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.

Pain screening in youth with sickle cell disease: A quality improvement study.

BACKGROUND: Youth with sickle cell disease (SCD) face several challenges as they age, including increased pain frequency, duration, and interference. The purpose of this study was to (i) determine the feasibility of routine pain screening; (ii) identify and describe various clinical pain presentations; and (iii) understand preferences/resources related to engaging in integrative health and medicine (IHM) modalities within an outpatient pediatric SCD clinic. METHODS: During routine outpatient visits, patients aged 8-18 completed measures of pain frequency, duration, and chronic pain risk (Pediatric Pain Screening Tool [PPST]). Participants screening positive for (i) persistent or chronic pain or (ii) medium or high risk for persistent symptoms and disability on the PPST were asked to complete measures of pain interference, pain catastrophizing, and interest in/resources for engaging in IHM modalities. RESULTS: Between March 2022 and May 2023, 104/141 (73.8%) patients who attended at least one outpatient visit were screened. Of these 104 (mean age 12.46, 53.8% female, 63.5% HbSS), 34 (32.7%) reported persistent or chronic pain, and 48 (46.2%) reported medium or high risk for persistent symptoms and disability. Patients completing subsequent pain screening measures reported a mean pain interference T-score of 53.2 ± 8.8 and a mean pain catastrophizing total score of 24.3 ± 10.2. Patients expressed highest interest in music (55.6%) and art therapy (51.9%) and preferred in-person (81.5%) over virtual programming (22.2%). CONCLUSIONS: Comprehensive pain screening is feasible within pediatric SCD care. Classifying patients by PPST risk may provide a means of triaging patients to appropriate services to address pain-related psychosocial factors.

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.

Anxiety, pain catastrophizing, and pain outcomes among older adults with chronic orofacial pain.

Although chronic orofacial pain (COFP) is common among older adults, the role of psychological factors in pain outcomes among this population has received limited attention. This study examined the role of anxiety and pain catastrophizing, two corelates of pain in other populations, in pain intensity and interference among 166 older adults with COFP (79% female, Mage = 68.84, SD = 5.56). Participants completed an online survey including measures of anxiety, pain catastrophizing, and pain intensity/interference. We applied mediation analyses to test indirect associations between anxiety and pain outcomes via pain catastrophizing. Results indicated that anxiety was positively associated with pain intensity and pain interference (bs = .70-1.12, ps < .05). There was also an indirect association between anxiety and pain interference through pain catastrophizing (b = .35, 95% CI [.0383, .7954]), indicating pain catastrophizing partially accounts for this relationship. Assessing and addressing anxiety and pain catastrophizing has the potential to improve treatment outcomes in this population.

The contribution of pain catastrophizing, depression and anxiety symptoms among patients with persistent pain and opioid misuse behaviours.

BACKGROUND: Anxiety, depression and pain catastrophizing are independently associated with risk of opioid misuse in patients with persistent pain but their relationship to current opioid misuse, when considered together, is poorly understood. This study will assess the relative contribution of these modifiable, and distinct psychological constructs to current opioid misuse in patients with persistent pain. METHODS: One hundred and twenty-seven patients referred to a specialized opioid management clinic for prescription opioid misuse within a tertiary pain service were recruited for this study. The Pain Catastrophizing Scale, Depression, Anxiety and Stress Scales and the Current Opioid Misuse Measure were administered pre-treatment. Pain severity and morphine equivalent dose based on independent registry data were also recorded. RESULTS: Higher levels of pain catastrophizing, depression, and anxiety were significantly associated with higher current opioid misuse (r = .475, 0.599, and 0.516 respectively, p < .01). Pain severity was significantly associated with pain catastrophizing (r = .301, p < .01). Catastrophizing, depression, and anxiety explained an additional 11.56% of the variance (R2 change = 0.34, p < .01) over and above age, gender, pain severity and morphine equivalent dose. Depression was the only significant variable at Step 2 (ß = 0.62, p < .01). CONCLUSION: Findings show that in a sample of people with persistent pain referred for treatment for opioid misuse, depression contributes over and above that of anxiety and pain catastrophizing. Theoretical and clinical practice implications are presented.

An Investigation of Associations between Pain Catastrophizing and Pain Disability in a Diverse Sample of Persons with Endometriosis.

OBJECTIVE: This study sought to investigate associations between components of pain catastrophizing (using the Pain Catastrophizing Scale; rumination, magnification, and helplessness) and components of pain disability (using the Pain Disability Index; family/home responsibilities, recreation, social activity, occupation, sexual behaviour, self-care, life-support activity) in a diverse sample of persons with endometriosis. METHODS: A total of 686 persons with a self-reported clinician-identified diagnosis of endometriosis participated in this study. Two-tailed independent samples t tests were used to examine between-group differences in pain disability and pain catastrophizing among those below and above clinically relevant moderate pain intensity levels. Between-group differences in pain disability among those below and above the clinically relevant pain catastrophizing level, and between-group differences in pain catastrophizing among those below and above the clinically relevant moderate pain disability level, were also analyzed. RESULTS: Experiencing moderate or greater levels of pain intensity was associated with increased levels of pain disability and pain catastrophizing (P < 0.001). Strong associations between clinically relevant levels of pain catastrophizing and increased levels of pain disability (P < 0.001), in addition to between clinically relevant levels of moderate pain disability and increased levels of pain catastrophizing (P < 0.001), were found at both the total and subdomain levels. CONCLUSION: Pain catastrophizing significantly affects pain disability and vice versa. Future research should examine the temporal relationship between catastrophizing and disability to inform intervention practices. Health care providers are strongly encouraged to evaluate the effects of endometriosis in patients using a biopsychosocial framework.

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.

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.

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.

The Power of Spiritual Well-Being: Its Relationship with Pain Intensity, Pain Management, and Pain Catastrophizing in Individuals with Chronic Pain.

BACKGROUND: Chronic pain negatively affects human life. Chronic pain is multidimensional. Therefore, a multidimensional approach that focuses on the biologic, psychological, sociologic, and spiritual needs of patients is required in pain management. AIM: This study was conducted to determine the relationship of spiritual well-being with the level of pain catastrophizing, pain intensity, and pain management in individuals with chronic pain. METHODS: The snowball sampling method was used in the research and the data were collected by individuals with ankylosing spondylitis and rheumatoid arthritis who had chronic pain via an online survey form. The study was completed between March and May 2023 with the participation of 399 people. The data of the study were collected using the Descriptive Characteristics Questionnaire, Pain Catastrophizing Scale, Three-Factor Spiritual Well-Being Scale, and Numerical Rating Scale. RESULTS: There was a negative, high-level correlation between the spiritual well-being and the Pain Catastrophizing Scale and its subscales. At the same time, there was a negative, weak level correlation between the levels of spiritual well-being and the pain intensity. Spiritual Well-Being Scale scores differ according to the method used in pain management. Spiritual well-being and pain intensity explain 68% of the total variance in pain catastrophizing. CONCLUSIONS: The results of this research show that there may be a relationship between increased spirituality and reduced perceptions of pain in this population.

A Review of the Extent of Pain Catastrophizing in Patients Who Have Undergone Total Knee Replacement.

OBJECTIVES: This study aimed to analyze the current status and influencing factors of pain catastrophizing in patients undergoing total knee replacement (TKR) and to provide a basis and reference for the clinical improvement of pain catastrophizing in these patients. DESIGN: This study was designed in accordance with PRISMA guidelines. DATA SOURCES: PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu and Chinese Biomedical Literature Databases. REVIEW/ANALYSIS METHODS: A scoping review was performed using PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu, and Chinese Biomedical Literature Databases, and after literature screening and data extraction, the results were summarized. RESULTS: A total of 23 articles were included in the study. Pain catastrophizing is mostly assessed using the Pain Catastrophizing Scale and the Coping Strategies Questionnaire. The level of pain catastrophizing is an independent predictor of pain in patients undergoing TKR and is influenced by demographic, psychological, co-morbid, and prognostic factors. Pain catastrophizing interventions mainly consist of surgery, physiotherapy, medication, and psychological therapy. CONCLUSIONS: Pain catastrophizing involves multiple factors, and it is necessary to explore the predictors affecting pain catastrophizing, improve the systematic evaluation of pain catastrophizing and adopt the appropriate intervention methods.

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.

Breaking the Disability Spiral: A Case Series Report Illustrating the Delivery of a Brief Skills Based Coaching Intervention to Prevent Chronic Dysfunction and Pain After Orthopedic Injury.

Orthopedic traumas are common, costly, and burdensome - particularly for patients who transition from acute to chronic pain. Psychosocial factors, such as pain catastrophizing and pain anxiety, increase risk for poor outcomes after injury. The Toolkit for Optimal Recovery (TOR) is a novel multi-component mind-body intervention informed by the fear-avoidance model to promote re-engagement in daily activities and prevent transition toward chronic pain and physical dysfunction. The current case series aims to 1) describe the intervention and 2) showcase the treatment course of three TOR completers from diverse geographic locations in the U.S. with distinct injury types and varying personal identities to illustrate how the intervention can be delivered flexibly. Results indicate pre-to-post program improvement in physical function, pain severity, pain catastrophizing, pain anxiety, and other relevant outcomes targeted by the intervention (i.e., depression, mindfulness, coping). Experiences of our three TOR completers suggest that integrating TOR with standard orthopedic care may promote physical recovery after injury.

[Pain neuroscience education : a practice in motion]. / Éducation neurophysiologique de la douleur : approche en mouvement.

Chronic pain is poorly explained by the pathological biomechanical model. Pain neuroscience education (PNE) aims to help patients reconceptualize their pain by understanding its physiology and dissociating it from the notion of threat. It must be combined with functional re-education. Catastrophism and kinesiophobia exacerbate the perception of pain and are an obstacle to movement. Gradual exposure to movement, whether virtual or real, is a tool for managing pain more effectively and regaining optimum functionality. According to the literature, PNE reduces pain intensity, catastrophizing, kinesiophobia, disability and improves functionality.

La douleur chronique est mal expliquée par le modèle biomédical. L'éducation neurophysiologique de la douleur (END) vise à aider les patients à reconceptualiser leur douleur en comprenant sa physiologie et en la dissociant de la notion de menace. L'association à de la rééducation fonctionnelle est nécessaire. Aggravant la perception de la douleur, le catastrophisme et la kinésiophobie sont des entraves à la remise en mouvement. L'exposition graduelle à la mobilisation, virtuelle ou réelle, constitue un outil permettant de mieux gérer la douleur et de retrouver une fonctionnalité optimale. Selon la littérature, l'END permet une diminution de l'intensité des douleurs, du catastrophisme, de la kinésiophobie, du handicap ainsi qu'une amélioration de la fonctionnalité.

Towards a better Comprehension and Management of Pain and Psychological Distress in Parkinson's: The Role of Catastrophizing.

OBJECTIVES: Pain is very prevalent in Parkinson's and challenging to manage. As many people with Parkinson's (PwP) with pain suffer from anxious and depressive symptoms, we examined the role of catastrophizing in mediating the relationship between pain and psychological distress for this population. METHODS: 169 international PwP completed an online survey with socio-demographic and medical data. Participants completed psychometric tests to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory and Parkinson Anxiety Scale), pain coping strategies (Coping Strategies Questionnaire) and pain catastrophizing (Pain Catastrophizing Scale). RESULTS: Depending on the tool used, 82.8% to 95.2% of participants reported pain. 23.5 % and 67.5% of participants showed respectively significant levels of depressive and anxiety symptoms. Psychological distress was significantly correlated with the quality of pain (both sensory and affective dimensions). Statistical models highlighted the mediating role of catastrophizing in the relationship between psychological distress and pain in Parkinson's. CONCLUSION: These findings offer new perspectives toward understanding the underlying mechanisms of pain in Parkinson's and for effective therapeutic intervention goals to facilitate adaptation to pain symptoms in Parkinson's.

Psychological Factors Associated With Fear of Falling Avoidance Behavior in Parkinson's Disease: The Role of Depression, Anxiety, and Catastrophizing.

PURPOSE: The purpose of this study was to examine the relationship between psychological factors (depression, anxiety, and catastrophizing) and fear of falling avoidance behavior (FFAB) among individuals with Parkinson's disease (PD). METHODS: A secondary analysis of cross-sectional data from 59 individuals with PD using hierarchical multiple regression. RESULTS: Disease severity (Movement Disorder Society - Unified PD Rating Scale) and catastrophizing (Consequences of Falling Questionnaire (CoF)) explained approximately 48.2% of the variance in the FFAB Questionnaire scores (P < .001). Catastrophizing was the only significant psychological variable (P < .001). The damage to identity subscale of the CoF was significant in the final model (P < .001). CONCLUSIONS: Catastrophizing about the consequences of falls explained the largest portion of variability in FFAB after controlling for disease severity. Catastrophizing about the immediate consequences of falling may play a prominent role in FFAB and may be a potential treatment target for mitigating FFAB.

Pain Severity and Pain Interference in Late Pregnancy: An Analysis of Biopsychosocial Factors Among Women Scheduled for Cesarean Delivery.

OBJECTIVE: Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who might be at higher pain risk. Although biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy. METHODS: In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy. RESULTS: Women in the study had a mean age of 34 years, and 73% identified as White, 11% as African American, 10% as Hispanic/Latina, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latina and having greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (versus repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing. CONCLUSIONS: Independent of demographic or clinical factors, psychological factors, including depression, sleep disturbance, and pain catastrophizing, conferred a greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy could benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.

The mediating effect of social functioning on the relationship between catastrophizing and pain among patients with chronic low back pain.

OBJECTIVE: Pain catastrophizing can be characterized as an interpersonal form of coping used to elicit support or empathy from others. Despite intentions of increasing support, catastrophizing can impair social functioning. While considerable work has addressed the relationship between catastrophizing and pain, limited empirical work has examined this relationship within a social context. First, we examined the role of catastrophizing as a potential contributor to group differences (chronic low back pain [cLBP] vs pain-free controls) in social functioning. Then we conducted a follow-up, exploratory analysis to examine the relationships between catastrophizing, social functioning, and pain within the subgroup of participants with cLBP. METHODS: In this observational study, participants with cLBP (N = 62) and pain-free controls (N = 79) completed validated measures of pain, social functioning, and pain catastrophizing. A mediation analysis was conducted to examine whether catastrophizing mediated group differences (cLBP vs controls) in social functioning. A follow-up, exploratory mediation analysis then tested whether social functioning mediated the association between catastrophizing and pain within the subgroup of cLBP participants. RESULTS: Participants with cLBP reported higher levels of pain, impaired social functioning, and higher catastrophizing compared to pain-free controls. Catastrophizing partially mediated the group difference in impaired social functioning. Additionally, social functioning mediated the association between higher catastrophizing and greater pain within the subgroup of cLBP participants. CONCLUSIONS: We showed that impaired social functioning was driving the relationship between higher pain catastrophizing and worse pain among participants with cLBP. Interventions, such as cognitive behavioral therapy, should address catastrophizing in individuals with cLBP, while simultaneously improving social functioning.

Psychological factors and pain medication use in adolescents with chronic pain.

OBJECTIVE: The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS: Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS: Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS: Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.

Assessing pain catastrophizing and functional disability in pediatric epidermolysis bullosa patients.

BACKGROUND/OBJECTIVES: The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). METHODS: Patients with EB ages 8-16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. RESULTS: Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84 = PCS parent; 34.58 = PCS child; 30.87 = parent FDI; 29.77 = child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p = .04) but not disease severity. Older children reported more functional disability than their parents and younger children (p = .02). CONCLUSIONS: Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB.