Disability reduction following a lumbar stabilization exercise program for low back pain: large vs. small improvement subgroup analyses of physical and psychological variables.

BACKGROUND: Little is known about why patients with low back pain (LBP) respond differently to treatment, and more specifically, to a lumbar stabilization exercise program. As a first step toward answering this question, the present study evaluates how subgroups of patients who demonstrate large and small clinical improvements differ in terms of physical and psychological changes during treatment. METHODS: Participants (n = 110) performed the exercise program (clinical sessions and home exercises) over eight weeks, with 100 retained at six-month follow-up. Physical measures (lumbar segmental instability, motor control impairments, range of motion, trunk muscle endurance and physical performance tests) were collected twice (baseline, end of treatment), while psychological measures (fear-avoidance beliefs, pain catastrophizing, psychological distress, illness perceptions, outcome expectations) were collected at four time points (baseline, mid-treatment, end of treatment, follow-up). The participants were divided into three subgroups (large, moderate and small clinical improvements) based on the change of perceived disability scores. ANOVA for repeated measure compared well-contrasted subgroups (large vs. small improvement) at different times to test for SUBGROUP × TIME interactions. RESULTS: Statistically significant interactions were observed for several physical and psychological measures. In all these interactions, the large- and small-improvement subgroups were equivalent at baseline, but the large-improvement subgroup showed more improvements over time compared to the small-improvement subgroup. For psychological measures only (fear-avoidance beliefs, pain catastrophizing, illness perceptions), between-group differences reached moderate to strong effect sizes, at the end of treatment and follow-up. CONCLUSIONS: The large-improvement subgroup showed more improvement than the small-improvement subgroup with regard to physical factors typically targeted by this specific exercise program as well as for psychological factors that are known to influence clinical outcomes.

The role of pain self-efficacy and pain catastrophising in the relationship between chronic pain and depression: A moderated mediation model.

Chronic pain is a substantial health problem with a high prevalence of comorbid depression. To understand the link between chronic pain and depression, cognitive factors including pain catastrophising and pain self-efficacy have been theorised as significant contributing variables. There is relatively strong evidence that pain catastrophising mediates the relationship between pain severity and depression symptoms. There is also emerging evidence that the mediation role of pain catastrophising may vary as a function of pain self-efficacy. However, it is unknown whether this model will apply in a tertiary pain clinic sample. Thus, this study aimed to examine the respective moderating and mediating roles of pain self-efficacy and pain catastrophising on the association between pain severity and depressive symptoms in a large clinical sample of Australian adults living with chronic pain. Participants (n = 1195) completed all questionnaire measures prior to their first appointments at one tertiary pain service. As expected, the PROCESS path analysis showed that pain catastrophising mediated the relationship between pain severity and depressive symptoms. Further, there was support for the moderating effect of pain self-efficacy; as pain self-efficacy decreased, the relationship strengthened between both pain severity and pain catastrophising, as well as pain catastrophising and depressive symptoms. These findings may have important clinical implications including how relationships between these factors may be considered in the provision of care for those with chronic pain. Notably, these measures could be used in triaging processes to inform treatment decisions.

The Contribution of Psychological Symptoms to Cognitive Difficulties in Youth With Postural Orthostatic Tachycardia Syndrome and Chronic Pain.

INTRODUCTION: Subjectively experienced cognitive difficulties are common in youth with postural orthostatic tachycardia syndrome. The pathophysiological and psychological contributions of these cognitive impairments remain unclear. METHOD: Participants were 96 adolescents and young adults diagnosed with postural orthostatic tachycardia syndrome and admitted to an intensive pain treatment program. Participants completed cognitive assessment and measures of postural orthostatic tachycardia syndrome symptoms, pain intensity, pain catastrophizing, anxiety, depression, and functional disability. RESULTS: Self-reported autonomic symptom intensity, but not severity of heart rate change, was associated with cognitive performance. Symptoms of depression were associated with decreases in most measures of cognitive functioning. Pain intensity, pain catastrophizing, and depression but not cognitive scores and physiological measures, were significant predictors of disability. CONCLUSION: Depression appears to be a significant contributor to the cognitive difficulties in youth with postural orthostatic tachycardia syndrome. These findings highlight the importance of assessing and treating affective symptoms in this population along with medical and lifestyle approaches to treating postural orthostatic tachycardia syndrome symptoms.

Gender differences in PTSD severity and pain outcomes: Baseline results from the LAMP trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms. AIM: Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. METHODS: Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. RESULTS: Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). CONCLUSION: These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.

A comprehensive investigation of biopsychosocial determinants influencing primary dysmenorrhea among university students.

Dysmenorrhea, characterized by pain and related symptoms, significantly impacts women's quality of life in work and education, prompting a comprehensive evaluation of associated factors. The objective of this study was to utilize structural equation modeling (SEM) to analyze and assess the biopsychosocial factors influencing dysmenorrhea among university students. Three hundred and thirty-nine university students were included in this cross-sectional descriptive study. Data were collected using the Participant Information Form, the Beck Anxiety Scale (BAS), the Beck Depression Scale (BDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Adverse Childhood Experiences Scale (ACES), the Pain Catastrophizing Scale (PCS) and the Visual Analogue Scale (VAS). It was determined that the variables of pain onset (t = 3.24, p < .05) and age at menarche (t = -2.16, p < .05) showed a significant relationship with the model. The variables of the PCS (t = 16.87, p < .001), BDS (t = 3.06, p < .05), and BAS (t = 5.13, p < .001) showed a significant relationship with the model. Social factors in the model were examined, and a family history of dysmenorrhea and the ACES variables did not contribute significantly to the model (p > .05). The study indicates primary dysmenorrhea influenced by biological and psychological factors. Nurses should conduct holistic assessments and provide comprehensive care for affected women.

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing.

BACKGROUND: Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. AIM: The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. METHODS: This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. RESULTS: Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. CONCLUSION: The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study.

BACKGROUND AND PURPOSE: Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP). METHODS: This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used. RESULTS: The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05). DISCUSSION: This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Cross-cultural adaption, validity, and reliability of the Japanese version of the Central Aspects of Pain in the Knee (CAP-Knee-J) questionnaire in patients with knee pain: a validation study.

BACKGROUND: Knee pain is a prominent concern among older individuals, influenced by the central nervous system. This study aimed to translate the Central Aspects of Pain in the Knee (CAP-Knee) questionnaire into Japanese and investigate its reliability and validity in older Japanese individuals with knee pain. METHODS: Using a forward-backward method, CAP-Knee was translated into Japanese, and data from 110 patients at an orthopedic clinic were analyzed. The Japanese version (CAP-Knee-J) was evaluated regarding pain intensity during walking, central sensitization inventory, and pain catastrophizing scale. Statistical analyses confirmed internal validity and test-retest reliability. Concurrent validity was assessed through a single correlation analysis between CAP-Knee-J and the aforementioned measures. Exploratory factor analysis was employed on each CAP-Knee-J item to examine structural validity. RESULTS: CAP-Knee-J showed good internal consistency (Cronbach's α = 0.86) and excellent test-retest reliability (intraclass correlation coefficient = 0.77). It correlated significantly with pain intensity while walking, central sensitization inventory scores, and pain catastrophizing scale scores. Exploratory factor analysis produced a three-factor model. CONCLUSIONS: CAP-Knee-J is a reliable and valid questionnaire for assessing central pain mechanisms specific to knee pain in older Japanese individuals, with moderate correlations with the CSI and weak with the PCS, thus indicating construct validity. This study supports the development of effective knee pain treatments and prognosis predictions.

Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications.

Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.

Influencing factors of kinesiophobia among stroke patients with hemiplegia: A mixed methods study.

OBJECTIVES: There is a scarcity of data regarding the effects of kinesiophobia on stroke patients with hemiplegia. Therefore, this paper aims to evaluate the level of kinesiophobia experienced by stroke patients with hemiplegia in China, examine the elements that influence it, and investigate the unique psychological experience of kinesiophobia combined with a qualitative study. METHODS: This mixed study was conducted in two steps. Four approved scales were used to evaluate a total of 163 patients: (i) Tampa Scale of Kinesiophobia, (ii) Pain Catastrophizing Scale, (iii) Self-Efficacy for Exercise Scale, and (iv) Hospital Anxiety and Depression Scale. A multivariate linear regression model was used to evaluate the predictors of kinesiophobia in stroke patients with hemiplegia. Subsequently, semi-structured interviews with 15 stroke patients with hemiplegia were conducted using an objective sampling method, and the Colaizzi 7-step analysis process was utilized to analyze the interview data. RESULTS: A total of 163 stroke patients with hemiplegia were included in this study, of them, 47.9% reported kinesiophobia. Multiple linear regression revealed that the influencing factors of kinesiophobia in stroke patients with hemiplegia were a history of falls, exaggeration, helplessness, anxiety, depression, and low exercise self-efficacy (P<0.05). The qualitative research focuses on two main topics: personal adoption of negative coping styles and insufficient external support. CONCLUSION: Our study showed that the kinesiophobia in stroke patients with hemiplegia was high, with several factors influencing their kinesiophobia. Some of these factors are modifiable and should be considered when formulating kinesiophobia intervention strategies for stroke patients with hemiplegia.

Chain-mediating effects of kinesiophobia and self-efficacy on pain catastrophizing and physical activity in haemophilia patients.

BACKGROUND: There is a lack of research on the relationship between pain catastrophizing, kinesiophobia, and physical activity (PA) in people with haemophilia (PWH), and the underlying mechanisms connecting these variables remain unclear. AIM: The study's aim was to clarify the roles of kinesiophobia and self-efficacy in the relationship between pain catastrophizing and PA in PWH. METHODS: This cross-sectional study included adult PWH at the Haemophilia Centre of a Tertiary hospital in Beijing, China. The following questionnaires were used to collect data: the general information, the International Physical Activity Short Questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia Scale, and the Exercise Self-Efficacy Scale. RESULTS: The study included a total of 187 PWH, including 154 having haemophilia A and 33 having haemophilia B. The median interquartile range of PA was 594 (198, 1554) MET-min/wk. There were significant differences in PA of patients based on age stage, treatment modality, highest pain score within the last seven days, and presence of haemophilic arthropathy (p < .05). It was showed that pain catastrophizing could directly predict PA (p < .001), accounting for 38.13% of the total effect. Pain catastrophizing also had indirect effects on PA through the mediating factors of kinesiophobia or self-efficacy, and through the chain-mediating effect of kinesiophobia and self-efficacy, accounting for 38.40%, 17.07%, and 6.40%, respectively. CONCLUSION: The study discovered that PWH have limited PA due to pain catastrophizing. This not only directly affects their activity but also indirectly influences it through kinesiophobia and self-efficacy.

Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis.

OBJECTIVES: To gain insight into the perceptions, and beliefs of patients with advanced cancer coping with chronic pain and to identify their attitudes and demands on pain management. METHODS: From July to September 2022, 17 patients with advanced cancer living with chronic pain were recruited from a tertiary cancer hospital in Hunan Province, China. Qualitative and semi-structured interviews were conducted individually, with 30-45 minutes for each. The Colaizzi 7-step analysis method in phenomenological research was used for data analysis. RESULTS: The experience of pain acceptance by advanced cancer patients with chronic pain was summarized into four themes: pain catastrophizing (unable to ignore the pain, try various methods to relieve the pain, exaggerating pain perception, and lack of knowledge about proper pain management), rumination (compulsive rumination and worrying rumination), avoidance coping (situational avoidance and repressive avoidance) and constructive action (setting clear value goal and taking reciprocal action). CONCLUSION: Most patients with advanced cancer had low pain acceptance and negative attitudes. Feeling helpless in the face of pain and suffering alone were their norm. Long-term negative emotions could lead to gradual depression and loss of hope for treatment, resulting in pain catastrophizing and persistent rumination. Nevertheless, a few patients accepted pain with positive attitudes. Medical professionals should pay more attention to the psychological status of advanced cancer patients with chronic pain, and employ alternative therapies, for example, cognitive behavioral therapy. More efforts are needed to reduce patients' pain catastrophizing, and promote their pain acceptance by a better understanding of pain through health education.

Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain.

BACKGROUND AND IMPORTANCE: Differences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification. OBJECTIVES: The aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain. DESIGN, SETTINGS AND PARTICIPANTS: Adults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain. OUTCOMES MEASURE AND ANALYSIS: The outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes. MAIN RESULTS: In total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes. CONCLUSIONS: This study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.

Pain catastrophizing in the elderly: An experimental pain study.

OBJECTIVES: Pain catastrophizing in the aging population has not been studied in great detail. Existing investigations have reported conflicting results on the effects of age on pain catastrophizing in relation to pain responses. This study investigated the relationship between pain catastrophizing, and its individual components (rumination, magnification, and helplessness), and the responses to standardized experimental pain stimuli in old and young, healthy adults. METHODS: Sixty-six volunteers (32 old: 65-87, 18 females; 34 young: 20-35, 17 females) participated in the study. Pain catastrophizing including the components of rumination, magnification, and helplessness was assessed with the pain catastrophizing scale (PCS). Experimental pain was induced by applying predefined pressure stimulations to the trapezius muscle. Pain intensity and unpleasantness were assessed using numerical rating scales. Pain catastrophizing levels and pain responses were statistically compared between the two age groups. RESULTS: Elderly individuals reported significantly (p = 0.028) lower scores of pain catastrophizing (Med = 5; interquartile range [IQR] = 14) than younger individuals; this difference was driven by the significantly lower components of rumination (Med = 2; IQR = 4; p = 0.017) and helplessness (Med = 2; IQR = 7; p = 0.049). A larger proportion of young (57.8%) rated pain catastrophizing at high levels, with scores above the 75th percentile (Med = 20). Additionally, elderly reported the lowest pain intensity (Med = 5; p = 0.034) and pain unpleasantness (Med = 4.5; p = 0.011) responses to the experimental pressure stimuli. In the elderly group, pain unpleasantness was positively and significantly associated with pain catastrophizing (r s = 0.416, p = 0.021), rumination (r s = 0.42, p = 0.019), and helplessness (r s = 0.434, p = 0.015), respectively. No associations were found in the young group. CONCLUSIONS: Elderly reported lower PCSs than young adults. Rumination and helplessness were reduced in the elderly group. The elderly population showed positive correlations between catastrophizing levels and pain unpleasantness to standardized pressure pain stimuli. Results supported the view that elderly possess resilience over specific domains of pain catastrophizing that could counteract pain perception due to physiological decline.

Higher Neck Pain Intensity and Pain Catastrophizing Soon After A Whiplash Injury Partially Explain the Presence of Persistent Headache: A Prospective Study.

OBJECTIVE: To understand whether pain-related factors soon after a whiplash injury can explain the presence of chronic headache. MATERIALS AND METHODS: A prospective study with a follow-up of 6 months was performed, including 42 patients with acute whiplash-associated disorders. Neck pain intensity, the Neck Disability Index, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, and the Anxiety State-Trait Scale were assessed at baseline. Differences in clinical characteristics between those with and without headache at 6 months were determined. The relative risk of presenting with headache was evaluated. A logistic regression model was performed to assess which factors at baseline could explain the presence of headache at 6 months. RESULTS: At 6 months, one-third of the sample presented with chronic headache. Significant differences were found for several outcome measures when people with and without headache were compared ( P <0.001). The highest relative risk of presenting with headache was found for moderate/severe levels of pain catastrophizing during the acute phase (RR=15.00, 95% CI=3.93, 57.22). The level of neck pain intensity and pain catastrophizing at baseline partially explained the presence of headache at 6 months ( R2 =0.627). DISCUSSION: The risk of presenting with persistent headache attributed to a whiplash injury is increased when people present with higher neck pain intensity and pain catastrophizing soon after a whiplash injury. Evaluating neck pain intensity and pain catastrophizing at baseline may assist in identifying those more likely to develop chronic headache, potentially providing an opportunity for early targeted interventions.

Pain coping and catastrophizing in youth with and without cerebral palsy.

OBJECTIVES: The aim of this study is to compare the use of pain coping strategies and pain catastrophizing in youth with and without cerebral palsy (CP), and to examine how these two groups differ with respect to the associations between pain coping, catastrophizing, and measures of psychological function and sleep disturbance. METHODS: Twenty-seven individuals with CP and 49 healthy controls aged 15-22 were included in this cross-sectional observational study. Pain was assessed using a semi-structured interviews and participants completed measures of pain coping, pain catastrophizing, psychological function, and sleep. RESULTS: Youth with CP used information seeking and problem solving (p = 0.003, Cohen's d (d) = -0.80) and sought social support (p = 0.044, d = -0.51) less often, and used internalizing as a coping strategy more often (p = 0.045, d = 0.59) than healthy controls. The use of information seeking and problem solving correlated more strongly with measures of depression (p = 0.023, Cohen's f (f) = 0.08) and sleep disturbance (p = 0.022, f = 0.08), while behavioral distraction correlated more strongly with measures of anxiety (p = 0.006, f = 0.11) and sleep disturbance (p = 0.017, f = 0.09) in youth with CP, compared to healthy controls. CONCLUSIONS: The study findings raise the possibility that youth with CP may benefit more in terms of psychological function and sleep quality from coping training interventions that focus on behavioral distraction, information seeking, and problem solving. Research to test these ideas in additional samples of youth with CP is warranted.

Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety.

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

Pain intensity and self-perceived burden mediate the relationship between family functioning and pain catastrophizing in patients with neuropathic pain.

This cross-sectional study aimed to investigate the relationship between family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Moreover, we also wanted to explore the multiple mediating roles of pain intensity and self-perceived burden. From October 2022 to March 2023, 252 Chinese people with neuropathic pain completed face-to-face questionnaires to assess family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Data analysis was done using descriptive statistics and a structural equation model. The results showed better family functioning was significantly associated with more intense pain, less self-perceived burden, and less pain catastrophizing. Mediation analysis showed that family functioning could indirectly affect pain catastrophizing through pain intensity and self-perceived burden in addition to a direct effect on pain catastrophizing. Moreover, the mediating variable of pain intensity played a masking role. These findings suggest that good family functioning can effectively reduce the self-perceived burden and pain catastrophizing in patients with neuropathic pain. However, family functioning cannot show its maximum effectiveness, and it may be necessary to construct a model of family functioning suitable for patients with neuropathic pain in the future.

Nonpharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. RESEARCH DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. RESULTS: Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. DISCUSSION AND IMPLICATIONS: Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire.

OBJECTIVES: Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ. METHODS: We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity. RESULTS: We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity. DISCUSSION: Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.