Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study.

OBJECTIVE: To investigate the predictive power of resilience and vulnerability factors in relation to pain-related disability. DESIGN: A two-year prospective study investigated whether back pain-related disability was predicted by the following variables, measured when pain was acute: 1) pain-related disability, 2) pain intensity, 3) depression, 4) fear avoidance beliefs, 5) anxiety sensitivity, and 6) resilience. METHODS: Two hundred thirty-two patients treated in five primary care centers participated in this study. They were assessed at baseline during an acute back pain episode and at six, 12, 18, and 24 months. Ninety-nine patients completed all the assessment sessions. Linear mixed models were used to examine the trajectory of disability across the measurement occasions and its association with the predictors. RESULTS: Individuals who had higher scores of disability and pain intensity when pain was acute also had higher scores of disability six months later; moreover, the increase in disability was greater over time in comparison with individuals with lower scores in disability and pain intensity when pain was acute. Individuals who had reported greater levels of fear avoidance beliefs when pain was acute also reported greater scores of disability six months later; however, no differences were found in the rate of change in disability. No associations were found between initial disability or rate of change and resilience, anxiety sensitivity, or depression. CONCLUSIONS: Patients with acute back pain who show high levels of pain-related disability, pain intensity, and fear avoidance beliefs are at risk of developing back pain-related disability and should be the target of a preventive intervention.

Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain.

Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months' duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability-understood as giving up normal activities-can lead to reductions in healthcare utilization and medication intake.

Exploring Changes in Activity Patterns in Individuals with Chronic Pain.

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity.

El malestar emocional como síntoma de estrés postraumático / Emotional distress as a symptom of post-traumatic stress

El trastorno por estrés postraumático (TEPT) tiene una importante prevalencia en la población, por lo que conocer los mecanismos psicológicos para la vulnerabilidad y el mantenimiento del trastorno es claramente relevante. Entre dichos mecanismos, se ha postulado el constructo de malestar emocional como transdiagnóstico a diversos trastornos mentales. El objetivo del presente estudio fue poner a prueba un modelo hipotético que analizaba la asociación entre tres variables pertenecientes a dicho constructo (evitación experiencial, tolerancia al malestar e intolerancia a la incertidumbre inhibitoria) y el TEPT. Participaron 328 estudiantes universitarios (74.7% mujeres y 25.3% hombres, con una media de edad de 21 años) que habían experimentado al menos un acontecimiento traumático de acuerdo con los criterios del DSM-5, quienes completaron una batería de cuestionarios. Se efectuó un análisis de ecuaciones estructurales cuyos resultados apoyaron parcialmente el modelo hipotético. La evitación experiencial mostró asociarse positiva y significativamente con la tolerancia al malestar, la intolerancia a la incertidumbre inhibitoria y los síntomas del TEPT. La tolerancia al malestar también se vinculó de forma positiva y significativa con dichos síntomas. Sin embargo, la intolerancia a la incertidumbre inhibitoria no mostró relación con esta sintomatología. En apoyo a la evidencia empírica precedente, los hallazgos de este estudio inciden en el papel de la evitación experiencial y la tolerancia al malestar como variables moderadoras de la sintomatología postraumática. Asimismo, apuntan hacia la necesidad de considerar estas variables en las intervenciones psicológicas para el tratamiento del TEPT

Post-traumatic stress disorder or PTSD has an important prevalence in the population, so knowing the psychological mechanisms of vulnerability and maintenance of this disorder is clearly relevant. Among those mechanisms, the emotional distress construct has been postulated as a trans-diagnostic tool related to different mental disorders. The objective of the present study was to test a hypothetical model for the analysis of the association between three variables of this construct (experiential avoidance, distress tolerance, and inhibitory uncertainty intolerance) and PTSD. The subjects of study amounted to 328 university students (74.7% women and 25.3% men, with a median age of 21) who had experienced at least one traumatic event according to the DSM-5 criteria. They were made to complete a set of questionnaires. A structural equation analysis was carried out, with results partially coincident with the hypothetical model. Exponential avoidance showed a positive and significant association with distress tolerance, inhibitory uncertainty intolerance and PTSD symptoms. Distress tolerance was also associated with these symptoms in a positive and significant way. However, inhibitory uncertainty intolerance was not associated with this symptomatology. Following the preexisting empirical evidence, the findings of this study have an impact on the role of experiential avoidance and distress tolerance, as variables that moderate post-traumatic symptomatology. Furthermore, the findings point to the need to consider these variables in psychological interventions for the treatment of PTSD

Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor.

Understanding which factors predict individual dissociative response during stressful situations is important to clarify the nature of dissociation and the mechanisms associated to its use as a coping strategy. The present study examined (1) whether experiential avoidance (EA), anxiety sensitivity (AS), depressive symptoms, and state anxiety concurrently predicted trait dissociation (TD)-absorption, amnesia, depersonalization, and total TD scores-and laboratory induced dissociation (LID); and (2) whether TD and catastrophizing predicted LID. We also examined whether catastrophizing mediated the relationships between both AS and depressive symptoms and LID. A total of 101 female undergraduate students participated in a cold pressor task, which significantly induced dissociation. Results of hierarchical regression analyses showed that AS at Time 1 (9 months before the experimental session), as well as depressive symptoms and catastrophizing at the time of the experiment (Time 2), predicted LID at Time 2. Depressive symptoms at Time 2 predicted total TD, absorption, and amnesia scores. AS at Time 1 and depressive symptoms at Time 2 predicted depersonalization. AS, depressive symptoms, and catastrophizing seem to facilitate the use of dissociative strategies by healthy individuals, even in response to non-traumatic but discomforting stress.

Effective therapies for the treatment of complex posttraumatic stress disorder: A qualitative systematic review / Terapias eficaces para el tratamiento de estrés postraumático complejo: Una revisión sistemática cualitativa

Abstract: Background: Current literature shows that posttraumatic stress disorder and complex posttraumatic stress disorder symptoms differ. Although the psychological treatments available for posttraumatic disorder are well established, little is known about the effectiveness of those aimed at the treatment of complex posttraumatic stress. Objective: To evaluate the efficacy of psychological treatments for complex posttraumatic stress disorder. Method: A systematic qualitative search was conducted according to PRISMA guidelines, searching four psychological and health electronic databases: Medline, Pilots, PsycINFO, and Pubmed. Three reviewers independently selected the studies in two phases: preselection (criteria for complex posttraumatic stress disorder, replicable psychological treatment, and treatment effect) and selection (additional criteria: type of study, participants, and treatment). Results: Of the 615 studies reviewed, 25 were preselected, eight of which met the inclusion and methodological quality criteria. Five studies explored adult populations (with one exception, all were randomized clinical trials) and three child populations (clinical studies with pre- post-treatment design, with and without control group). Most studies with adult populations included psychoeducation, cognitive restructuration, and exposure therapy. The studies with child samples included EMDR and mindfulness as the most frequent treatment components. Discussion and conclusion: The evidence was insufficient to determine the most effective treatment. More research on this issue is required.

Resumen: Antecedentes: La literatura actual muestra una diferenciación entre los síntomas de trastorno por estrés postraumático y estrés postraumático complejo (TEPTC). Si bien los tratamientos psicológicos para el primer tipo de sintomatología están claramente establecidos, son menos conocidas las intervenciones para el TEPTC. Objetivo. Evaluar la eficacia de las terapias psicológicas para reducir los síntomas del TEPTC. Método: Se realizó una revisión sistemática cualitativa basada en la guía de publicación PRISMA. Se usaron cuatro bases de datos: Medline, Pilots, Psycinfo y Pubmed. Con base en criterios previamente definidos, tres revisores independientes eligieron los trabajos en dos fases: preselección (criterios para TEPTC, tratamiento psicológico replicable, datos sobre efectos) y selección (considerando tres criterios adicionales: tipo de estudio, de participantes y de intervención). Resultados: De los 615 encontrados, se preseleccionó un total de 25 artículos para revisión de texto completo, de los cuales se seleccionaron un total de ocho. Cinco trabajos incluyeron población adulta (a excepción de un estudio, todos eran ensayos clínicos controlados aleatorizados) y el resto infantil (diseño pre-post-tratamiento, con o sin grupo control). Mayoritariamente, los componentes de los tratamientos para adultos fueron: psicoeducación, reestructuración cognitiva y exposición. Los estudios con muestras infantiles incluyeron técnicas más heterogéneas, si bien el uso del EMDR y mindfulness fueron comunes a dos de las intervenciones. Discusión y conclusión: Dada la escasez de estudios encontrados y los problemas de control metodológico, no es posible destacar un tratamiento de elección para el TEPCT con eficacia superior al resto. Se requiere de más investigación en este ámbito.

El papel mediador de la gestión de las metas vitales entre el optimismo y el bienestar en mujeres con fibromialgia / The mediating role of goal adjustment strategies between optimism and well-being in women with fibromyalgia

El optimismo disposicional se ha mostrado como una variable predictora del bienestar de los individuos que padecen dolor crónico. Este estudio tiene como objetivo analizar el papel mediador de la tenacidad y la flexibilidad, como estrategias de regulación de metas, entre el optimismo disposicional y la adaptación en una muestra de 99 mujeres con fibromialgia. Los análisis de regresión señalan al optimismo y la tenacidad como las únicas variables que se asocian con el propósito vital y el bienestar, teniendo la intensidad de dolor un efecto sobre el afecto positivo. La interacción entre la tenacidad y la flexibilidad surge como variable predictora del bienestar y mediadora en la relación del optimismo con el propósito vital, afecto positivo y el bienestar psicológico de las mujeres. La interacción entre la persecución tenaz de las metas y el ajuste flexible de las mismas es una estrategia eficaz que media entre el optimismo y el bienestar de las mujeres con fibromialgia

Dispositional optimism has been shown as a predictor of the well-being of individuals suffering from chronic pain. The present study aims to analyze the mediating role of tenacity and flexibility, as goal-setting strategies, between dispositional optimism and adaptation in a sample of 99 women with fibromyalgia. The regression analyses point to optimism and tenacity as the only variables that are associated with vital purpose and well-being, with the intensity of pain having an effect on positive affect. The interaction between tenacity and flexibility emerges as a predictor of well-being and a mediator in the relationship of optimism with vital purpose, positive affect and psychological well-being of the women. The interaction between the tenacious pursuit of goals and the flexible adjustment is an effective strategy that mediates between optimism and wellbeing of women with fibromyalgia

Personality characteristics as differential variables of the pain experience.

This study analyzes the relationships between neuroticism, extroversion, age, and sex and the intensity of perceived pain and the coping strategies used. We worked with a sample of 96 patients with chronic pain. The assessment tools were the following: the Vanderbilt Pain Management Inventory, a Spanish version of the McGill Pain Questionnaire, and the Eysenck Personality Inventory. The hypothetical model establishes positive relationships between neuroticism, the use of passive coping strategies, and the intensity of pain. On the other hand, extraversion is expected to be positively related to the use of active coping strategies and negatively related to the perceived intensity of pain. The results support the hypotheses formulated regarding the effects of the variables neuroticism and extraversion. Age is negatively related to active coping strategies and pain intensity. Men use more active strategies than women, while the latter have a greater perception of pain.

Desarrollo de un inventario para la evaluación cognitiva en pacientes con dolor crónico / Development of an inventory of cognitive appraisal in chronic pain patients

En el ámbito de estudio del dolor crónico, trabajos recientes subrayan la importancia de la evaluación cognitiva que llevan a cabo los pacientes sobre su dolor, sin embargo, es muy escaso el número de instrumentos que nos permite medir dicha variable. El principal objetivo de este trabajo es desarrollar un inventario para ello. Con una muestra de 224 pacientes, se crean los ítems del instrumento partiendo de la definición de evaluación cognitiva incluida en el modelo transaccional del estrés y las consecuencias del padecimiento de dolor crónico (p.ej., pérdida de autonomía, sensación de amenaza sobre su estatus familiar y laboral). El análisis de componentes principales arroja tres componentes de evaluación primaria: pérdida o daño, amenaza y desafío, incluidos en un total de 31 ítems. Las tres escalas mostraron altos niveles de consistencia interna y validez concurrente respecto al dolor, el afrontamiento y el funcionamiento diario. El Inventario de evaluación cognitiva para pacientes con dolor crónico (IEC) aparece así como un instrumento prometedor para su utilización en futuras investigaciones con este tipo de pacientes (AU)

In chronic pain context, recent studies have begun to consider the relevance of the patient’s cognitive appraisal about their pain. Nevertheless, there are not many instruments that allow us to measure the cognitive appraisal o pain. The main purpose of this study was the development of an instrument to measure cognitive primary appraisal in chronic pain patients. First, following transactional models of stress and considering the consequences that chronic pain has in patients (e.g., loss of autonomy, threat to familiar or work roles), the items of the instrument were formulated. Principal component analysis revealed three components of primary appraisal: (1) loss or harm, (2) threat and (3) challenge. In a sample of 224 subjects with chronic pain, the three scales showed high internal consistency and criteria validity in relation to pain, coping and functioning. The Cognitive Appraisal Inventory («Inventario de evaluación cognitiva», IEC) appears to be a promising scale for use in future chronic pain research

Neuroticismo, afrontamiento y dolor crónico / Neuroticism, coping and chronic pain

El objetivo principal de este estudio es contrastar las hipótesis respecto a la relación entre los niveles de neuroticismo, la intensidad de dolor percibida y las estrategias de afrontamiento utilizadas por pacientes con dolor crónico. Para ello, contamos con una muestra compuesta por 100 pacientes con dolor crónico, tanto benigno como oncológico, que acuden a la Unidad del Dolor y al Servicio de Reumatología de la Residencia Hospitalaria Carlos Haya de Málaga. Los instrumentos de evaluación utilizados son: Escala Vanderbilt de Afrontamiento al Dolor (Brown y Nicassio, 1987); Cuestionario de McGill de Dolor (Ruiz et al., 1990) y el Inventario de Personalidad de Eysenck (Eysenck y Eysenck, 1990). El modelo hipotético formulado fue sometido a contrastación empírica mediante el programa LISREL.8.20 (Jöreskog y Sörbom, 1993), utilizando el método de los mínimos cuadrados no ponderados. Los resultados del presente trabajo proporcionan evidencia empírica que apoya la teoría propuesta acerca de la relación existente entre la variable de personalidad neuroticismo y las estrategias de afrontamiento que utilizan los pacientes con dolor crónico. Podríamos decir que altos niveles de neuroticismo se convierten en predictores del catastrofismo y de la búsqueda de apoyo social, como estrategias de afrontamiento poco eficaces. (AU)

Adaptación al castellano de la escala Courtauld de control emocional en pacientes con cáncer / Spanish adaptation of the Courtauld Emotional Control Scale: evidence of a exploratory analysis in patients with cancer

Los estudios en torno al "Tipo C" constituyen un importante tópico de la investigación generando en los últimos treinta años más de 300 artículos y 68 libros y capítulos de libros (Fernández-Ballesteros y Ruis, 1997). Aunque el núcleo del "Tipo C" parece estar bien delimitado (inhibición, represión o supresión de las emociones negativas- o anti-emocionalidad- junto con la necesidad de mantener relaciones interpersonales armoniosas), no existe acuerdo entre la naturaleza de estas variables. Así mientras unos autores consideran que se trata de mecanismos de defensa frente a la ansiedad (Temoshock y Dreher, 1992; Spielberg, 1988a), otros sostienen que, más bien, puede ser considerado un estilo o patrón comportamental de anti-emocionalidad o supresión emocional (Greer y Watson, 1985). Más aún, dentro de este último grupo existen autores que plantean para este estilo comportamental una especificidad por emociones (Watson y Greer, 1983), frente a otros que defienden una especificidad por acciones (Bleiker, Van Der Ploeg, Hendriks, Leer y Kleijn, 1993). Los resultados son consistentes (aunque parcialmente) con ambas propuestas (AU)

In the last 30 years, the contribution of «Type C» to cancer disease has been an important research topic. From 1974 through 1995 a search of the literature on Psychlit and Medline identified more than 300 journal articles and 68 books and book chapters (Fernández-Ballesteros y Ruiz, 1997). Although the principal variables of «Type C» has been identified (inhibition, repression or suppression of negative emotions - anti-emotionality - and need for harmony), there is not agreement about the nature of this variables. Thus, for some authors the variables mentioned are defensiveness mechanisms to anxiety (Temoshok y Dreher, 1992; Spielberger, 1988a). Other authors consider the variables said as a behavioural style of anti-emotionality or suppression emotional (Greer y Watson, 1985). On the other hand, between this authors that defend that «Type C» is a behavioural style neither there is agreement. So, while Watson y Greer (1983) emphasize specific «Type C» components related to the emotions (anger, anxiety, depressed mood - only control - ), Bleiker, Van Der Ploeg, Hendriks, Leer y Kleijn (1993) emphasize specific «Type C» components related to the actions (expression, repression and emotional control). The results are consistent (only partially) with both proposal (AU)