In the face of pain: the relationship between psychological well-being and disability in women with fibromyalgia

BACKGROUND: Few studies have examined the potentially beneficial role of positive psychological functioning in individuals with chronic pain. This study examined the relationship of psychological well-being (PWB) to pain and disability in women with fibromyalgia (FM) as compared to women with rheumatoid arthritis (RA) and healthy controls (HC). We targeted several domains of PWB that have been associated with health, and also tested whether PWB was related to the women's social network. METHODS: PWB, pain, and disability were assessed in 125 women (57 with FM, 20 with RA, and 48 HC) on two occasions. RESULTS: Women with FM reported lower overall PWB than did RA and HC women. Further, greater PWB was associated with less disability and fatigue, but not pain in women with FM. Self-acceptance, environmental mastery, purpose in life, and positive relations with others emerged as four important constructs in the association between PWB and disability. In addition, PWB mediated the relationship between social network size and disability. CONCLUSIONS: This assessment of PWB provides insight into those psychological domains that should be emphasized in treatments aimed at reducing the disabling aspects of FM.     

Further development of an instrument to assess psychological flexibility in people with chronic pain

Recently, an expansion of traditional coping models for chronic pain has been offered. This model specifically includes acceptance of chronic pain, as well as the more general process of psychological flexibility. Psychological flexibility includes qualities of behavior such as acceptance and mindfulness, and the capacity to take committed and values-directed or goals-directed action, among other qualities. The present study was intended to refine and validate a measure of psychological flexibility, titled the Brief Pain Response Inventory (BPRI), and determine its relation with key indices of patient functioning. In total, 205 adults with chronic pain who were beginning a program of treatment completed a battery of self-report questionnaires. Exploratory factor analysis indicated the presence of two factors within the items of the BPRI: Flexible Action and Willing Engagement. Subscale and total scores were generally unrelated with patient background variables, although they were related to, and accounted for significant variance in, measures of emotional, physical, and psychosocial functioning. These analyses provide additional support for the relevance of psychological flexibility to the problem of chronic pain, as well as initial evidence for the BPRI as a measure of this process.     

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.     

The complex relationship between pain intensity and physical functioning in fibromyalgia: the mediating role of depression

Fibromyalgia (FM ) is typically associated with the experience of diffuse pain and physical impairment. Depression also commonly co‐exists in patients with FM and has been correlated with pain intensity and physical functioning. Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients. This may suggest that another factor such as depression is mediating this relationship. The present work examined mediating role of depression. Two hundred sixteen patients with FM completed measures of pain intensity, depression, and physical function as part of a larger longitudinal study. Assessments were completed at baseline, 12, 24, and 36 weeks. Longitudinal mediational analyses indicated that depression is a partial mediator of the relationship between pain intensity and physical functioning at all four assessment points. Beta coefficients for the path from pain to physical functioning ranged from 0.18 to 0.36, with attenuated path coefficients ranging 0.03–0.08, still showing significant but decreased associations when depression was added as a mediator. Clinical implication includes the importance of treating comorbid depression in patients with FM early in the course of treatment to prevent engagement in the cycle of disability.     

A measure to assess the workplace well‐being of psychological practitioners

The well‐being of psychological practitioners is a key factor in the effective delivery of psychological therapies and the effectiveness of mental health services. Despite this, there are no measures of well‐being for this professional group. The 26‐item psychological practitioner workplace well‐being measure (PPWWM) measures psychological well‐being for psychological practitioners and was informed by a qualitative study. Items were generated and then verified by groups of practitioners using sorting tasks. The items reflect a broad range of issues relevant to the workplace well‐being of psychological practitioners. The PPWWM was validated with a sample of 400 psychological practitioners recruited through professional networks. Internal consistency (α = .92) and test–retest reliability (r = .94) were high. Construct validity was indicated by positive correlations with the Health and Safety Executive Management Standards Indicator Tool and Satisfaction with Life Scale and negative correlation with the General Health Questionnaire. Exploratory factor analysis produced six factors, explaining 61.2% of the variance: professional and organizational; support and flexibility; professional role; physical environment; clinical supervision; and external personal. PPWWM scores were not significantly associated with a range of demographic variables (gender, health/disability, profession, and type of organization), but it did correlate significantly and negatively with age. The PPWWM has potential application as a brief measure, suitable for large‐scale surveys that specifically measures workplace well‐being in psychological practitioners. Future research could include cross validation with new samples and validation with subgroups of psychological practitioners.     

Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms

OBJECTIVE: The aim of this study was to determine illness comorbidity rates for individuals with chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS). An additional objective was to identify characteristics related to the severity of fatigue, disability, and psychiatric comorbidity in each of these illness groups. METHODS: A random sample of 18,675 residents in Chicago, Illinois, was first interviewed by telephone. A control group and a group of individuals with chronic fatigue accompanied by at least four minor symptoms associated with CFS received medical and psychiatric examinations. RESULTS: Of the 32 individuals with CFS, 40.6% met criteria for MCS and 15.6% met criteria for FM. Individuals with MCS or more than one diagnosis reported more physical fatigue than those with no diagnosis. Individuals with more than one diagnosis also reported greater mental fatigue and were less likely to be working than those with no diagnosis. Individuals with CFS, MCS, FM, or more than one diagnosis reported greater disability than those with no diagnosis. CONCLUSIONS: Rates of coexisting disorders were lower than those reported in prior studies. Discrepancies may be in part attributable to differences in sampling procedures. People with CFS, MCS, or FM endure significant disability in terms of physical, occupational, and social functioning, and those with more than one of these diagnoses also report greater severity of physical and mental fatigue. The findings illustrate differences among the illness groups in the range of functional impairment experienced.     

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds.

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.     

Empirical contributions

We investigated the association between psychological factors, physical function, and moderate levels of spinal pain. Participants were 720 people selected from a general population survey with either No Pain (n = 449) or Moderate Pain (n = 271). The Moderate Pain group reported an average intensity of 4.7 (on a 0 to 10 scale), no health care visits, and only 1 day of work absence during the past year. A questionnaire containing items about physical function, work, and psychological factors including abuse, fear-avoidance beliefs, anxiety, depression, distress, and catastrophizing was employed. A series of discriminant analyses showed that distress, perceived workload, physical function, sexual abuse, and catastrophizing were associated with moderate pain. The final solution correctly classified 77% of the participants. These findings underscore that psychological and functional factors are relevant, even for moderate pain problems and before health care or insurance authorities have become involved. Because of the cross-sectional nature of the study more work is needed to understand the process by which persistent pain and disability develop.     

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain

Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.     

A Validation and Generality Study of the Committed Action Questionnaire in a Swedish Sample with Chronic Pain

Purpose

Psychological flexibility is the theoretical model that underpins Acceptance Commitment Therapy (ACT). There is a growing body of evidence indicating that ACT is an effective treatment for chronic pain but one component of the model, committed action, has not been sufficiently researched. The purpose of this study is to validate Swedish-language versions of the full length Committed Action Questionnaire (CAQ; CAQ-18) and the shortened CAQ (CAQ-8), to examine the generality of previous results related to committed action and to further demonstrate the relevance of this construct to the functioning of patients with chronic pain.

Method

The study includes preliminary analyses of the reliability and validity of the CAQ. Participants were 462 consecutive referrals to the Pain Rehabilitation Unit at Skåne University Hospital.

Results

The Swedish-language versions of the CAQ (CAQ-18 and CAQ-8) demonstrated high levels of internal consistency and satisfactory relationships with various indices of patient functioning and theoretically related concepts. Confirmatory factor analyses showed that the Swedish versions of the CAQ yielded similar two-factor models as found in the original validation studies. Hierarchical regression analyses identified the measures as significant contributors to explained variance in patient functioning.

Conclusion

The development, translation and further validation of the CAQ is an important step forward in evaluating the utility of the psychological flexibility model to the treatment of chronic pain. The CAQ can both assist researchers interested in mediators of chronic pain treatment and further enable research on change processes within the psychological flexibility model.

     

Impact of two types of expectancy on recovery from total knee replacement surgery (TKR) in adults with osteoarthritis

This study examines the impact of 2 classes of psychological variables--expectancies for the future and self-efficacy--on recovery of function and reduction in symptomatology among individuals seeking total knee replacement surgery (TKR). The authors collected outcome measures (SF-36, WOMAC, Clinician assessments) prior to surgery, 4-6 weeks after surgery, and 6 months postsurgery for surgery patients and controls. Linear trend analyses by group gauged the impact of the surgical intervention on recovery, revealing significant improvements over time on physical health outcomes for the surgery patients not attained by controls. In addition, two classes of psychosocial variables--expectancies and efficacy beliefs--predicted the extent of gains in physical and mental health outcomes among those patients who elected to have surgery. When initial status was controlled, between 9 and 13 percent of the variance in TKR outcomes was due to expectations and efficacy. These results point to the importance of psychosocial variables in recovery of function and reduced symptoms after knee surgery.     

Pilot Study of Comprehensive Geriatric Assessment (CGA) in Allogeneic Transplant: CGA Captures a High Prevalence of Vulnerabilities in Older Transplant Recipients

Comprehensive geriatric assessment (CGA) is frequently used in oncology to measure the health status of older adults with cancer, but it has not been studied in allogeneic hematopoietic cell transplantation (HCT). We conducted a prospective pilot study of CGA in allogeneic HCT recipients aged ≥50 years to examine the prevalence of vulnerabilities in this population. Patients aged ≥50 years eligible for HCT were enrolled. CGA consisted mainly of self-reported, performance-based, and chart-extracted measures evaluating domains of comorbidity, physical and mental function, frailty, disability, and nutrition. Of 238 eligible patients, 166 completed CGA and underwent HCT. Only 1% had a Zubrod Performance Status score >1; 44% had high comorbidity defined by the Hematopoietic Cell Transplantation Comorbidity Index, and 66% had high comorbidity defined by the Cumulative Illness Rating Scale–Geriatrics. The presence of additional vulnerability was frequent. Disability was present in 40% by Instrumental Activities of Daily Living. Self-reported physical and mental function were significantly lower than population age group norms, 58% were pre-frail, and 25% were frail. Among those with Zubrod Performance Status score of 0, 28% demonstrated disability, 58% were pre-frail, 15% were frail, 35% reported low physical function, and 55% reported low mental function. CGA uncovers a substantial prevalence of undocumented impairments in functional status, frailty, disability, and mental health in older allogeneic HCT recipients.     

Trauma Sequelae are Uniquely Associated with Components of Self-Reported Sleep Dysfunction in OEF/OIF/OND Veterans

While the associations between psychological distress (e.g., posttraumatic stress disorder [PTSD], depression) and sleep dysfunction have been demonstrated in trauma-exposed populations, studies have not fully explored the associations between sleep dysfunction and the wide range of common physical and physiological changes that can occur after trauma exposure (e.g., pain, cardiometabolic risk factors). We aimed to clarify the unique associations of psychological and physical trauma sequelae with different aspects of self-reported sleep dysfunction. A comprehensive psychological and physical examination was administered to 283 combat-deployed trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. The Pittsburgh Sleep Quality Index (PSQI) and PSQI Addendum for PSTD (PSQI-A) were administered along with measures of PTSD, depression, anxiety, pain, traumatic brain injury, alcohol use, nicotine dependence, and cardiometabolic symptoms. We first performed a confirmatory factor analysis of the PSQI and then conducted regressions with the separate PSQI factors as well as the PSQI-A to identify unique associations between trauma-related measures and the separate aspects of sleep. We found that the PSQI global score was composed of three factors: Sleep Efficiency (sleep efficiency/sleep duration), Perceived Sleep Quality (sleep quality/sleep latency/sleep medication) and Daily Disturbances (sleep disturbances/daytime dysfunction). Linear regressions demonstrated that PTSD symptoms were uniquely associated with the PSQI global score and all three factors, as well as the PSQI-A. For the other psychological distress variables, anxiety was independently associated with PSQI global as well as Sleep Efficiency, Perceived Sleep Quality, and PSQI-A, whereas depression was uniquely associated with Daily Disturbances and PSQI-A. Notably, cardiometabolic symptoms explained independent variance in PSQI global and Sleep Efficiency. These findings help lay the groundwork for further investigations of the mechanisms of sleep dysfunction in trauma-exposed individuals and may help in the development of more effective, individualized treatments.     

Factors associated with poor self-reported function and quality of life in patients with end-stage knee or hip osteoarthritis immediately prior to total joint arthroplasty

IntroductionThe aim was to evaluate patients’ perception of function and physical and mental dimensions of health-related quality of life (HRQoL) in patients with end-stage knee or hip osteoarthritis (OA) immediately prior to surgery and to identify the factors associated with the outcomes.Material and methodsThe study included 200 patients with end-stage OA (100 knee OA and 100 hip OA patients). Self-reported physical function was assessed using the Oxford Knee Score or Oxford Hip Score. Physical and mental dimensions of HRQoL were assessed using the physical and mental component summary scores of the 36-Item Short-Form Health Survey. Multivariate linear regression analysis was used to identify the sociodemographic, clinical and psychological factors associated with self-reported function and physical and mental dimensions of HRQoL.ResultsEnd-stage knee or hip OA patients had poor function and physical dimension of HRQoL, while the mental dimension of HRQoL was not impaired. In knee OA, pain, flexion range of motion (ROM), catastrophizing, and anxiety were significantly associated with self-reported function (explained 56% of the variance), whereas catastrophizing explained 10% of the variance of the physical dimension of HRQoL. In hip OA, flexion ROM, catastrophizing and being employed were significantly associated with self-reported function (explained 44% of the variance), whereas catastrophizing and flexion ROM explained 34% of the variance of the physical dimension of HRQoL.ConclusionsMany investigated factors were associated with poor self-reported function and HRQoL in knee and hip OA. However, the most important factors for both knee and hip OA were catastrophizing and flexion ROM.     

Social support as a predictor of perceived health status in patients with multiple sclerosis

OBJECTIVE: The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. METHODS: Two hundred and seven MS patients (38.4+/-10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. RESULTS: Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. CONCLUSION: PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. PRACTICE IMPLICATIONS: The results show the importance of supporting social ties and relationships between MS patients and others.     

PREDICTORS OF THE PHYSICAL AND PSYCHOLOGICAL INTEGRATION OF HOMELESS ADULTS WITH PROBLEMATIC SUBSTANCE USE

This study examined predictors of physical and psychological integration in homeless adults with problematic substance use. Homeless adults with problematic substance use (n = 115) in Ottawa, Canada, completed questionnaires regarding their demographics (age, gender, Aboriginal ethnicity), health and social functioning (physical health, mental health, alcohol use problems, drug use problems, social skills), environmental factors (satisfaction with personal safety, social support), physical integration, and psychological integration. Participants reported low physical integration (i.e., participation in activities in the community) and did not feel strongly psychologically integrated (i.e., sense of belonging). The final models accounted for 36% and 19% of the variance in physical and psychological integration, respectively. Higher levels of social skills and social support were associated with greater physical integration. Higher levels of mental health functioning and satisfaction with safety were related to greater psychological integration. Implications of the findings for community support services are discussed.     

Comorbid somatic symptoms and functional status in patients with fibromyalgia and chronic fatigue syndrome: sensory amplification as a common mechanism

BACKGROUND: Somatic symptoms are common in conditions such as fibromyalgia (FM) and chronic fatigue syndrome (CFS). OBJECTIVE: Authors investigated a potential shared pathologic mechanism: a generalized perceptual abnormality where there is heightened responsiveness to varied sensory stimulation, including pain. METHOD: A composite measure of sensory sensitivity was created and compared with measures of somatic symptoms, comorbid psychological disturbances, and self-reported physical functioning in 38 patients with FM and/or CFS. RESULTS: Sensory amplification influenced physical functioning indirectly through pain intensity, and physical symptoms and fatigue also independently contributed to physical functioning. CONCLUSION: Sensory amplification may be an underlying pathophysiologic mechanism in these disorders that is relatively independent of depression and depressive symptoms.     

Evaluating the Effects of Somatization Disorder for Patients With Severe End‐Stage Lower‐Extremity Osteoarthritis

This study examined how somatization disorder relates to physical and psychosocial measures for patients with chronic lower‐extremity osteoarthritis (OA). A cohort of 421 patients with lower‐extremity OA of the hip or knee consented to preoperative evaluations. The Patient Health Questionnaire was administered to identify patients with and without somatization disorder. Analyses were conducted to determine differences between demographic and preoperative physical and psychosocial variables. Patients with somatization disorder scored significantly worse on measures of pain, stiffness, function, perceived disability, and quality of life measures. Somatization disorder can have profound effects on patients' physical and psychosocial measures. Recommended treatment for chronic pain patients often includes using a biopsychosocial approach, which involves treating both the psychological state along with the pain condition.     

Psychological distress and visual functioning in relation to vision‐related disability in older individuals with cataracts

Objective. To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision‐related disability. Methods. Participants were 105 individuals (mean age = 73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out‐patient ophthalmology clinics. Visual disability was measured with the Visual Functioning‐14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co‐morbid conditions were obtained. Results. Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision‐related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non‐visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self‐reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. Conclusion. Vision‐related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision‐related disability, affecting recreational activities, activities of daily living and driving.     

利用结构方程模型研究老年糖尿病患者健康相关生命质量与临床表现之间的关系

目的以Wilson-Cleary模型为向导构建结构方程模型（SEM）,了解老年糖尿病患者的健康相关生命质量（HRQOL）与临床表现之间的相互关系。方法自行设计调查问卷,选择来本院诊断治疗的450例老年糖尿病患者作为研究人群,运用SF-36生活质量调查表、老年人多功能评估问卷（OMFAQ）、医疗社会支持量表（MOS-SSS）、兰特心理健康量表（RMHI）和临床结果（与糖尿病有关的特征和生理数据）进行评估,构建机构方程模型。采用拟合优度的指标来评估路径模型的整体,配合卡方检验处理数据。结果心理困扰、收入和充足社会保障等四个因素,可通过一般健康感知对HRQOL产生直接影响（66%变异量）;而症状、身体功能状态和心理状态等三个因素,则通过一般健康感知对HRQOL产生间接的影响（64%的变异量）。另外,症状、年龄、性别和体力活动等四个因素通过身体功能状态间接影响HRQOL（72%的变异量）。结论提高社会和财政支持或提供其他干预措施,可有效地提高老年糖尿病患者身体素质和心理抗压能力,并提高他们的HRQOL。