Implicit associations between pain and self-schema in patients with chronic pain

Chronic pain often interferes with daily functioning, and may become a threat to an individual’s sense of self. Despite the development of a recent theoretical account focussing upon the relationship between the presence of chronic pain and a person’s self, research investigating this idea is limited. In the present study we aimed to (1) compare the strength of association between self- and pain schema in patients with chronic pain and healthy control subjects and (2) research whether the strength of association between self- and pain-schema is related to particular pain-related outcomes and individual differences of patients with chronic pain. Seventy-three patients with chronic pain (M_age = 49.95; SD = 9.76) and 53 healthy volunteers (M_age = 48.53; SD = 10.37) performed an Implicit Association Test (IAT) to assess the strength of association between pain- and self-schema. Patients with chronic pain also filled out self-report measures of pain severity, pain suffering, disability, depression, anxiety, acceptance, and helplessness. Results indicated that the pain- and self-schema were more strongly associated in patients with chronic pain than in healthy control subjects. Second, results indicated that, in patients with chronic pain, a stronger association between self- and pain-schema, as measured with the IAT, is related to a heightened level of pain severity, pain suffering, anxiety, and helplessness. Current findings give first support for the use of an IAT to investigate the strength of association between self- and pain-schema in patients with chronic pain and suggest that pain therapies may incorporate techniques that intervene on the level of self-pain enmeshment.     

The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy

The aim of this study was to determine the extent to which a number of distinct cognitive factors were differentially related to the levels of pain and disability reported by 183 chronic low back pain (CLBP) patients presenting for physiotherapy. After adjusting for demographics, the cognitive factors accounted for an additional 30% of the variance in pain intensity, with functional self-efficacy (beta=-0.40; P<0.001) and catastrophizing (beta=0.21; P<0.01) both uniquely contributing to the prediction of outcome. The cognitive factors also explained an additional 32% of the variance in disability after adjusting for demographics and pain intensity (total R(2)=0.61). Higher levels of functional self-efficacy (beta=-0.43; P<0.001) and lower levels of depression (beta=0.23; P<0.01) were uniquely related to lower levels of disability. Our findings clearly show that there is a strong association between cognitive factors and the levels of pain and disability reported by CLBP patients presenting for physiotherapy. Functional self-efficacy emerged as a particularly strong predictor of both pain intensity and disability. In view of our findings it would seem that targeting specific cognitive factors should be an integral facet of physiotherapy-based treatments for CLBP.     

规范化管理在外科手术后疼痛病人中的应用

[目的]探讨规范化管理在外科手术后疼痛病人中应用。[方法]将240例在我院行手术的病人随机分为两组,每组各120例,观察组对护理人员进行疼痛知识培训并采用规范化疼痛护理管理方法,对照组采用传统的护理方法。[结果]观察组疼痛持续时间、住院天数小于对照组（P〈0.01）,出院时满意度大于对照组（P〉0.05）。[结论]疼痛病人中实施规范化管理,能提高护理人员对疼痛的认识,减少病人痛苦,提高病人满意度。     

规范化管理在外科手术后疼痛病人中的应用

[目的]探讨规范化管理在外科手术后疼痛病人中应用。[方法]将240例在我院行手术的病人随机分为两组,每组各120例,观察组对护理人员进行疼痛知识培训并采用规范化疼痛护理管理方法,对照组采用传统的护理方法。[结果]观察组疼痛持续时间、住院天数小于对照组(P<0.01),出院时满意度大于对照组(P>0.05)。[结论]疼痛病人中实施规范化管理,能提高护理人员对疼痛的认识,减少病人痛苦,提高病人满意度。     

The persistence of pain behaviors in patients with chronic back pain is independent of pain and psychological factors

The primary purpose of the present study was to examine the temporal stability of communicative and protective pain behaviors in patients with chronic back pain. The study also examined whether the stability of pain behaviors could be accounted for by patients’ levels of pain severity, catastrophizing, or fear of movement. Patients (n = 70) were filmed on two separate occasions (i.e., baseline, follow-up) while performing a standardized lifting task designed to elicit pain behaviors. Consistent with previous studies, the results provided evidence for the stability of pain behaviors in patients with chronic pain. The analyses indicated that communicative and protective pain behavior scores did not change significantly from baseline to follow-up. In addition, significant test-retest correlations were found between baseline and follow-up pain behavior scores. The results of hierarchical multiple regression analyses further showed that pain behaviors remained stable over time even when accounting for patients’ levels of pain severity. Regression analyses also showed that pain behaviors remained stable when accounting for patients’ levels of catastrophizing and fear of movement. Discussion addresses the potential contribution of central neural mechanisms and social environmental reinforcement contingencies to the stability of pain behaviors. The discussion also addresses how treatment interventions specifically aimed at targeting pain behaviors might help to augment the overall impact of pain and disability management programs.     

The beliefs of people with chronic pain in relation to 'important' treatment components.

BACKGROUND: The beliefs of people with chronic pain (service users) about the importance of treatment components offered through both multidisciplinary and other types of chronic pain programmes are not widely examined in the literature. AIM AND METHOD: As part of a wider research study of the congruence between what service providers and service users believe to be important treatments for chronic pain, members of three chronic pain support groups located in the North-West region of England were surveyed. The survey asked service users' opinion about whether specific treatment components are important or not important for people with chronic pain. The survey also included Skevington's Beliefs About Pain Control Questionnaire (BPCQ) that measures beliefs in the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events. RESULTS AND CONCLUSION: Findings show that no treatment components were endorsed as important by more that 67% of the participants. Endorsements clustered around treatments that focused on self-management and biomedical interventions. A statistically significant relationship emerged between certain treatment components and BPCQ scores. These findings contribute to the growing cautions regarding standardised, 'one-size-fits all' treatment programs and the mistake of assuming people with pain form a homogenous group.     

Reliability and validity of the Japanese-language version of the physical performance test (PPT) battery in chronic pain patients

Purpose.?To prepare a Japanese-language version of the Physical Performance Test (PPT) Battery and assess its reliability and validity.

Method.?Activity limitations by pain were evaluated by means of the Japanese-language version of the PPT Battery in 82 patients with chronic pain in the limbs and trunk. Two self-report questionnaires, one related to sensory evaluation of pain, and the other related to affective evaluation of pain, and the Functional Independence Measure (FIM), which evaluates activities of daily living, were simultaneously administered to the subjects.

Results.?The results for reliability showed that the ICC values for inter-rater reliability and intra-rater reliability were 0.91 or more for every item. The results for validity showed significant associations between the scores for all of the items on the Japanese-language version of the PPT Battery and the total scores on the FIM (p < 0.01). Significant associations were found between 5 of the 8 items on the Japanese-language version of the PPT Battery and affective state due to the pain.

Conclusions.?The Japanese-language version of the PPT Battery was shown to possess adequate reliability and validity as a scale for evaluating the activity limitations of patients with chronic limb or trunk pain. The results also suggested that it might be possible to improve the activity limitations of patients with chronic pain by improving their affective state in response to the pain.     

Adaptations to pain rehabilitation programmes for non-native patients with chronic pain

Purpose.?(i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place.

Subjects.?Rehabilitation institutes and rehabilitation departments of general hospitals in The Netherlands who offer a pain rehabilitation programme.

Method.?A questionnaire was handed over in person or by e-mail to the rehabilitation physicians of the participating institutes. Twenty-seven (90%%) questionnaires were returned. The questionnaire concerned programme adaptations and institute characteristics. The data were analysed by χ² tests or Fischer's exact tests and logistic regression analysis.

Results.?Twelve institutes (44.4%%) reported having adaptations in place for non-native patients in their pain rehabilitation programme. The most common adaptations were as follows: increased number of consultations (25.9%% of the institutes); longer consultations (25.9%%) and education for employees regarding cultural competency (11.1%%). Institutes which treated a high percentage (≥11%%) of non-native patients had implemented significantly more frequently adaptations to their rehabilitation programme (p == 0.04). The number of adaptations was neither associated with the proportion of non-native citizens in the local population nor with the number of the institutes' employees.

Conclusion.?Less than half of the institutes had implemented one or more programme adaptations for non-native patients. Institutes which had made adaptations to their rehabilitation programme treated more non-native patients.     

The relation of social support and depression in patients with chronic low back pain

Purpose: Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP.

Method: Patients with LBP (n?=?483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression.

Results: More social support (overall functional social support) at baseline was associated with recovery from depression (OR?=?0.24; 95% CI 0.10, 0.55) and less depressive symptoms (β?=?1.68; 95% CI?=?0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes.

Conclusions: Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation.

• Implications for Rehabilitation

• Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes.

• This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems.

• Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.

     

A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain

This study examined the relationships between self-report of depressive symptoms, perceived disability, and physical performance among 267 persons with chronic pain. Prior research has reported a relationship between depression and disability using self-report measures. However, self-report instruments may be prone to biases associated with depression as depressed persons with pain may have an exaggerated negative view of their level of function. In addition, we examined whether the relationship between depression and functional activity was mediated by physiologic effort (as measured by heart rate). The results indicated that self-report of depressive symptoms (using the Center for Epidemiological Studies-Depression Scale (CES-D)) was significantly correlated with self-report of disability on the Quebec Back Pain Disability Scale (QBPDS) and physical performance on the Progressive Isoinertial Lifting Evaluation (PILE). Regression analyses revealed that depression assessed by the CES-D significantly contributed to the prediction of QBPDS scores and PILE performance even when controlling for age, gender, site of pain, and pain intensity. The magnitude of the relationships between depression and self-report and functional activity were similar, suggesting that a self-report bias associated with depression is not responsible for an observed relationship between depression and disability. Physiologic effort partially mediated the relationship between depression and physical performance. The findings further highlight the importance of depression in the experience of chronic pain.     

疼痛规范化护理管理对肝癌患者术后疼痛及睡眠状况的改善效果

目的 探讨疼痛规范化护理管理对肝癌患者术后疼痛及睡眠状况的改善效果.方法 回顾性分析2016年7月至2020年3月我院收治的行手术治疗的46例肝癌患者的临床资料,根据护理方法的不同将其分为对照组(23例,常规护理管理)和观察组(23例,疼痛规范化护理管理).比较两组的护理效果.结果 护理后,观察组NRS评分低于对照组,...     

Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain

Purpose: To explore the change in kinesiophobia in relation to activity limitation after a multidisciplinary rehabilitation programme in patients with chronic back pain. Method: A prospective cohort study was made including 265 patients. Data were collected at baseline, after rehabilitation, and at 6-months follow-up. Outcome measures were the Tampa Scale for kinesiophobia (TSK) and the disability rating index (DRI). The smallest detectable change (SDC) in TSK was set to 8 scores. Relationships between kinesiophobia and activity limitation/physical ability were explored with regard to subgroups with high, medium and low baseline TSK scores, and for those patients who did or did not reach the SDC in TSK. Results: Improvements in TSK showed high effect sizes in the groups with high and medium baseline TSK scores. Improvements in DRI showed medium effect sizes in all three TSK subgroups. One third of the patients reached the SDC in TSK, and this group also improved significantly more in DRI. The correlation between change in TSK and change in DRI was low. Half of the patients with high TSK score at baseline remained having high DRI at follow-up. Conclusions: Improvement in physical ability was not related to the initial degree of kinesiophobia but to the SDC in TSK. To prevent patients with high kinesiophobia from preserving high activity limitations, it might be useful to include targeted treatment of kinesiophobia.

Implications for Rehabilitation

• Intensive multidisciplinary rehabilitation decreases kinesiophobia and activity limitation in patients with chronic back pain.

• Patients improving >8 scores on the Tampa Scale for kinesiophobia are likely to increase their physical ability.

• Patients with an initially high degree of kinesiophobia as well as a high level of activity limitation need targeted treatment of kinesiophobia to increase their physical ability.

     

Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale

Objectives:?The objective of this study was to test whether a Turkish version of the Neck Pain and Disability Scale retains its reliability and validity of the original English version.

Methods:?Sixty-one patients with chronic neck pain were enrolled in the study. The Neck Pain and Disability Scale (NPDS), the Pain Disability Index (PDI) and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbach's alpha and item-total correlation. Validity was examined by correlating the NPDS scores to the Visual Analogue Scale (VAS), PDI and HADS scores.

Results:?Cronbach's alpha value for NPDS was found to be 0.86 and this was statistically significant (p?<?0.0001). The item-total correlations of NPDS varied between 0.08 and 0.69. The cross-sectional construct validity coefficients were 0.51 for PDI, 0.45 for VAS, 0.35 and 0.33 for Hospital Anxiety and Depression Scales.

Conclusion:?Despite its major limitations, our results seem to support previous findings of the English and French versions of the Neck Pain and Disability Scale, indicating that this functional scale is valid and reliable.     

The relationship between pain,disability, quality of life and cognitive-behavioural factors in chronic back pain

Purpose: This pilot study systematically examined the correlations between the outcome variables pain intensity, disability and health-related quality of life (HRQOL) and between these outcomes and known psychological risk factors for chronic low back pain (CLBP), such as depression, trait anxiety, avoidance- and endurance-related pain responses at two different assessment points. Method: Data from 52 CLBP inpatients treated in an orthopedic clinic were investigated at two points in time: during the first days after admission and 6 months after the termination of the inpatient treatment. Bivariate relationships between pain intensity, disability, HRQOL and psychological variables were examined with the help of Pearson product moment correlations. Furthermore, the differences that exist between correlations at baseline and follow-up were tested for significance. Results: Significant and large differences were found between the correlations with low correlations at baseline and high correlations at the follow-up. Furthermore, HRQOL showed a positive correlation with endurance-related and a negative correlation with avoidance-related pain responses. Conclusions: Focusing on a systematic comparison of two significant assessment time points in CLBP with an acute exacerbation at baseline, the results of this study underlined the recurrent course of LBP. The results highlight that the assessment time points play an important role in CLBP.

Implications for Rehabilitation

• Low back pain is a major public health problem with high direct and indirect back-pain-related costs.

• Chronic low back pain is a disabling disease which restricts quality of life.

• Psychological factors may have a larger impact on disability and quality of life than pain itself.

• The recurrent course of low back pain highlights the importance of multidisciplinary pain management even during acute exacerbations of pain.

     

Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale

OBJECTIVES: The objective of this study was to test whether a Turkish version of the Neck Pain and Disability Scale retains its reliability and validity of the original English version. METHODS: Sixty-one patients with chronic neck pain were enrolled in the study. The Neck Pain and Disability Scale (NPDS), the Pain Disability Index (PDI) and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbach's alpha and item-total correlation. Validity was examined by correlating the NPDS scores to the Visual Analogue Scale (VAS), PDI and HADS scores. RESULTS: Cronbach's alpha value for NPDS was found to be 0.86 and this was statistically significant (p<0.0001). The item-total correlations of NPDS varied between 0.08 and 0.69. The cross-sectional construct validity coefficients were 0.51 for PDI, 0.45 for VAS, 0.35 and 0.33 for Hospital Anxiety and Depression Scales. CONCLUSION: Despite its major limitations, our results seem to support previous findings of the English and French versions of the Neck Pain and Disability Scale, indicating that this functional scale is valid and reliable.     

骨科慢性疼痛患者疼痛灾难化与疼痛强度、情绪状态的关系

目的 了解骨科慢性疼痛患者疼痛灾难化现状,探索疼痛强度、情绪状态与疼痛灾难化的关系。方法 采用方便抽样的方法选择某三甲医院骨科慢性疼痛患者262例作为研究对象,采用一般资料调查表、疼痛数字评分表(number rating scale,NRS)、疼痛灾难化量表(pain catastrophizing scale,PCS)、正性负性情绪量表(positive and negative affect schedule,PANAS)对其进行调查。结果 骨科慢性疼痛患者NRS、PANAS和PCS评分分别为(6.59±2.31)、(64.94±11.45)和(34.51±9.63)分。不同居住方式、是否有配偶的患者间PCS得分比较,差异均有统计学意义(t=2.021,P=0.042; t=2.724,P=0.012),PCS和NRS、PANAS-PA、PANAS-NA间的相关系数(r)分别为0.397、-0.325和0.388(均P<0.01),多元线性回归结果显示疼痛强度和情绪状态对疼痛灾难化具有预测作用。结论 骨科慢性疼痛患者疼痛强度、情绪状态和疼痛灾难化呈中等程度相关,疼痛干预、增强社会支持和负性情绪与积极心理干预是减低疼痛灾难化的可能措施。     

胶囊内镜在慢性腹痛患者中的应用价值

目的探讨胶囊内镜在慢性腹痛中的诊断价值和安全性。方法对2008年8月至2009年11月期间不明原因的慢性腹痛患者24例进行胶囊内镜检查,同期12例体检者作为对照组。观察两组患者的小肠运转时间、病变及部位、图像质量及顺应性。结果所有受检者在胶囊内镜检查过程中无任何不适和并发症,均顺利完成检查,所得图像清晰。胶囊1～3d自然排出。腹痛组小肠转运时间为（252．69±95．19）min,体检组小肠运转时间为（209．33±34．32）min。其中腹痛组4例胶囊未通过回盲瓣,体检组1例胶囊未通过回盲瓣。检出病变有胃溃疡、小肠炎症、克罗恩病、小肠NSAIDs溃疡、息肉、间质瘤及肠道寄生虫等。结论胶囊内镜检查无痛苦,成功率高,对病变检出率高,对不明原因慢性腹痛患者有较好的诊断价值。     

The relationship between self-efficacy and disability in chronic low back pain patients

This study examined the reliability of an adapted version of the Arthritis Self-Efficacy Scale in a sample of 59 chronic low back pain patients. The present study also investigated the relationship between self-efficacy and measures of disability. Regression analyses indicated a significant negative relationship between self-efficacy and low back pain disability. That is, patients who report higher levels of self-efficacy have higher activity levels (R ²=0.34,P<0.01), work more hours (R ²=0.25,P<0.01), and have lower levels of psychological distress (R ²=0.29,P<0.01), pain severity (R ²=0.46,P<0.01), and pain behavior (R ²=0.27,P<0.01) after controlling for the demographic variables of gender, duration of back pain, and having a lawyer on retainer. The results support the use of the Back Pain Self-Efficacy Scale (BPSES) as a general measure of self-efficacy in the chronic low back pain population.     

Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain

Abstract

Purpose: The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems. Methods: A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential predictors were patient characteristics, duration of complaints, baseline functioning, pain, personality, coping style, fear of movement, psychological distress and type of treatment. Outcome measures were physical functioning, mental health, pain and patient-reported effect. Multiple (logistic) regression models were used to identify predictors. Results: Patients who were more disabled and patients with more pain benefitted more from the rehabilitation treatment than less disabled patients or those with less pain. Age, work status, vitality, depression and coping style also predicted outcomes significantly. The models explained between 27 and 80% of the outcomes. There was an interaction between type of treatment, work status and the baseline pain score as regards the outcome in terms of pain. Conclusions: No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly.

• Implications for Rehabilitation

• It remains challenging to correctly predict the outcome of treatment from patients’ baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome.

• Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation.

• Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning.

• Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program.

• Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.