Breathlessness catastrophizing relates to poorer quality of life in adults with cystic fibrosis

Background

Cystic Fibrosis (CF) is the most common genetic disease affecting children and young adults in Canada. It is a multi-system disease, however lung disease is largely responsible for mortality. Treatment advances have resulted in increased life expectancy and a subsequent need to better understand psychosocial issues associated with quality of life in adults living with CF. Emerging research suggests that anxiety and depression are related to poorer health-related quality of life (HRQoL) in CF patients, but there is little research examining cognitive processes, such as breathlessness catastrophizing. The present study addresses this gap in the literature. Methods: Participants in this study are based on a convenience sample of patients recruited during their regular CF clinic appointments at a tertiary care center. Forty-five adults (M_age?=?30.73?years) completed measures of lung function, depression, anxiety, pain, breathlessness catastrophizing, and HRQoL at one time point. Results: Results of a hierarchical multiple regression indicate that increased breathlessness catastrophizing was related to poorer HRQoL, after controlling for lung function, depression, anxiety, and pain (p?<?.05). Depression, pain, and breathlessness catastrophizing all emerged as significant unique predictors of HRQoL. Conclusions: Breathlessness catastrophizing is a potential target for clinical intervention and might impact HRQoL. Further research on breathlessness catastrophizing in CF is warranted including longitudinal studies to examine the mechanisms by which breathlessness catastrophizing relates to HRQoL and treatment outcomes in CF.     

A typology of pain coping strategies in pediatric patients with chronic abdominal pain

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n=699) were pediatric patients (ages 8-18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children's pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n=311) that replicated in Sample 2 (n=388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients' pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.     

Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up

Recent research has found individual differences in back pain patients due to behavioral avoidance vs persistence. However, there is a lack of prospective studies of nonspecific low back pain patients. The avoidance-endurance model (AEM) suggests at least 3 pathways leading to chronic pain: fear-avoidance response, distress-endurance response, and eustress-endurance response. We sought to compare these 3 maladaptive subgroups with an adaptive group using a classification tool that included the following scales: the thought suppression and behavioral endurance subscale of the Avoidance-Endurance Questionnaire and the Beck Depression Inventory. The psychological characteristics, and pain and disability of the AEM subgroups were investigated. We report results from 177 patients with subacute nonspecific low back pain at the start of outpatient treatment and at follow-up after 6 months. At baseline, a multivariate analysis of variance found that the fear-avoidance patients scored higher in pain catastrophizing than the other groups. The distress-endurance patients displayed elevated anxiety/depression and helplessness/hopelessness accompanied with the highest scores in the classification variables thought suppression and persistence behavior. The eustress-endurance patients had the highest humor/distraction scores, pain persistence, and positive mood despite pain. All 3 maladaptive groups revealed a higher pain intensity than the adaptive patients at follow-up after 6 months; however, disability at follow-up was elevated only in the fear-avoidance and distress-endurance patients. The study provides preliminary evidence for the construct and prospective validity of AEM-based subgroups of subacute, nonspecific back pain patients. The results suggest the need for individually targeted cognitive behavioral treatments in the maladaptive groups.     

A longitudinal study of pain and pain catastrophizing in a cohort of National Guard troops at risk for PTSD

A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing were prevalent and highly correlated with posttraumatic stress disorder (PTSD). At issue in the present study was whether pain and catastrophizing before military deployment could account for individual differences in PTSD symptoms after deployment. An anonymous survey was administered to a population sample of New Jersey National Guard troops before they were sent overseas and again when they returned home (1year later). The survey included a validated PTSD screening questionnaire, numerical ratings of pain intensity, and a measure of pain catastrophizing. A cohort of 922 National Guard members completed the survey before and after deployment. An uncontrolled analysis indicated that pain and catastrophizing before deployment were significantly but modestly associated with PTSD symptoms after deployment (accounting for 4.5% and 1.3% of the variance, respectively). A hierarchical regression model that controlled for sex, preexisting PTSD symptoms, and recent combat found that pain but not pain catastrophizing explained variance in postdeployment PTSD. The size of the effect, however, was negligible (0.8%, p<.01). Consistent with previous research, a cross-sectional analysis revealed that postdeployment pain and catastrophizing successfully accounted for unique variance in postdeployment PTSD. The failure of longitudinal predictors in the present study, therefore, cannot be attributed to insensitive screening instruments. These findings offer little or no support for the hypothesis that predeployment pain and catastrophizing can account for individual differences in PTSD after exposure to combat trauma.     

Catastrophizing: a predictive factor for postoperative pain

Background

Postsurgical pain is a major cause of delayed recovery and discharge after surgery. A significant proportion of patients develop chronic postsurgical pain, which affects their quality of life. Cognitive and psychological factors are reported to play a significant role in the severity of reported postsurgical pain. High levels of catastrophizing are associated with a heightened pain experience and appear to contribute to the development of chronic pain. This article describes the concept of pain catastrophizing, its association with postsurgical pain, and its potential role in the management of postsurgical pain and postsurgical quality of life.

Methods

Data for this review were identified from MEDLINE, EMBASE, and PsycINFO. Reference lists of selected articles were cross-searched for additional literature.

Results

High catastrophizing levels were found to be associated with increased pain severity, increased incidence of development of chronic pain, and poorer quality of life after surgery. There was no consensus on the relation between catastrophizing and analgesia consumption.

Conclusions

Identifying and reducing catastrophizing levels can help to optimize pain management in surgical patients.     

The role of depression and catastrophizing in musculoskeletal pain

Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built‐in replication from two clinical samples of patients with sub‐acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross‐sectionally and at follow‐up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.     

Cognitive intrusion of pain and catastrophic thinking independently explain interference of pain in the activities of daily living

Patients with musculoskeletal illness often report that pain interferes with their ability to engage in activities of daily living. Catastrophic thinking is consistently depicted as an important cognitive factor that hinders adjustment to pain. Current research has also shown that pain negatively impacts an individual's ability to maintain attention on the task at hand. While a measure of the experience of cognitive intrusion of pain (ECIP) has been recently developed to quantify the extent of that impact, little research has explored this issue in everyday settings. This study tested the mediating roles of cognitive intrusion of pain and pain catastrophizing scale (PCS) on the association of pain intensity with pain interference in 142 patients with upper-extremity musculoskeletal illness. We found that both cognitive intrusion of pain (b = 0.136, bootstrap SE = 0.048, 95% BCa CI [0.052, 0.245]) and pain catastrophizing (b = 0.114, bootstrap SE = 0.044, 95% BCa CI [0.047, 0.221]) partly and independently mediated the relationship between pain intensity and pain interference. Although comparable, the mediation effect of cognitive intrusion of pain was slightly larger than that of pain catastrophizing (25.7%, bootstrap SE = 0.094 vs. 21.5%, bootstrap SE = 0.080). Results suggest that pain sensations can interfere with activities of daily living through two distinct mechanisms. A combination of traditional cognitive behavioral therapy and mindfulness skills training targeting both pain catastrophizing and cognitive intrusion has the potential to decrease pain interference and help patients return to normal healthy living in spite of acute or persistent pain.     

Persistent pain in postmastectomy patients: Comparison of psychophysical,medical, surgical,and psychosocial characteristics between patients with and without pain

Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients’ responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual’s psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.     

Association Between Symptoms of Central Sensitization and Cognitive Behavioral Factors in People With Chronic Nonspecific Low Back Pain: A Cross-sectional Study

Objective

The objective of this cross-sectional study was to analyze the relationship between symptoms of central sensitization (CS) and important cognitive behavioral and psychosocial factors in a sample of patients with chronic nonspecific low back pain.

Pain,pain catastrophizing,and past mental healthcare utilization

Objective

Pain symptoms have been associated with a number of psychiatric disorders, particularly mood and anxiety disorders as well as personality disorders. However, to our knowledge, no study to date has examined pain symptoms in terms of participants' past mental healthcare utilization—the focus of the present study.

Methods

Using a cross-sectional approach and a self-report survey methodology in a sample of 242 consecutive internal medicine outpatients, we examined pain symptoms at assessment, over the past month, and over the past year as well as pain catastrophizing in relationship to 4 mental healthcare variables (i.e., ever seen a psychiatrist, ever been in a psychiatric hospital, ever been in counseling, and ever been on medication for “nerves”).

Results

Only three of the four mental-healthcare-utilization variables were analyzed due to response rate (i.e., ever been hospitalized in a psychiatric hospital was infrequently endorsed and not analyzed), and each demonstrated statistically significant relationships with self-reported pain levels at all three time-points and with pain catastrophizing at the p < .001 level.

Conclusions

In this study, primary care outpatients with histories of mental health treatment evidenced statistically significantly higher levels of pain as well as statistically significantly higher levels of pain catastrophizing than their peers.