The distinct longitudinal impact of pain catastrophizing on pain interference among youth living with sickle cell disease and chronic pain

Journal of Behavioral Medicine - Youth living with chronic sickle cell disease (SCD) pain are at risk for psychosocial distress and high levels of pain catastrophizing that contribute to functional...     

The impact of chronic pain on adolescents: a review of previously used measures

OBJECTIVE: To review the use of instruments to assess the impact of adolescent chronic pain, focussing on the development of instruments, the domains covered, psychometric properties, and published use with adolescent chronic pain patients. METHODS: Systematic literature searching recovered 706 articles, yielding 116 relevant articles, employing a total of 43 separate measurement instruments, which were subjected to content analysis. RESULTS: Most instruments were in the psychological domain (n = 22), with a self-report format (n = 36). Thirty instruments were specifically developed for adolescent populations; only 12 instruments had psychometric evaluation with adolescent chronic pain patients. The median use of any one instrument in published studies was two. Clinically relevant psychometric data were missing for many instruments. CONCLUSIONS: There is a diversity of instrumentation with some pockets of depth of use, but some domains of chronic pain experience with no routine assessment. Further development of the knowledge base of measurement of the impact of chronic adolescent pain is necessary.     

The impact of threatening information about pain on coping and pain tolerance

This study examined the impact of threatening information on coping and pain tolerance in a healthy adult sample. Prior to engaging in a Cold Pressor Test (CPT), 121 college students were randomly assigned to one of three conditions: a threat condition in which they read an orienting passage warning them about symptoms and consequences of frostbite (pain as a signal for nociception), a reassurance condition in which they read an orienting passage about the safety of the CPT (pain independent of nociception), or a control condition in which no orienting passage was read before the experimental task. Only 15.6% of participants in the threat group completed the CPT to its 4‐minute duration, compared with 55.6% in the reassurance group and 45.2% of those in the control group. Even though groups did not differ on level of reported pain, threatened participants catastrophized more about the pain and reported less use of cognitive coping strategies (reinterpreting pain sensations, ignoring pain, diverting attention away from pain to other experiences, and using coping self‐statements) than other respondents. A path analysis indicated that the relation between threat and pain tolerance was fully mediated by catastrophizing and cognitive coping. Together, findings suggest that pain appraised as threatening contributes to a specific pattern of coping responses associated with a reduced capacity to bear pain.     

The MMPI and chronic pain: The diagnosis of psychogenic pain

This study investigates the capacity of the MMPI to discriminate among groups of patients with different types of pain. When multivariate analysis of variance is used, the standard set of MMPI scales discriminates between acute pain and chronic pain but not between chronic pain of two different etiologies (surgicaliatrogenic vs. unknown). The three scales that discriminate acute from chronic pain patients are those in the neurotic triad, Hs, D, and Hy. The possibility that the unknown pain etiology group could be broken down into psychogenic pain and undetected somatogenic pathology subgroups was explored using cluster analysis. This procedure did not yield any group of patients who could be identified as having chronic pain of psychogenic origin. These results suggest that the MMPI is not a reliable tool for the differential diagnosis of chronic pain. It appears, however, that patterns of findings are partly contingent on population characteristics. Researchers should be cautious about generalizing to populations other than those from which samples are drawn.This research was supported in part by a grant from Roche Laboratories, Nutley, New Jersey, and the Anesthesiology Research Center, Grant No. GM1599-1-06, University of Washington, Seattle, Washington.     

Assessing change in chronic pain severity: the chronic pain grade compared with retrospective perceptions.

BACKGROUND: There is no standard method of measuring change in chronic pain severity. Clinical trials commonly use serial assessment scales, completed at two points in time, to estimate change in pain severity, while clinicians usually ask patients to make a retrospective assessment of change. How the two methods compare is not known. AIM: To assess different methods of measuring change in chronic pain severity, by comparing changes in scores on a serial measure of chronic pain severity using the Chronic Pain Grade (CPG) questionnaire and responders' retrospective perception of change in pain severity. DESIGN OF STUDY: Postal self-completion questionnaires. SETTING: The Grampian region of Scotland. METHOD: Postal questionnaires were sent in March and September 1998 to a random sample of 535 adults with chronic pain, drawn from responders to a postal survey of the region conducted in 1996. RESULTS: Corrected response rates of 87.5% and 90.7% were obtained. Over a six-month period poor levels of agreement were found, with responders' retrospective perceptions mirroring recorded changes in 41.8% of individuals (kappa = 0.081). A low partial correlation coefficient between the two measures (-0.209) was also found. Over a two-year period there were again poor levels of agreement, with responders' retrospective perceptions mirronng recorded changes in 35.2% of individuals (kappa = 0.071). A low partial correlation coefficient (-0.401) was again found. CONCLUSION: There was poor agreement and low correlation between two commonly used methods for assessing change in pain severity over time. This finding has important implications for both service practitioners and researchers.     

The autoimmune aetiology of unexplained chronic pain

Chronic pain is the leading cause of life years lived with disability worldwide. The aetiology of most chronic pain conditions has remained poorly understood and there is a dearth of effective therapies. The WHO ICD-11 has categorised unexplained chronic pain states as ‘chronic primary pains’ (CPP), which are further defined by their association with significant distress and/or dysfunction. The new mechanistic term, ‘nociplasticic pain’ has been developed to illustrate their presumed generation by a structurally intact, but abnormally functioning nociceptive system. Recently, researchers have unravelled the surprising, ubiquitous presence of pain-sensitising autoantibodies in four investigated CPP indicating autoimmune causation. In persistent complex regional pain syndrome, fibromyalgia syndrome, chronic post-traumatic limb pain, and non-inflammatory joint pain associated with rheumatoid arthritis, passive transfer experiments have shown that either IgG or IgM antibodies from patient-donors cause symptoms upon injection to rodents that closely resemble those of the clinical disorders. Targets of antibody-binding and downstream effects vary between conditions, and more research is needed to elucidate the molecular and cellular details. The central nervous system appears largely unaffected by antibody binding, suggesting that the clinically evident CNS symptoms associated with CPP might arise downstream of peripheral processes. In this narrative review pertinent findings are described, and it is suggested that additional symptom-based disorders might be examined for the contribution of antibody-mediated autoimmune mechanisms.     

The effect of social feedback on receiver's self-concept change: an examination of the role of receiver's perception on sender's self-concept

Cognitive processes for feedback information on self-concept as influenced by the receiver's perception of the sender's trait were examined in 40 male and female undergraduates. Subjects in the consistent and inconsistent feedback situations received information consistent and inconsistent with their initial self-rating of a trait, respectively. The sender (confederate) had a higher or lower scale score for the same trait than the subjects. Subsequently, subjects did final self-rating. Inconsistent feedback produced self-concept changes no more than consistent feedback only when the sender had a higher trait tendency than the subjects. This finding suggests: (1) only in the inconsistent feedback situation, the receiver sets out to search cause of feedback; (2) whether or not the receiver changes one's self-concept depends on causal attribution of inconsistent feedback; and (3) the direction of causal attribution is influenced by the receiver's consideration of the sender's trait tendency.     

The impact of implementing a chronic care residency training initiative on asthma outcomes.

PURPOSE: To examine the impact of a chronic care residency training intervention on continuity clinic patients' asthma-related emergency department use and primary care residents' application of key elements of the Chronic Care Model (CCM). METHOD: In 2002 and 2003, the authors conducted a pre- and posttraining survey of 41 intervention residents at Maine Medical Center to assess residents' implementation of the CCM. The change in implementation for intervention residents was compared with that of 77 primary care residents not receiving CCM training. Asthma-related emergency department (ED) use by 441 patients cared for by intervention residents was compared with that of other asthma patients at Maine Medical Center using hospital billing records. RESULTS: At baseline, residents in both groups reported sporadic application of key elements of the CCM. At posttest, Maine Medical Center residents reported significantly greater increases in CCM implementation than the comparison group for 4 out of the 12 items. The greatest increases were in residents' access to asthma guidelines, the proportion of patients receiving written asthma management plans, and residents' access to information on community asthma programs. The number of asthma-related ED visits dropped significantly among patients treated by intervention residents (pediatric patients 42%, adults 44%). There was a slight increase in asthma ED use for nonintervention pediatric patients at the hospital (8%) and a very small decrease for adults (3%). CONCLUSIONS: Chronic care training programs for residents may influence the health outcomes of patients treated in their continuity clinics while simultaneously offering an important educational experience in an underemphasized area of medicine.     

Self-management of chronic low back pain: An exploration of the impact of a patient-centered website

Objective

This paper examines from a qualitative approach the role of a patient-centered website – named “Oneself” – on patients’ chronic low back pain self-management attitudes and behaviors in the Italian part of Switzerland.

Methods

In-depth interviews have been conducted with a purposive and convenient sample of 18 chronic low back pain sufferers who had used Oneself during 6 months. Data collection and analysis were driven by grounded theory.

Results

Reported positive effects of the use of Oneself on self-management attitudes and behaviors include self-comprehension, improvement of argumentative abilities, orientation, development of self-confidence and maintenance of a high level of attention. In some cases, participants affirm to have experienced negative effects such as confusion and discouragement. The individual's previous awareness of cLBP and level of self-management plays a main role in the way people use the website and in its impact. Based on this criterium, a typology of four patterns of use is drawn.

Conclusion

Patient-centered websites are useful for enhancing self-management of chronic low back pain. However, individuals take advantage of this means differently, based on their stage of advancement in the self-management process.

Practice implications

Information and supports provided online should be tailored according to people's stage of advancement.     

The long road of pain: chronic pain increases perceived distance

Spatial perception is sensitive to the energetic costs required to perform intended actions. For example, hills look steeper to people who are fatigued or burdened by a heavy load. Similarly, perceived distance is also influenced by the energy required to walk or throw to a target. Such experiments demonstrate that perception is a function, not just of optical information, but also of the perceiver’s potential to act and the energetic costs associated with the intended action. In the current paper, we expand on the notion of “cost” by examining perceived distance in patients diagnosed with chronic pain, a multifactorial disease, which is experienced while walking. We found that chronic pain patients perceive target distances to be farther away compared with a control group. These results indicate the physical, and perhaps emotional, costs of chronic pain affect spatial perceptions.     

The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management

The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n=30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.     

Results of behavior modification in the treatment of chronic pain.

Two hundred patients with chronic pain were treated in an in-patient program in which behavior modification was the major therapeutic modality. The patients were characterized by having had pain of many years' duration, multiple operations, treatment failures, prolonged disability, compensation factors, and dependency on medication. At hospital dismissal, 59% of the patients had achieved moderate improvement or better. At a 3-mo follow-up, 40% of the admitted patients (75% of those successfully treated) were still doing well, and after 1 yr, 25% of those originally admitted continued to do well (65% of those successfully treated).     

The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome

Objective  

To confirm the hypothesis of prostatic stromal involvement in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).     

Development and validation of an instrument to measure the impact of genetic testing on self-concept in Lynch syndrome

A positive genetic test result may impact on a person's self-concept and affect quality of life. The purpose of the study was to develop a self-concept scale to measure such impact for individuals carrying mutations for a heritable colorectal cancer Lynch syndrome (LS). Two distinct phases were involved: Phase 1 generated specific colorectal self-concept candidate scale items from interviews with eight LS carriers and five genetic counselors, which were added to a previously developed self-concept scale for BRCA1/2 mutation carriers, Phase II had 115 LS carriers complete the candidate scale and a battery of validating measures. A 20-item scale was developed with two dimensions identified through factor analysis: stigma/vulnerability and bowel symptom-related anxiety. The scale showed excellent reliability (Cronbach's α = 0.93), good convergent validity by a high correlation with impact of event scale (r(102) = 0.55, p < 0.001) and Rosenberg self-esteem scale (r(108) = -0.59, p < 0.001), and a low correlation with the Fear questionnaire (r(108) = 0.37, p < 0.001). The scale's performance was stable across participant characteristics. This new scale for measuring self-concept has potential to be used as a clinical tool and as a measure for future studies.