, chronic LBP patients report more somatic symptoms of depression (e.g.. emo ltional and self disturbance complaints) than cognitive-affective symptoms. Finally, correlation statistics reveal significant relations between the level of disability and depression scores. Whereas chronic patients show a significant correlation between the somatic subscale and level of disability, in acute patients the cognitive-affective subscale is significantly related to the level of disability. The findings suggest careful consideration of whether somatic symptoms of depression are related to pain when using self-report measurements of depression in pain patients. The separation of cognitive-affective and somatic symptoms of depression to evaluate pain problems seems appropriate.     

Parental reinforcement of recurrent pain: the moderating impact of child depression and anxiety on functional disability

OBJECTIVE: To examine whether children's distress moderates the relationship between parental responses to children's pain behaviors and functional disability. METHODS: Participants were 215 children (ages 8 to 16 years) diagnosed with either headaches, juvenile idiopathic arthritis, or sickle cell disease. Children and parents completed questionnaires assessing sociodemographics, pain, depression, anxiety, parental solicitous responses to pain behaviors, and functional disability. RESULTS: Hierarchical linear regressions computed for parental responses to children's pain significantly predicted child functional disability, controlling for children's pain intensity. Significant interactions between parental solicitous behaviors and child depressive symptoms (beta =.74, p <.01) and between solicitous behaviors and child anxiety symptoms (beta =.91, p <.01) indicated that for children with more psychological distress, parental solicitous behaviors were associated with greater child functional disability. CONCLUSIONS: Child psychological distress may exacerbate the impact of parental solicitous responses to pain on functioning, suggesting the potential role of family intervention to enhance optimal functioning in children with recurrent pain.     

The prevalence of anxiety disorders among patients with mitral valve prolapse syndrome and chest pain

Nineteen patients from a cardiology practice with complaints of chest pain and with mitral valve prolapse syndrome were compared with 26 patients with chest pain but no discernible cardiac disorder. Instruments included a truncated form of the Diagnostic Interview Schedule, the symptom checklist 90 revised (SCL-90-R), the McGill Pain Questionnaire, and life events, physical activity, and family history questionnaires. Neither panic disorder nor self-rated anxiety were more common in the mitral valve prolapse group. This study failed to confirm the reported high association between mitral valve prolapse syndrome and panic disorder.     

Sleep in depressed and nondepressed participants with chronic low back pain: electroencephalographic and behaviour findings

STUDY OBJECTIVES: To study the nature of sleep disturbance in depressed and nondepressed patients with chronic low back pain (CLBP). DESIGN: A controlled, consecutive 4-night polysomnographic study. PATIENTS: Participants were screened (psychologic, psychiatric, and physical) to determine their study group, and 21 participants (CLBP: 4 depressed, 6 nondepressed and 11 controls) were studied. MEASUREMENTS AND RESULTS: On all nights, standard polysomnographic sleep measures as well as midline occipital and frontal electroencephalography and respiration were recorded on a Grass Model 7 polygraph. Pain, sleep quality, and depression were also measured. Participants with CLBP reported significant levels of pain and sleep disturbance as compared to controls, but all groups had equivalent amounts of sleep and comparable sleep architecture. The electroencephalographic power spectral analyses revealed significant differences, with controls having more sigma across sites, more low beta activity occipitally and frontally than nondepressed patients with CLBP, and more occipital sigma and less high beta activity than depressed participants. Between pain subgroups, the depressed participants showed more occipital delta, more occipital and central alpha, and more high beta activity across all sites than did the nondepressed participants. CONCLUSIONS: Lower sigma power in participants with CLBP suggests less-effective sensorimotor gating that may contribute to poor sleep quality. Pain subgroup differences underscore the need to consider the influence of depression in the evaluation of sleep in clinical populations. This study controlled for many factors other than pain that may contribute to the sleep complaints in this population. Consequently, the absence of signs of major sleep disturbance must not be interpreted as evidence of a lack of a true sleep problem in CLBP but more likely reflects control of these factors as well as the difficulty in measuring sleep quality.     

Group therapy and hypnosis reduce metastatic breast carcinoma pain

The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.     

Cognitive and somatic item response pattern of pain patients, psychiatric patients, and hospital employees

Standard psychological tests generally provide a single global score that reflects multidimensional constructs, such as depression and anxiety. This single score, however, integrates a range of item contents, including cognitive/affective, somatic, and behavioral characteristics of these multidimensional constructs. The present study was designed to compare the pattern of item endorsement among chronic pain patients (N = 50), psychiatric inpatients (N = 50), and hospital employees (N = 50) on the SCL-90-R (Derogatis, Rickels, & Rock, 1976). Pain patients reported the highest SCL-90 scale level of Somatization, while the psychiatric inpatients reported the highest level of Anxiety and Depression. Additionally, the within-scale pattern of item responses on the Anxiety and Depression scales differed among groups. Although psychiatric inpatients endorsed equivalent levels of somatic and cognitive items, the pain patients' reports of psychological distress were limited primarily to somatic signs of anxiety and depression. Thus, the interpretation of pain patients' psychological profiles and subsequent treatment recommendations may be inappropriate if based on normative data obtained from psychiatric and/or normal populations.     

Illness behavior, depression and anhedonia in myofascial face and back pain patients

Levels of depression, anhedonia, and illness behavior, as well as clinical and demographic variables, were measured in two groups of patients with chronic pain, one with facial, the other with back pain. For the total sample, significant correlations (p less than 0.01) were found between illness behavior and pain estimate (r = 0.30), anhedonia and depression (r = 0.33), and pain estimate and pain duration (r = 0.31). Facial pain patients showed illness behavior most strongly related to estimate of pain severity (r = 0.62); back pain patients showed illness behavior significantly related to depression (r = 0.59). Results also show that the physical site of pain relates to illness behavior but not mood of chronic pain patients.     

Depression, mood state, and back pain during microgravity simulated by bed rest.

OBJECTIVE: The objective of this study was to develop a ground-based model for spinal adaptation to microgravity and to study the effects of spinal adaptation on depression, mood state, and pain intensity. METHODS: We investigated back pain, mood state, and depression in six subjects, all of whom were exposed to microgravity, simulated by two forms of bed rest, for 3 days. One form consisted of bed rest with 6 degrees of head-down tilt and balanced traction, and the other consisted of horizontal bed rest. Subjects had a 2-week period of recovery between the studies. The effects of bed rest on pain intensity in the lower back, depression, and mood state were investigated. RESULTS: Subjects experienced significantly more intense lower back pain, lower hemisphere abdominal pain, headache, and leg pain during head-down tilt bed rest. They had higher scores on the Beck Depression Inventory (ie, were more depressed) and significantly lower scores on the activity scale of the Bond-Lader questionnaire. CONCLUSIONS: Bed rest with 6 degrees of head-down tilt may be a better experimental model than horizontal bed rest for inducing the pain and psychosomatic reactions experienced in microgravity. Head-down tilt with balanced traction may be a useful method to induce low back pain, mood changes, and altered self-rated activity level in bed rest studies.     

Reciprocal relationship between pain and depression in older adults: evidence from the English Longitudinal Study of Ageing

BACKGROUND: Previous cross-sectional studies have shown an association between pain and depression, but it is unclear which comes first. Our objectives were to determine the temporal relationship between pain and depression, and to investigate whether these two syndromes share predictors. METHODS: A 2-year, population-based, prospective, observational study of 3654 older adults aged 65 and above selected from the English Longitudinal Study of Ageing Waves 1 and 2. Pain, 8-item CES-D, socio-economic variables, health indicators, and social support were assessed. RESULTS: Logistic regression analyses revealed that pain at baseline was an independent predictor of becoming depressed 2 years later and depression at baseline was a predictor of developing pain at 2 years. Individuals with mobility disability and poor sight were at risk of becoming depressed as well as developing pain. Moreover, older age, poor sight and mobility disability were common predictors for pain and depression after baselines of both syndromes were adjusted. CONCLUSION: Individuals who develop pain or depression are at risk for developing the other, with a spiraling risk of pain and depression. Because pain and depression share predictors, individuals who are at high risk of developing these two outcomes can be identified by aged care service practitioners.     

Kinesiophobia in chronic low back pain patients—does the startle paradigm support the hypothesis?

Pain research has shown that fear-avoidance beliefs determine disability from back pain to a significant degree. It is assumed that anxiety regarding certain movements or activities motivates avoidance behavior. It has not yet been established whether chronic low back pain (CLBP) patients actually experience fear of movement when confronted with back pain-related movements. Startle response measures reliably differentiate the affective quality of a stimulus. This study investigates whether CLBP patients show a startle response typical for aversive stimuli when confronted with pictures of back pain-related movements. In 36 patients with CLBP, 18 headache patients and 18 healthy controls, the startle response was examined in the presence of pictures of back pain-related movements (e.g., bending) and pleasant movements (e.g., taking a relaxed position). Back pain patients did not show the predicted startle potentiation when viewing back pain-related pictures, although they rated these pictures as more aversive than did the other two groups. Results may indicate that it is not fear of pain that motivates avoidance behavior and determines disability, but rather an individual’s beliefs and attitudes concerning back stressing movements.