Goal frustration, coping and well-being in the context of adolescent headache: A self-regulation approach

The aim of this study was to investigate the relationships between goal frustration, coping and well-being in the context of adolescent headache. Firstly, we investigated whether adolescents with weekly, monthly or no headache complaints differed with regard to the importance assigned to their personal goals, experience of goal frustration, coping with goal frustration and well-being. Secondly, the extent to which goal and coping factors contributed to well-being and whether this relationship differed according to the frequency of headache complaints was examined. For this purpose, 1202 adolescents aged 12–18 completed self-report questionnaires in schools. Adolescents were divided into three groups based on their experience of headache: no headache reported (38%); monthly headache (40%); weekly headache (18%). Results show that these groups did not differ with respect to the importance they attach to goals. They did, however, differ according to experience of goal frustration, use of strategies to cope with goal frustration and well-being, although effect sizes were small. After controlling for individual and headache characteristics, frustration of self acceptance and health goals, and the use of self blame, rumination and other blame were consistently related to lower well-being. Moreover, interactions with headache group indicated that for adolescents with weekly headache, greater frustration of school and self acceptance goals and a lower importance assigned to health goals was more detrimental to well-being than for those with no headache complaints. We conclude that frustration to goal pursuit and strategies for coping with this frustration are important factors in adolescent well-being and may offer important targets for intervention.     

A Comparison of Medical Comorbidities,Psychosocial, and Sexual Well-being in an Online Cross-Sectional Sample of Women Experiencing Persistent Genital Arousal Symptoms and a Control Group

BackgroundPersistent genital arousal disorder (PGAD) is characterized by symptoms of distressing physiological sexual arousal (Persistent genital arousal [PGA] symptoms such as genital vasocongestion, sensitivity, or both) that occur in the absence of sexual desire. There continues to be a lack of systematic research on this condition. Little is known about the common medical comorbidities and psychological, sexual, or relationship well-being of individuals who experience PGA symptoms.AimsTo compare these biopsychosocial factors in an age-matched sample of women with and without symptoms of PGA. A secondary aim was to examine what symptom factors (associated distress, symptom severity) and cognitive factors (eg, catastrophizing of vulvar sensations) were associated with psychosocial outcomes in women with symptoms of PGA.MethodsAge-matched samples of women with (n = 72) and without (n = 72) symptoms of PGA completed a comprehensive online survey.Main Outcome MeasuresParticipants self-reported their medical histories and completed validated measures of psychosocial functioning (depressive and anxiety symptoms, catastrophizing of vulvar sensations, sexual functioning and distress, and relationship functioning).ResultsWomen with symptoms of PGAD reported significantly greater depressive and anxiety symptoms, sexual distress, and suicidal ideation, as well as significantly poorer relationship functioning than women without PGA symptoms. Catastrophizing of vulvar sensations was related to PGA symptom ratings (greater severity, distress) and psychosocial outcomes (greater depression, anxiety, and sexual distress).Clinical ImplicationsThe results of this study highlight medical and psychosocial difficulties associated with PGA symptoms, which should be assessed and addressed as essential components of treatment.Strengths & LimitationsThis study seeks to address the paucity of research on the well-being of women with PGA symptoms by undertaking a comparison of age-matched samples using validated questionnaires. This study is limited by its self-report, cross-sectional design.ConclusionPGA symptoms are associated with significant health and psychological difficulties. These results highlight the need for continued research in this area to improve identification and treatment for this population.Jackowich RA, Poirier É, Pukall CF. A Comparison of Medical Comorbidities, Psychosocial, and Sexual Well-being in an Online Cross-Sectional Sample of Women Experiencing Persistent Genital Arousal Symptoms and a Control Group. J Sex Med 2020;17:69–82.     

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.     

Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical,emotional and cognitive factors

BackgroundSleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown.ObjectiveThe aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities.MethodsParticipants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (M_age = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses.ResultsAfter controlling for age and sex, the predictors explained an additional 7–16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%.ConclusionsConsistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.     

A brief cognitive-behavioural intervention for pain reduces secondary hyperalgesia

Repeated exposure to pain can result in sensitization of the central nervous system, enhancing subsequent pain and potentially leading to chronicity. The ability to reverse this sensitization in a top-down manner would be of tremendous clinical benefit, but the degree that this can be accomplished volitionally remains unknown. Here we investigated whether a brief (∼5 min) cognitive-behavioural intervention could modify pain perception and reduce central sensitization (as reflected by secondary hyperalgesia). In each of 8 sessions, 2 groups of healthy human subjects received a series of painful thermal stimuli that resulted in secondary hyperalgesia. One group (regulate) was given brief pain-focused cognitive training at each session, while the other group (control) received a non-pain-focused intervention. The intervention selectively reduced pain unpleasantness but not pain intensity in the regulate group. Furthermore, secondary hyperalgesia was significantly reduced in the regulate group compared with the control group. Reduction in secondary hyperalgesia was associated with reduced pain catastrophizing, suggesting that changes in central sensitization are related to changes in pain-related cognitions. Thus, we demonstrate that central sensitization can be modified volitionally by altering pain-related thoughts.     

Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients’ level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick). Catastrophizing accounted for 35% of the variance in phantom limb pain (p = 0.001) independently of anxiety and depression. Catastrophizing was also positively associated with wind-up-like pain in non-medicated patients (p = 0.015), but not to pain thresholds. These findings suggest that cognitive-emotional sensitization contributes to the altered nociceptive processing seen in phantom limb pain patients. The possible interactions between pain catastrophizing, wind-up-like pain, and peripheral input in generating and maintaining phantom limb pain are discussed.     

Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers' compensation claimants

The fear avoidance model of pain (FAM) conceptualizes pain catastrophizing as the cognitive antecedent of pain-related fear, and pain-related fear as the emotional antecedent of depression and disability. The FAM is essentially one of mediation whereby pain-related fear becomes the process by which depression or disability ensue. However, emerging literature suggests that pain catastrophizing, pain-related fear, and depression might be at least partially distinct in their prediction of different pain-related outcomes. The primary purpose of the present study was to evaluate whether psychological factors in the FAM (pain catastrophizing, pain-related fear, and depression) differentially predict long-term pain-related outcomes. Toward this objective, we conducted a prospective study using a cohort of 202 individuals with subacute work-related musculoskeletal injuries. Participants completed a 7-week physical therapy program with a functional rehabilitation orientation. Posttreatment measures of fear of movement, pain catastrophizing, depression, and pain self-efficacy were used to predict the persistence of pain symptoms, healthcare use, medication use, and return-to-work at one-year follow-up. Results from hierarchical linear and logistic regression analyses revealed that pain catastrophizing and fear of movement act as differential predictors of long-term pain-related outcomes. Specifically, we found unique relationships between pain catastrophizing and long-term pain intensity, and fear of movement and long-term work disability. After controlling for pain intensity and FAM variables, pain self-efficacy was shown to be a unique predictor of medication use. Implications for the FAM and the clinical management of musculoskeletal pain conditions are discussed.     

An Online Cross-Sectional Comparison of Women With Symptoms of Persistent Genital Arousal,Painful Persistent Genital Arousal,and Chronic Vulvar Pain

Background

Persistent genital arousal disorder (PGAD) is an understudied condition characterized by unwanted physiologic genital arousal in the absence of subjective sexual arousal. Markos and Dinsmore (Int J STD AIDS 2013;24:852–858) theorized that PGAD shares a number of similarities with vulvodynia (unexplained chronic vulvar pain [CVP]), including symptom characteristics and comorbidities.

Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial

Objective

To investigate the effects of an osteopathic manipulative treatment (OMT), which includes a diaphragm intervention compared to the same OMT with a sham diaphragm intervention in chronic nonspecific low back pain (NS-CLBP).