Emotion Regulation in Dementia Caregiving: The Role of Neuropsychiatric Symptoms and Attachment Orientation.

Family caregivers are usually the main source of support for persons living with dementia, being exposed to a loved one's suffering, which can lead to experiencing strong and negative emotions. This study aimed to identify factors capable of explaining individual differences in the way caregivers regulate their emotions. This cross-sectional study included 78 informal caregivers (M = 64.84 years; SD = 13.32) and 84 controls (non-caregivers) (M = 77 years; SD = 7.59). Neuropsychiatric symptoms (NPS), attachment orientations, and emotion regulation were measured using self-report scales. Caregivers of persons living with dementia used more expressive suppression in comparison to non-caregivers. NPS and attachment avoidance were associated with expressive suppression. Moderation analyses showed that NPS only predicted expressive suppression when attachment avoidance was low or medium. The present study showed that caregivers are more likely to suppress their emotions in the presence of NPS, especially those with lower/middle levels of attachment avoidance. Psychological interventions targeting emotion regulation should be offered especially to caregivers that face NPS of persons living with dementia and present lower/middle levels of attachment avoidance.

Facilitating pain assessment and communication in people with deafness: a systematic review.

BACKGROUND: Pain is a common reason for seeking out healthcare professionals and support services. However, certain populations, such as people with deafness, may encounter difficulties in effectively communicating their pain; on the other side, health care professionals may also encounter challenges to assess pain in this specific population. AIMS: To describe (a) the state of the research in the field of pain assessment in individuals with deafness; (b) instruments validated; and (b) strategies facilitating the pain communication or assessment in this population. METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were performed, searching Medline, CINAHL, Scopus, Embase and PsycInfo databases, from their initiation to July 2023. Primary and secondary studies, involving adults with deafness and investigating pain assessment and communication difficulties, facilitators, or barriers, were eligible. The included studies were assessed in their methodological quality with the Quality Assessment for Diverse Studies tool; data extraction and the narrative synthesis was provided by two researchers. RESULTS: Five studies were included. Two were validation studies, while the remaining were a case report, a case study and a qualitative study. The interRAI Community Health Assessment and the Deafblind Supplement scale have been validated among people with deafness by reporting few psychometric properties; in contrast, instruments well established in the general population (e.g. Visual Analogue Scale) have been assessed in their usability and understandability among individuals with deafness, suggesting their limitations. Some strategies have been documented as facilitating pain communication and assessment: (a) ensuring inclusiveness (the presence of family members as mediators); (b) ensuring the preparedness of healthcare professionals (e.g. in sign language); and (c) making the environment friendly to this population (e.g. removing masks). CONCLUSIONS: The research regarding pain in this population is in its infancy, resulting in limited evidence. In recommending more research capable of establishing the best pain assessment instrument, some strategies emerged for assessing pain in which the minimum standards of care required to offer to this vulnerable population should be considered.

Perceived barriers, facilitators and usefulness of a psychoeducational intervention for individuals with chronic musculoskeletal pain and depression in primary care.

Background and aims: Self-management interventions have the potential to improve patient' pain condition as they involve tasks aimed at managing symptoms and reducing interference with activities, mood and relationships due to pain. However, research on factors that facilitate or hinder pain self-management has overlooked patients with both chronic musculoskeletal pain and depression in primary care settings, also leaving unattended patient views on the usefulness of such programs. Thus, the main aim of this study was to gather meaningful information to help promoting adequate self-management. Specifically, it attempts to identify patients' perceptions of barriers and facilitators of group-based psychoeducational intervention and to explore its perceived usefulness in promoting self-management. Method: This qualitative study explored perceived barriers and facilitators of a psychoeducational intervention for the management of chronic musculoskeletal pain and depression previously tested in a Randomized Control Trial. We conducted focus groups and individual interviews with fifteen adult patients with both chronic musculoskeletal pain and depression recruited from primary care centres in Tarragona province (Catalonia, Spain). A content thematic analysis was carried out to examine the data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Findings revealed that perceived barriers included lack of motivation, time constraints, pain, depression, ineffectiveness of pain-relief strategies and activity avoidance. Facilitators were having a supportive family/friends, the positive effects of self-management, high motivation, being a proactive patient. Peer support and identification, the positive effect of sessions, and free expression were highlighted as key elements of the psychoeducational intervention. Conclusion: The psychoeducational intervention was perceived as useful in promoting self-management practices. Barriers and facilitators in using self-management strategies were related, mainly, to internal personal characteristics of the patients being similar among different cultural backgrounds and distinct chronic conditions. Implications: These findings can help to guide clinicians in the development and implementation of more effective pain self-management interventions for patients with chronic pain and depression by attending to their needs and preferences.

Short and long-term predictors of pain severity and interference in primary care patients with chronic musculoskeletal pain and depression.

BACKGROUND: Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain. OBJECTIVE: To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression. METHODS: Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes. RESULTS: 83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (ß = 0.53; 95% CI = 0.37-0.68) and at 12 months (ß = 0.48; 95% CI = 0.29-0.67). Also, pain > 2 years of evolution predicted long term pain severity (ß = 0.91; CI95%=0.11-1.71). Baseline pain interference predicted interference at 3 and 12 months (ß = 0.27; 95%CI = 0.11-0.43 and ß = 0.21; 95%CI = 0.03-0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (ß = 0.26; 95%CI = 0.10-0.42 and ß = 0.20; 95%CI = 0.02-0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (ß = 0.91; CI95%=0.11-1.71, and ß = 1.23; CI95%=0.41-2.04). Depression severity predicted more interference at 12 months (ß = 0.58; CI95%=0.04-1.11). Occupational status as active worker predicted less interference throughout the follow-up (ß=-0.74; CI95%=-1.36 to -0.13 and ß=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (ß=-0.77; CI95%=1.52 - 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (ß = 0.03; 95% CI = 0.00-0.05 and ß = 0.03; 95% CI = 0.00-0.05), but not at long term. CONCLUSION: In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02605278), registered 16/11/2015.

Individuals with hearing impairment/deafness during the COVID-19 pandemic: A rapid review on communication challenges and strategies.

AIMS AND OBJECTIVES: This study aimed (a) to identify the communication issues and problems faced by individuals with hearing impairment (HI)/deafness during the COVID-19 pandemic and (b) to describe strategies to overcome the issues/problems and/or prevent their negative impact. BACKGROUND: Individuals with mild or severe HI face everyday communication problems, which have been worsened during the COVID-19 pandemic. However, no studies have summarised the available evidence to better understand the communication challenges faced by them and strategies allowing better interactions. The long duration of the outbreak-more than 2 years, with policies that have just been lifted in some countries-and the possible return of restrictions in the next Winter suggest the need to summarise evidence in the field. DESIGN AND METHODS: A rapid review is reported here in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Medline, CINAHL and Scopus databases were searched, including (a) primary or secondary studies published from January 2020 to 12 January 2022, (b) involving individuals with HI/deafness, (c) during the COVID-19 pandemic and (d) written in English. Data were extracted and summarised by using a content analysis approach. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. RESULTS: Fourteen studies were included as follows: three non-systematic reviews, seven cross-sectional, three quasi- experimental and one qualitative study, performed mainly in the US and the UK. Face mask covering use; physical and social distancing; and information, education, rehabilitation, and healthcare accessibility have emerged as the main challenges triggering consequences such as social isolation, loneliness, poor knowledge regarding the prevention and mental health issues. Strategies mitigating these challenges are as follows: (a) adopting transparent face masks, (b) using basic skills while interacting (e.g. maintaining eye contact), (c) improving the availability of sign language interpreters, (d) allowing the presence of family members and (e) teaching basics of sign language to healthcare professionals. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Individuals with HI/deafness live with several challenges, suggesting that their vulnerability has increased tremendously during the COVID-19 pandemic. The effectiveness of strategies to overcome these difficulties should be scrutinised by conducting more research. Moreover, there should be increased awareness among all citizens by equipping them with simple strategies to communicate effectively with individuals with HI, an approach that may increase inclusiveness and prevent further negative consequences and burden.

Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression: a qualitative study of primary care physicians and nurses.

BACKGROUND: Primary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement. METHODS: One year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts. RESULTS: The results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation. CONCLUSIONS: The INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03285659 ; Registered 18th September, 2017.

Electronic Health Literacy in Individuals with Chronic Pain and Its Association with Psychological Function.

Electronic health literacy skills and competences are important for empowering people to have an active role in making appropriate health care decisions. The aims of this cross-sectional study were to (1) examine the frequency of use of the Internet for seeking online information about chronic pain, (2) determine the level of eHealth literacy skills in the study sample, (3) identify the factors most closely associated with higher levels of eHealth literacy, and (4) examine self-efficacy as a potential mediator of the association between eHealth literacy and measures of pain and function in a sample of adults with chronic pain. One-hundred and sixty-one adults with chronic pain completed measures assessing internet use, eHealth literacy, pain interference, anxiety, depression, and pain-related self-efficacy. Results indicated that 70% of the participants are active users of the Internet for seeking information related to their health. The level of eHealth literacy skills was not statistically significantly associated with participants' age or pain interference but was significantly negatively associated with both anxiety and depression. In addition, the findings showed that self-efficacy fully explained the relationship between eHealth literacy and depression and partially explained the relationship between eHealth literacy and anxiety. Self-efficacy should be considered as a treatment target in eHealth literacy interventions, due to its role in explaining the potential benefits of eHealth literacy.

Improving the Quality of Life of Cancer Survivors in School: Consensus Recommendations Using a Delphi Study.

Successful school re-entry is important for children following cancer treatment. However, this process is a challenge for teachers. OBJECTIVES: To identify (1) the difficulties and needs that teachers have in helping youth cancer survivors be successful in school, (2) the most effective resources that teachers are currently using for helping them, and (3) the ideal contents for a program that could help teachers in this area. METHODS: Twenty-eight teachers participated in a Delphi study. RESULTS: A lack of knowledge regarding how to best help and having to deal with the student's problems were identified as difficulties. Specific training, psychological support, and advice from health professionals were the most commonly reported needs. Maintaining contact with the family and the students and providing personalized attention were viewed as the most useful resources. Finally, knowledge about the disease itself and how to facilitate successful school re-entry were identified as important program components. CONCLUSION: The findings provide important new information regarding the lack of both resources and support for teachers who seek to help youth cancer survivors. The findings can be used to inform the development of an intervention to help teachers become more successful in facilitating successful school re-entry.

Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship.

ABSTRACT: Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.

Behavioral Activation and Inhibition Systems: Further Evaluation of a BIS-BAS Model of Chronic Pain.

OBJECTIVES: The role of the behavioral inhibition system (BIS) and behavioral activation system (BAS) in function has been evaluated in a wide range of populations. However, research on the role of the BIS and BAS in pain is in its early stages. This study sought to evaluate the utility of a BIS-BAS model of chronic pain. METHODS: Participants were 164 individuals with chronic pain who responded to an online survey. Participants provided information about pain location, intensity, and frequency and completed questionnaires assessing behavioral inhibition and activation sensitivity, pain catastrophizing, pain interference, activity engagement, pain willingness, hope, and pain self-efficacy. Seven hierarchical regression analyses were conducted to test hypothesized associations between BIS and BAS sensitivity and measures of participant function. RESULTS: BIS scores were significantly and positively associated with pain catastrophizing, anxiety, depression, and pain interference and were negatively associated with activity engagement, hope, and pain self-efficacy (P<0.01). BAS scores showed significant and positive associations with activity engagement and hope and showed significant negative associations with pain catastrophizing and anxiety (P<0.05). Furthermore, BIS sensitivity evidenced stronger associations with all the other study measures than did BAS sensitivity. CONCLUSIONS: The findings provide important new information regarding the utility of the BIS-BAS model of chronic pain. Our results support the idea that BIS activation is more important than BAS activation in explaining a variety of pain-related outcomes, including positive and negative responses to pain, and suggest that modification of the model may be indicated. These results have several theoretical and clinical implications.

Cost-effectiveness of a collaborative care program for managing major depression and chronic musculoskeletal pain in primary care: Economic evaluation alongside a randomized controlled trial.

BACKGROUND: We designed a collaborative care program for the integrated management of chronic musculoskeletal pain and depression, which frequently coexist in primary care patients. The aim of this study was to evaluate the cost-effectiveness of this program compared with care as usual. METHODS: We performed a cost-effectiveness analysis alongside a randomized clinical trial. Results were monitored over a 12-month period. The primary outcome was the incremental cost-effectiveness ratio (ICER). We performed cost-effectiveness analyses from the perspectives of the healthcare system and society using an intention-to-treat approach with imputation of missing values. RESULTS: We evaluated 328 patients (167 in the intervention group and 161 in the control group) with chronic musculoskeletal pain and major depression at baseline. From the healthcare system perspective, the mean incremental cost was €234 (p = .17) and the mean incremental effectiveness was 0.009 QALYs (p = .66), resulting in an ICER of €23,989/QALY. Costs from the societal perspective were €235 (p = .16), yielding an ICER of €24,102/QALY. These estimates were associated with a high degree of uncertainty illustrated on the cost-effectiveness plane. CONCLUSIONS: Contrary to our expectations, the collaborative care program had no significant effects on health status, and although the additional costs of implementing the program compared with care as usual were not high, we were unable to demonstrate a favorable cost-effectiveness ratio, largely due to the high degree of uncertainty surrounding the estimates.

The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression.

OBJECTIVE: The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. DESIGN: Cross-sectional design. METHODS: Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. RESULTS: The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. CONCLUSIONS: These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.

Social Factors, Disability, and Depressive Symptoms in Adults With Chronic Pain.

OBJECTIVES: The primary aim of this study was to better understand the role that social factors (ie, social support, satisfaction in participation with social roles, social isolation, and self-perceived ability to perform social roles and activities) play in pain-related interference and depressive symptoms in adults with chronic pain. Moreover, this study also examined if sex exerts a moderating role in these associations. MATERIALS AND METHODS: In this cross-sectional study, 364 adults with chronic pain participated: 133 were university students and 231 were individuals from the community. University students completed a paper-and-pencil survey and individuals from the community responded to a web-based survey. Both surveys included the same questions assessing sociodemographic, pain characteristics, pain-related interference, depressive symptoms, and social factors. RESULTS: Only satisfaction in participation in usual social roles and self-perceived ability for participating in such social roles contributed independently, significantly, and negatively to the prediction of pain interference, whereas all 4 social factors made independent and significant contributions to the prediction of depressive symptoms. Satisfaction with participation in usual social roles, self-perceived social ability, and social support were negatively related to depressive symptoms, whereas social isolation was positively related. The results also indicated that sex moderated the associations between social factors and depressive symptoms, but not between social factors and pain interference. DISCUSSION: The study provides important new findings regarding the associations between social factors and physical and psychological functioning of individuals with chronic pain, supporting biopsychosocial models.

An Evaluation of Sex Differences in Patients With Chronic Pain Undergoing an Interdisciplinary Pain Treatment Program.

OBJECTIVES: To determine if there are sex differences in a sample of patients participating in a 4-week interdisciplinary pain treatment program in (1) pretreatment pain intensity, physical function, psychological function, pain beliefs, kinesiophobia, pain catastrophizing, and activity management patterns; and (2) treatment response. METHODS: Seventy-two men and 130 women with chronic pain completed study measures. Analyses of covariance (ANCOVAs) were performed to compare men and women on pretreatment measures. Repeated-measures ANCOVAs were used to compare both sexes on 3 treatment outcomes (pain intensity, physical function, and depressive symptoms). RESULTS: Before treatment, compared to women, men reported higher levels of kinesiophobia, were more likely to view their pain as being harmful, and used more activity pacing when doing daily activities. Women were more likely to use an overdoing activity pattern than men. No sex differences emerged for pretreatment pain intensity, physical function, psychological function, catastrophizing, activity avoidance, or measures of other pain-related beliefs. At posttreatment, women reported more improvements in pain intensity and physical function compared to men, while both sexes reported similar reductions in depressive symptoms. All effect sizes for statistically significant findings were of small to moderate magnitude. DISCUSSION: The results of this study suggest that men and women have a comparable profile with respect to the overall burden of chronic pain. Nevertheless, sex differences were found for certain pain beliefs and coping styles. Women appear to reap more benefits from the interdisciplinary pain management program than men. These findings indicate that further research to develop sex-specific assessment procedures and tailored pain treatments may be warranted.

Effectiveness of a collaborative care intervention for managing major depression and chronic musculoskeletal pain in primary care: A cluster-randomised controlled trial.

BACKGROUND: Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care. METHODS: A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period. TRIAL REGISTRATION: NCT02605278 (ClinicalTrials.gov). RESULTS: After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26]. LIMITATIONS: This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation. CONCLUSION: The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.

Are attitudes about pain related to coping strategies used by adolescents in the community?

Background and aims To better understand the associations between pain beliefs and pain coping strategies in a sample of community adolescents. Methods Four hundred and thirty-four adolescents were asked to complete measures of physical function, pain-related beliefs and use of pain coping strategies. A series of three hierarchical regression analyses were performed. Results Approach coping strategies demonstrated significant and positive associations with beliefs about the importance of solicitousness responding and control over pain. Problem-focused avoidance coping strategies evidenced a negative association with the belief of being disabled by pain, and a positive association with the importance of exercise. Emotion-focused avoidance coping strategies showed significant and positive associations with beliefs about being disabled by pain and that emotions affect pain, and negative associations with beliefs about control over pain and the appropriateness of pain medications. Conclusions The findings provide important new information regarding the potential role that beliefs could play as predictors of pain coping in adolescents living in the community. Prospective studies are needed to evaluate the possible causal role that beliefs play in decisions to use what pain coping strategy and under what circumstances. Implications The role that pain beliefs and coping strategies play in the adjustment to pain in adolescents in the community has both similarities to and differences with the role that these factors play in adolescent clinical populations. This information can guide the development of community-based treatment programs for adolescents with pain.

The Utility and Construct Validity of Four Measures of Pain Intensity: Results from a University-Based Study in Spain.

OBJECTIVE: Pain intensity is the most commonly assessed domain in pain research and clinical settings. To facilitate cross-cultural research, knowledge regarding the psychometric properties of pain intensity measures in individuals from different countries is needed. However, the majority of this research has been conducted in English-speaking countries. DESIGN: Survey study. SETTING: University. SUBJECTS: Four hundred nineteen college students. METHODS: Participants were asked to complete four measures assessing average pain intensity: 1) the 0-10 numerical rating scale (NRS-11), 2) the 100-mm visual analog scale (VAS), 3) the four-point verbal rating scale (VRS-4), and 4) the Faces Pain Scale-Revised (FPS-R). RESULTS: The rates of incorrect completion of the four scales were uniformly low (range = 1-2%). The NRS-11 had the highest preference rate (31%), although a substantial number of participants also preferred each of the other three scales (range = 22-24%). The findings support the utility and construct validity of all four pain intensity scales in this Spanish-speaking sample. CONCLUSIONS: When considered in light of research from other non-English-speaking samples indicating significant psychometric weaknesses for the NRS-11 and VAS and relative strengths of the FPS-R in some groups, the findings suggest that the FPS-R might be the most appropriate pain intensity scale to use when comparisons across populations from different countries is a goal. More research is needed to determine the extent to which demographic (i.e., age, education levels, socioeconomic status) vs cultural factors (i.e., country of origin) influence the reliability, validity, and utility of different pain measures.

Pain-related Activity Management Patterns and Function in Patients With Fibromyalgia Syndrome.

OBJECTIVES: To clarify the importance of avoidance, pacing, and overdoing pain-related activity management patterns as predictors of adjustment in patients with fibromyalgia syndrome. METHODS: A total of 119 tertiary care patients with fibromyalgia syndrome who agreed to be part of an activity management pain program completed a survey, which requested information about demographics, pain intensity and pain interference, psychological and physical function, and pain-related activity management patterns. Hierarchical regression analyses were used to identify the unique contributions of the 3 different pain-related activity management patterns (avoidance, pacing, and overdoing) to the prediction of pain interference, psychological function, and physical function. RESULTS: The avoidance pattern was a significant and unique predictor of worse psychological and physical function as well as greater pain interference. Pacing was significantly associated with less pain interference and better psychological function, whereas overdoing was not found to predict patient functioning. DISCUSSION: The findings confirm the importance of pain-related activity management patterns as predictors of patient function, and support the necessity of addressing these factors in chronic pain treatment. In addition, the results suggest that targeting increases in activity pacing and decreases in pain avoidance, specifically, might yield the best patient outcomes. However, further research to evaluate this possibility is necessary.

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

BACKGROUND: Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. METHODS: Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. DESIGN: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. PARTICIPANTS: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). INTERVENTION: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. MEASURES: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. DISCUSSION: This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.

Factors Associated with Suicidal Ideation in Patients with Chronic Non-Cancer Pain.

Objectives: This study's aim was to identify the most important general and pain-related risk factors of suicidal ideation in a large sample of patients with chronic non-cancer pain. Methods: A total of 728 patients with chronic non-cancer pain were recruited from the waitlists of eight multidisciplinary pain clinics across Canada. Patients were assessed using self-administered questionnaires to measure demographic, pain-related (intensity, duration, interference, sleep problems), psychological (anxiety, anger, depressive symptoms including suicidal ideation), cognitive (catastrophizing, attitudes/beliefs), and health-related quality of life variables. A hierarchical logistic regression analysis was used to identify the factors that were associated with presence/absence of suicidal ideation while controlling for depressive symptoms. Results: The results showed that being a male, longer pain duration, higher anger levels, feelings of helplessness, greater pain magnification, and being more depressed were significant independent predictor factors of suicidal ideation, while better perceived mental health was related with a lesser likelihood of suicidal ideation. Moreover, being in a relationship and believing in a medical cure for pain might be protective of suicidal ideation while being anxious may be more associated with suicidal ideation. Conclusions: These results indicate that development of suicidal ideation is more closely related to pain chronicity and certain psychosocial factors than how severe or physically incapacitating the pain is. Many of these factors could potentially be modified by early identification of suicidal ideation and developing targeted cognitive interventions for suicidal at-risk patients. Research to examine the efficacy of these interventions for reducing suicidal ideation is warranted.