Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury.

UNLABELLED: The current study examined the utility of a biopsychosocial model of chronic pain, and the associations between specific pain-related beliefs, coping, and social support and both mental health and pain interference, in persons with Spinal Cord Injury (SCI) and pain. A total of 157 patients completed surveys assessing physical and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Greater catastrophizing and pain-related beliefs (eg, the belief that pain signals damage) were related with increased pain interference and poorer mental health, while coping styles (eg, resting, asking for assistance) were related only with pain interference. Alternatively, greater perceived social support was related with better mental health. The findings are consistent with a biopsychosocial model, implicating the need to consider the impact of process and clinical variables on adjustment to chronic pain in persons with SCI. PERSPECTIVE: This article identifies several psychosocial variables, including coping, catastrophizing, pain-related beliefs, and social support that are related to adjustment in persons with SCI and pain. These results have implications for interventions designed to treat pain interference in persons with SCI.

The reliability and validity of pain interference measures in persons with spinal cord injury.

UNLABELLED: The current study compared the psychometric properties of 2 commonly used measures of pain-related interference, the Graded Chronic Pain (GCP) Disability scale and 3 modified versions of the Brief Pain Inventory (BPI) Interference scale. Participants were 127 persons with spinal cord injury (SCI) who reported pain on a survey. The results suggest that the GCP Disability scale and 3 versions of the BPI Interference scale are reliable and valid measures of pain-related interference in persons with SCI and pain. All 4 measures evidenced excellent internal consistency. The composite scores and individual items of the GCP Disability scale and each version of the BPI Interference scale were significantly related to average pain intensity during the past week and a global measure of psychological functioning. Finally, as pain intensity ratings increased (from mild to moderate to severe), so did the composite and item-level ratings of interference for each version of the BPI Interference scale and GCP Disability scale. Strengths and weaknesses of each measure for use with persons with disability and pain are discussed. PERSPECTIVE: The GCP Disability scale and 3 versions of the BPI Interference scale (modified for use in persons with disabilities) appear to be reliable and valid measures of pain-related interference in persons with SCI. Future research should examine their psychometric properties in other disability populations.

The reliability and validity of pain interference measures in persons with multiple sclerosis.

Valid measures of pain-related interference with functioning could serve as useful outcome measures in much needed clinical trials of pain treatments for persons with multiple sclerosis (MS). The purpose of this study was to examine the psychometric properties of two pain interference measures in persons with MS and chronic pain. Modified versions of the Interference scale of the Brief Pain Inventory (BPI) and the Disability scale of the Graded Chronic Pain Scale were administered via a mailed survey to 187 community-dwelling persons with MS. Data from the 125 participants who reported pain were analyzed. Although both measures demonstrated excellent internal consistency, in the current sample, evidence regarding the construct and concurrent validity was stronger for the modified versions of the BPI Interference scale. These results provide preliminary support for the reliability and validity of modified versions of the BPI Interference scale in persons with MS and chronic pain.

Psychologic interventions for chronic pain.

As a biopsychosocial understanding of chronic pain has become more sophisticated during recent decades, a variety of psychologically based treatment approaches have been developed and empirically validated for helping people better manage their pain. These approaches to pain management have much to offer persons with chronic pain in terms of enhancing quality of life and pain-related coping, as well as reducing disability and pain-related interference with functioning. Although some treatments, like hypnotic analgesia, may require referral to a specialized provider, several of the principles of other psychologically based treatment approaches for pain management (eg, operant behavioral therapy, cognitive-behavioral therapy, motivational interviewing) can easily be integrated into work with persons with pain in a rehabilitation setting. Rehabilitation providers who are interested in incorporating these treatment strategies into their clinical work who do not have prior exposure to these approaches are encouraged to review the suggested references and to seek out related training opportunities.

Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation.

OBJECTIVES: The current study examined the relationship between preoperative anxiety and acute postoperative phantom limb pain (PLP), residual limb pain (RLP), and analgesic medication use in a sample of persons undergoing lower limb amputation. MATERIALS AND METHODS: Participants included 69 adults admitted to a large level 1 trauma hospital for lower limb amputation. Participants' average pain and anxiety during the previous week were assessed before amputation surgery. RLP, PLP, and analgesic medication use were measured on each of the 5 days following amputation surgery. RESULTS: Results of partial-order correlations indicated that greater preoperative anxiety was significantly associated with greater ratings of average PLP for each of the 5 days following amputation surgery, after controlling for preoperative pain ratings and daily postoperative analgesic medication use. Partial correlation values ranged from 0.30 to 0.62, indicating medium to large effects. Preoperative anxiety was also significantly associated with ratings of average RLP only on postoperative day 1, after controlling for preoperative pain ratings and daily postoperative analgesic medication use (r=0.34, P<0.05). Correlations between preoperative anxiety and daily postoperative analgesic medication dose became nonsignificant when controlling for preamputation and postamputation pain ratings. DISCUSSION: These findings suggest that anxiety may be a risk factor for acute postamputation PLP and RLP, and indicate that further research to examine these associations is warranted. If replicated, the findings would support research to examine the extent to which modifying preoperative anxiety yields a reduction in postoperative acute PLP and RLP.

Changes in pain-related beliefs, coping, and catastrophizing predict changes in pain intensity, pain interference, and psychological functioning in individuals with myotonic muscular dystrophy and facioscapulohumeral dystrophy.

OBJECTIVES: The primary aim of this study was to test hypothesized associations between changes in psychological variables (ie, pain beliefs, catastrophizing, and coping strategies) and changes in pain intensity and related adjustment (ie, pain interference and psychological functioning) in individuals with myotonic muscular dystrophy (MMD) and facioscapulohumeral muscular dystrophy (FSHD). METHODS: A sample of 107 adults with a diagnosis of MMD or FSHD, reporting pain in the past 3 months, completed assessments at 2 time points, separated by approximately 24 months. RESULTS: Results showed that changes in pain-related psychological variables were significantly associated with changes in psychological functioning, pain intensity, and pain interference. Specifically, increases in the belief that emotion influences pain, and catastrophizing were associated with decreases in psychological functioning. Increases in the coping strategies of asking for assistance and resting, and the increases of catastrophizing were associated with increases in pain intensity. Finally, increases in pain intensity and asking for assistance were associated with increases in pain interference. DISCUSSION: The results support the use of the biopsychosocial model of pain for understanding pain and its impact in individuals with MMD or FSHD. These findings may inform the design and implementation of psychosocial pain treatments for people with muscular dystrophy and chronic pain.

Partner responses to patient pain and well behaviors and their relationship to patient pain behavior, functioning, and depression.

The goals of the current study were to examine the associations between patient-reported spouse responses to pain and well behaviors as assessed by the Spouse Response Inventory (SRI) [22] and (1) patient-reported pain behavior, (2) depression, and (3) physical dysfunction, independent of patient demographics and pain severity. Moreover, we sought to examine the potential moderating influence of marital satisfaction on these relationships. We also evaluated the construct and concurrent validity and internal reliability of the SRI. The findings indicate that encouragement of well behaviors is related to lower levels of patient-reported pain behaviors, while negative responses to well behavior is related to greater patient physical dysfunction. Likewise, higher levels of negative responses to pain behaviors, as well as higher levels of solicitous responses to pain behaviors are generally related to poorer patient functioning. Furthermore, marital satisfaction did not moderate the relationship between any SRI subscales and patient-reported pain behaviors. In summary, our results support the internal reliability and validity of the SRI scales as measures of spousal responses to both pain and well behaviors. The current study also supports the importance of examining the potential impact of responses to both well and pain behaviors. Further research is needed to examine the potential impact of other contextual variables and marital satisfaction on the relationship of spouse responses to both well and pain behaviors.

To lump or to split? Comparing individuals with traumatic and nontraumatic limb loss in the first year after amputation.

OBJECTIVE: To compare individuals with traumatic (TE) vs. nontraumatic (NTE) amputation etiology on pain, psychological, and social variables over the first 12 months postamputation, and to explore changes in mean levels of and correlations between these variables over time. PARTICIPANTS: There were 111 adults with newly acquired limb loss. SETTINGS: A VA medical center and a Level I trauma hospital in a large metropolitan area. MAIN OUTCOME MEASURES: Characteristic Pain Severity, Pain Interference, Patient Health Questionnaire depression module, Posttraumatic Stress Disorder Checklist, Social Constraints Scale, Aversive Emotional Support Scale, Centers for Disease Control and Prevention single item Social Support measure, single item loneliness measure. RESULTS: The NTE group was significantly older, had lower income, and had greater medical comorbidity, preamputation pain, and physical disability. The etiology groups did not differ significantly in mean levels of outcome variables except that the TE group reported greater aversive emotional support at 6 and 12 months. The TE group demonstrated a quadratic change in pain interference, with highest levels at 6 months and a linear increase in social constraints. Both etiology groups showed a linear increase in PTSD symptoms over time. Correlations between physical, psychological, and social distress were observed earlier in the year for the NTE group. CONCLUSION: Despite significant demographic and preamputation experience differences, few differences in outcomes emerged by etiology group in the first year after amputation. Findings suggest that the year after amputation may be a time of greater change for those with traumatic amputation compared to those with nontraumatic amputation.

Psychosocial factors in chronic pain in the dysvascular and diabetic patient.

Dysvascular and diabetic patients are faced with high rates of chronic pain as a consequence of numerous secondary sequelae, including diabetic neuropathy and limb loss. Researchers and scientists have put forth a tremendous amount of effort to understand the complex nature of pain in this population of individuals, as well as others with chronic pain secondary to illness and injury. The emergent understanding of anatomy and sensory physiology within the past century has fueled an initial focus of understanding pain from a purely neurologic and biochemical perspective. Over the past few decades, the field has moved toward an understanding of pain as a process involving the dynamic interaction of biologic, psychological, behavioral, and social variables. This article provides a brief overview of several psychosocial processes, cognitive, affective, and behavioral, that have emerged as influential to the experience, impact, and treatment of pain.

Psychosocial factors and adjustment to chronic pain in spinal cord injury: replication and cross-validation.

Recent studies have documented the importance of psychological factors in the experience of chronic pain in persons with spinal cord injury (SCI). The current study sought to replicate and extend previous work demonstrating associations among specific pain-related beliefs, coping, mental health, and pain outcomes in persons with SCI. A return-by-mail survey assessing psychological functioning and pain was completed by 130 individuals with SCI. Measures included short forms of the Survey of Pain Attitudes and the Chronic Pain Coping Inventory. After factor analysis, multiple regression was used to predict pain outcomes (psychological functioning and pain interference) after controlling for pain intensity. Results indicated that psychological factors, particularly beliefs about pain (including catastrophizing) and pain-related coping strategies (including passive coping), were significant predictors of pain outcomes and accounted for 21% to 25% of unique variance. Zero-order correlations suggested that the specific variables most closely associated with negative pain outcomes were perception of oneself as disabled, perceptions of low control over pain, and tendency to catastrophize. In general, negative attributions and coping were stronger predictors of pain adjustment than were positive ones. Results highlight the importance of psychological factors in understanding chronic pain in persons with SCI and provide further support for the biopsychosocial model.

Impact of biopsychosocial factors on chronic pain in persons with myotonic and facioscapulohumeral muscular dystrophy.

To assess the role of biopsychosocial factors in patients with type 1 myotonic and facioscapulohumeral muscular dystrophy (MMD1/FSHD) with chronic pain. Associations between psychosocial factors were found to be important in other samples of persons with pain and both psychological functioning and pain interference in a sample of patients suffering from MMD/FSHD. Prospective, multiple group, survey study of 182 patients with confirmed MMD1 and FSHD. Participants completed surveys assessing pain interference and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Analyses indicated that greater catastrophizing was associated with increased pain interference and poorer psychological functioning, pain attitudes were significantly related to both pain interference and psychological functioning, and coping responses were significantly related only to pain interference. In addition, greater perceived social support was associated with better psychological functioning. The results support the use of studying pain in persons with MMD/FSHD from a biopsychosocial perspective, and the importance of identifying psychosocial factors that may play a role in the adjustment to and response to pain secondary to MMD/FSHD.

A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain.

Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.

Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury.

Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.

Prosthesis use in persons with lower- and upper-limb amputation.

This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper- and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full- or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered.

A longitudinal examination of social support, agreeableness and depressive symptoms in chronic kidney disease.

Research examining the role of social support in patient adjustment to chronic illness has been inconsistent suggesting that patient individual differences play a moderating role. This study examined the hypothesis that the relationship between social support and depressive symptoms would differ as a function of individual differences in trait Agreeableness. Fifty-nine patients with chronic kidney disease were assessed using the Social Provisions Scale, Beck Depression Inventory and NEO-Five-Factor Inventory and were followed-up a year and a half later. After controlling for baseline depressive symptoms and clinical characteristics, regression analyses revealed a significant interaction between social support and Agreeableness predicting change in depressive symptoms. Greater social support among individuals high in Agreeableness was associated with a decrease in depressive symptoms over time, while support had little effect on depression change for individuals low in Agreeableness. These findings underscore the importance of individual difference variables in understanding adjustment to chronic illness.