RESUMO
Knee osteoarthritis (KOA) is linked to an enhanced release of interleukin-6 (IL-6). Increased levels of IL-6 are associated with greater pain and insomnia. While total knee arthroplasty (TKA) typically results in the reduction of pain, for a subgroup of patients, pain does not improve. Understanding patients' propensity to upregulate IL-6 may provide insight into variation in the clinical success of TKA for improving pain, and insomnia may play an important modulatory role. We investigated the association between pre- and post-surgical changes in clinical pain and IL-6 reactivity, and whether change in insomnia moderated this association. Patients (n = 39) with KOA came in-person before and 3-months after TKA. At both visits, patients completed validated measures of clinical pain and insomnia, as well as underwent quantitative sensory testing (QST). Blood samples were collected to analyze IL-expression both before and after QST procedures to assess changes in IL-6 in response to QST (IL-6 reactivity). Patients were categorized into two groups based on change in clinical pain from pre- to post-surgery: 1) pain decreased > 2 points (pain improved) and 2) pain did not decrease > 2 points (pain did not improve). Based on this definition, 49 % of patients had improved pain at 3-months. Among patients with improved pain, IL-6 reactivity significantly decreased from pre- to post-surgery, whereas there was no significant change in IL-6 reactivity among those whose pain did not improve. There was also a significant interaction between pain status and change in insomnia, such that among patients whose insomnia decreased over time, improved pain was significantly associated with a reduction in IL-6 reactivity. However, among patients whose insomnia increased over time, pain status and change in IL-6 reactivity were not significantly associated. Our findings suggest that the resolution of clinical pain after TKA may be associated with discernible alterations in pro-inflammatory responses that can be measured under controlled laboratory conditions, and this association may be moderated by perioperative changes in insomnia. Randomized controlled trials which carefully characterize the phenotypic features of patients are needed to understand how and for whom behavioral interventions may be beneficial in modulating inflammation, pain, and insomnia.
Assuntos
Artroplastia do Joelho , Interleucina-6 , Osteoartrite do Joelho , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/metabolismo , Masculino , Feminino , Interleucina-6/sangue , Interleucina-6/metabolismo , Idoso , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medição da Dor/métodos , Dor/metabolismo , Dor Pós-Operatória/metabolismo , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models. METHODS: In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery. RESULTS: A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain. CONCLUSIONS: The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire.
Assuntos
Analgésicos Opioides , Dor Pós-Operatória , Gravidez , Humanos , Feminino , Analgésicos Opioides/uso terapêutico , Estudos Prospectivos , Dor Pós-Operatória/prevenção & controle , Inquéritos e Questionários , FenótipoRESUMO
PURPOSE: Patients with cancer may experience pain from cancer itself or its treatment. Additionally, chronic pain (CP) predating a patient's cancer diagnosis may make the etiology of pain less clear and the management of pain more complex. In this brief report, we investigated differences in biopsychosocial characteristics, pain severity, and opioid consumption, comparing groups of cancer patients with and without a history of CP who presented to the emergency department (ED) with a complaint of cancer-related pain. METHODS: This secondary analysis of a prospective cohort study included patients with cancer who presented to the ED with a complaint of pain (≥ 4/10). Sociodemographic, clinical, psychological, and pain characteristics were assessed in the ED and subsequent hospitalization. Mann-Whitney U-, T-, and Chi-square tests were used to compare differences between patients with and without pre-existing CP before cancer. RESULTS: Patients with pre-existing CP had lower income (p = 0.21) and less formal education (p = 0.25) and were more likely to have a diagnosis of depression or substance use disorder (p < 0.01). Patients with pre-existing CP reported significantly greater pain severity in the ED and during hospitalization compared to those without pre-existing CP (p < 0.05), despite receiving greater amounts of opioid analgesics (p = 0.036). CONCLUSION: Identifying a history of pre-existing CP during intake may help identify patients with cancer with difficult to manage pain, who may particularly benefit from multimodal interventions and supportive care. In addition, referral of these patients for the management of co-occurring pain disorders may help decrease the usage of the ED for undertreated pain.
Assuntos
Dor Aguda , Dor Crônica , Neoplasias , Humanos , Dor Crônica/etiologia , Dor Crônica/terapia , Estudos Prospectivos , Neoplasias/complicações , Serviço Hospitalar de Emergência , Analgésicos Opioides/uso terapêuticoRESUMO
PURPOSE: Engagement in physical activity (PA) is often associated with better sleep quality and less pain severity among patients diagnosed with breast cancer. However, less research has focused on whether patients' PA prior to breast surgery, including their perceived decrease in PA level, is associated with worse preoperative sleep quality, and subsequently, greater postoperative pain. This longitudinal study investigated whether patients' preoperative PA was associated with their postoperative pain. We also explored whether preoperative sleep disturbance partially mediated the relationship between preoperative PA and postoperative pain. METHODS: Prior to breast surgery, patients self-reported both their overall level of PA and whether they perceived a decrease in their PA since the diagnosis/onset of treatment for cancer. Patients also completed a measure of preoperative sleep disturbance. Two weeks after surgery, patients completed a measure of postoperative surgical-area pain severity. RESULTS: Our results showed that preoperatively perceiving a decrease in PA level was significantly associated with greater preoperative sleep disturbance and postoperative pain. A mediation analysis revealed that the association between preoperative decreased PA and postoperative pain was partially mediated by preoperative sleep disturbance. Notably, patients' overall preoperative level of PA was not related to preoperative sleep disturbance or postoperative pain. CONCLUSION: These findings suggest that maintaining, or even increasing, PA after diagnosis/treatment may be more important than the absolute amount of PA that women engage in during the preoperative period. Potentially, some patients with breast cancer may benefit from a preoperative intervention focused on both maintaining PA and bolstering sleep quality.
Assuntos
Neoplasias da Mama , Exercício Físico , Dor Pós-Operatória , Período Pré-Operatório , Transtornos do Sono-Vigília , Humanos , Feminino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Transtornos do Sono-Vigília/etiologia , Estudos Longitudinais , Exercício Físico/fisiologia , Adulto , Idoso , Qualidade do Sono , Autorrelato , Medição da DorRESUMO
OBJECTIVE: We investigated the impact of favorite music on pain processing among individuals with fibromyalgia. We also examined differences in pain processing between individuals with fibromyalgia and healthy controls (HC) while listening to favorite music and explored whether psychosocial factors contributed to these differences. METHODS: Individuals with fibromyalgia and HC completed baseline psychosocial questionnaires and then underwent quantitative sensory testing (QST) during 3 randomized music conditions (meditative music, favorite music, white noise). Among individuals with fibromyalgia, Friedman tests were used to investigate differences in QST across conditions. Analyses of Covariance were used to examine group (HC vs fibromyalgia) differences in QST during favorite music. Correlations were conducted to explore associations of baseline psychosocial factors with QST during favorite music. Mediation analyses were conducted to explore whether psychosocial factors contributed to greater pain sensitivity among individuals with fibromyalgia compared to HC during favorite music. RESULTS: Individuals with fibromyalgia were less sensitive to pressure pain while listening to their favorite music compared to white noise. Compared to HC, individuals with fibromyalgia reported higher baseline negative affect and lower pain thresholds and tolerances during favorite music. Negative affect partially mediated the relationship between pain status (HC vs fibromyalgia) and pain sensitivity during favorite music. CONCLUSIONS: Individuals with fibromyalgia were less pain sensitive while listening to favorite music than white noise, although they were more sensitive than HC. Greater negative affect endorsed by individuals with fibromyalgia contributed to their greater pain sensitivity. Future studies should explore the impact of favorite music on clinical pain. CLINICAL TRAILS REGISTRATION: This study was registered with ClinicalTrials.gov (NCT04087564) and began on 6/13/2019.
Assuntos
Fibromialgia , Música , Limiar da Dor , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Afeto/fisiologia , Fibromialgia/psicologia , Música/psicologia , Medição da Dor/métodos , Limiar da Dor/fisiologiaRESUMO
BACKGROUND: It is well established that catastrophic thinking about pain modulates clinical pain severity, but it may also relate to interindividual differences in the pain experience during procedures. This mixed-methods study investigated the relationship between ratings of situational pain catastrophizing and reported pain sensitivity in the context of receiving a nerve block without sedation, and explored participants' experiences. METHODS: Healthy volunteers (n = 42) completed baseline psychosocial questionnaires, underwent quantitative sensory testing, and received a lower extremity nerve block, followed by further psychosocial assessment and interviews. Associations of catastrophizing scores with pain sensitivity and procedural site pain were assessed using Spearman's correlations. Interviews were reviewed using an immersion/crystallization approach to identify emergent themes. RESULTS: Greater situational catastrophizing scores were associated with higher pain sensitivity, measured as lower pain threshold and tolerance. Although females exhibited greater pain sensitivity generally, moderation analysis revealed a significant association between situational catastrophizing scores and pain sensitivity only among male participants. Qualitative interviews revealed the importance of participants' emotional responses to pain, and a mismatch of expectation and experience with procedural pain. Males also reported more negative comments about procedural pain. DISCUSSION: Examination of the variable subjective experience while receiving a nerve block in this experimental lab-based study revealed an important relationship between situational pain catastrophizing scores and pain sensitivity, which was more prominent among male participants. These findings reinforce how insight into individual expectations, emotions, and thought processes may impact pain sensitivity during procedures, and may inform strategies to personalize care, improving patient satisfaction and procedural acceptance.
RESUMO
Mounting evidence suggests distinct functional contributions of the anterior and posterior hippocampus to autobiographical memory retrieval, but how these subregions function under different retrieval demands as memories age is not yet understood. Specifically, autobiographical memory retrieval is not a homogeneous process; rather, it is thought to consist of the following multiple stages: an early stage of memory construction and a later stage of detailed elaboration, which may differently engage the hippocampus over time. In the present study, we analyzed data from 40 participants (23 female/17 male) who constructed and overtly elaborated on recent and remote memories in response to picture cues in the fMRI scanner. We previously reported a temporal gradient in the posterior hippocampus during the elaboration period of autobiographical retrieval, with posterior hippocampal activation observed for recent but not remote time points. Here, we consider the previously unanalyzed construction stage of retrieval, where participants searched for and selected a memory. We found no evidence of a temporal gradient during memory construction, instead observing strong anterior hippocampus activity regardless of memory remoteness. Our findings suggest a unique contribution of the anterior hippocampus to the construction process of autobiographical retrieval over time. These findings highlight that retrieval processes, which have yet to be integrated with current models of systems consolidation, offer novel insights into hippocampal subregion function over time.SIGNIFICANCE STATEMENTHippocampal contributions to autobiographical memory retrieval may depend on several distinct factors including memory age and the retrieval process engaged. We previously found that the contribution of the posterior hippocampus to detailed elaborative retrieval diminishes as memories age, with no reliable activation of the anterior hippocampus over time. Here, we report that consideration of the earlier "construction" period of retrieval, where participants search for and retrieve general aspects of the memory, yielded significant anterior hippocampus activation regardless of memory age. These results provide evidence for a unique contribution of the anterior hippocampus to the constructive process of autobiographical retrieval over time and suggest that component processes of retrieval should be integrated into models of systems consolidation.
RESUMO
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.
Assuntos
Cesárea , Dor Crônica , Gravidez , Feminino , Humanos , Adulto , Medição da Dor , Estudos Prospectivos , Catastrofização/psicologiaRESUMO
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.
Assuntos
Dor Crônica , Dor Lombar , Humanos , Dor Lombar/psicologia , Dor Crônica/psicologia , Interação Social , Catastrofização/psicologia , Adaptação PsicológicaRESUMO
OBJECTIVE: To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine 1) whether patients who received MBCBT differed from matched controls who received treatment-as-usual with regard to postsurgical pain outcomes and 2) whether changes in pain catastrophizing, depression, or anxiety explained the potential effects of MBCBT on pain outcomes. DESIGN: Pilot clinical trial. SETTING: An academic teaching hospital serving a large urban and suburban catchment area surrounding the Boston, Massachusetts metropolitan region. SUBJECTS: Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received treatment-as-usual (n = 22). METHODS: The MBCBT intervention included four 60-minute sessions delivered by a pain psychologist in person and via telephone during the perioperative period. Participants were assessed at baseline and at 6 weeks, 3 months, and 6 months after surgery. RESULTS: Compared with matched controls, patients who received MBCBT had lower pain severity and pain interference at 6 weeks after surgery. Group differences in outcomes were mediated by changes in pain catastrophizing but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group did at 3 and 6 months after surgery. CONCLUSIONS: This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention could lead to enhanced pain-related outcomes.
Assuntos
Artroplastia do Joelho , Terapia Cognitivo-Comportamental , Atenção Plena , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/psicologia , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/psicologia , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. RECENT FINDINGS: Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.
Assuntos
Dor Crônica , Humanos , Estados Unidos/epidemiologia , Dor Crônica/terapia , Comorbidade , Manejo da Dor , EscolaridadeRESUMO
COVID-19 social distancing mandates increased social isolation, resulting in changes in pain severity and interference among individuals with chronic pain. Differences in personality (e.g., introversion/extraversion) may modulate responses to social isolation. We examined the influence of introversion on reported social distancing-related increases in pain interference and assessed for mediators of this relationship. Individuals with chronic pain (n = 150) completed validated questionnaires 4-8 weeks after implementation of social distancing mandates. Introversion/extraversion was measured using a subscale of the Myers-Briggs Type Indicator and changes in pain and psychosocial variables were calculated by comparing participants' recalled and current scores. Association between introversion/extraversion and other variables were assessed using linear regression. A parallel mediation was used to examine mediators of the association between introversion and change in pain interference. Higher introversion was associated with a decrease in pain interference after social distancing (Rho = - .194, p = .017). Parallel mediation analysis revealed that the relationship between introversion/extraversion and change in pain interference was mediated by changes in sleep disturbance and depression, such that higher introversion was associated with less isolation-induced sleep disruption and depression, and thereby less worsening of pain interference. These findings suggest that personality factors such as introversion/extraversion should be considered when personalizing treatment of chronic pain.
Assuntos
COVID-19 , Dor Crônica , Humanos , Dor Crônica/complicações , Extroversão Psicológica , Introversão Psicológica , Análise de Mediação , Personalidade , Isolamento SocialRESUMO
PURPOSE: Younger age is a risk factor for worse pain outcomes following breast cancer surgery, yet little is known about how younger women's psychological state may contribute to their pain experience. Using prospectively collected longitudinal data from a surgical cohort, we examined whether early postoperative psychological distress at 2 weeks mediated the association between younger age and subsequent worse pain-related functioning 3 months after surgery. METHODS: Patients (N = 159) were recruited before breast cancer surgery into this longitudinal cohort study. Age at time of surgery, psychological distress (anxiety, depression, and sleep disturbance) assessed 2 weeks postoperatively, and impact of surgical pain on cognitive/emotional functioning and physical functioning assessed 3 months postoperatively were used for analysis. RESULTS: Younger age was associated with greater depression, anxiety, and sleep disturbance 2 weeks postoperatively. Younger age was also associated with greater ratings of pain impacting cognitive/emotional functioning and physical functioning 3 months postoperatively. The association between younger age and worse cognitive/emotional impact of pain was mediated by greater anxiety and sleep disturbance. Similarly, the association between younger age and worse physical impact of pain was mediated by greater sleep disturbance. CONCLUSION: The degree of anxiety and sleep disturbance that occur early after breast surgery may contribute to greater chronic pain-related functional disability among younger patients. Anxiety and sleep disturbance are modifiable with behavioral interventions, making them potential perioperative targets to improve long-term outcomes in young breast cancer survivors.
Assuntos
Neoplasias da Mama , Angústia Psicológica , Transtornos do Sono-Vigília , Humanos , Feminino , Recém-Nascido , Lactente , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Estudos Longitudinais , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos do Sono-Vigília/complicações , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologiaRESUMO
OBJECTIVE: Little is known about how changes in psychosocial factors impact changes in pain outcomes among patients with cancer and chronic pain. This longitudinal cohort study of cancer patients investigated the relationships between changes in psychosocial factors and changes in pain severity and interference over time. METHODS: Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their baseline visit (Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at a follow-up visit (Time 2), on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time. RESULTS: Participants were an average age of 59 years, were 61% female, and 69% White. Overall, a decrease in pain severity (p ≤ 0.001), but not pain interference, was observed among the group over time. In multivariable analyses, increased pain catastrophizing was significantly associated with increased pain severity over time (ß = 0.24, p ≤ 0.001). Similarly, increased pain catastrophizing (ß = 0.21, p ≤ 0.001) and increased depression (ß = 0.20, p ≤ 0.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes. CONCLUSIONS: Increased pain catastrophizing was uniquely associated with increased chronic pain severity and interference. Our findings indicate that cancer patients with chronic pain would likely benefit from the incorporation of nonpharmacological interventions, simultaneously addressing pain and psychological symptoms.
Assuntos
Dor Crônica , Neoplasias , Catastrofização/psicologia , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Medição da Dor , Sistema de Registros , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later. METHODS: In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19-related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. RESULTS: A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism. CONCLUSIONS: An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.
Assuntos
COVID-19 , Dor Crônica , Atenção Plena , Humanos , Dor Crônica/epidemiologia , Dor Crônica/terapia , Dor Crônica/psicologia , Solidão , Estudos Longitudinais , Pandemias , Apoio SocialRESUMO
Negative interpretation bias, or the tendency to interpret ambiguous life events in a negative manner rather than positive or neutral, is a precursor to depression and anxiety. Evidence suggests that mindfulness reduces depression and anxiety, as well as a number of different negative cognitive biases. However, little is known about the association between mindfulness and negative interpretation bias specifically. Across two cross-sectional studies, we investigated this relation. In Study 1 (N = 135), greater trait mindfulness was correlated with less negative interpretation bias. In Study 2 (N = 173), we experimentally tested whether a brief mindfulness induction, compared to a mind-wandering task, decreased negative interpretation bias. Although there was not a direct effect of condition (mindfulness vs. mind-wandering) on negative interpretation bias, there was a significant indirect effect through negative mood. That is, participants in the mind-wandering condition reported greater negative mood following the induction compared to participants in the mindfulness condition, which was associated with more negative interpretation bias. The results suggest mindfulness is associated with less negative interpretation bias and may reduce negative interpretation bias by decreasing negative mood.
Assuntos
Atenção Plena , Afeto , Ansiedade , Viés , Estudos Transversais , HumanosRESUMO
Although an inverse relation between social support and psychological distress among chronic pain patients has been previously reported, little is known about what mediates this association. We examined mindfulness as a mediator of the relationship between social support and psychological distress. In this cross-sectional study, chronic pain patients (N=94) completed assessments of social support, mindfulness, and psychological distress. Greater social support was associated with less psychological distress. Greater mindfulness was associated with greater social support and less psychological distress. Mediation analyses demonstrated that mindfulness partially mediated the relationship between social support and psychological distress. Findings support and extend prior research by demonstrating a potentially important mediating effect of mindfulness within chronic pain patients. This suggests an important link between social support and mindfulness, and that their integration in the pursuit of mental health should be considered in future behavioral interventions.
RESUMO
Financial literacy and financial experience may be important for understanding age differences in financial decisionmaking. Older adults generally have more financial experience than younger adults do, and some studies suggest they also have better financial literacy. We investigated associations among age (N = 594, aged 20-88, Mage = 46.48), financial experience, financial literacy, and preferences for receiving larger (versus smaller) amounts of money sooner (versus later). Older age was correlated with preferences for receiving larger amounts of money sooner and smaller amounts later, but this association was no longer significant after accounting for financial experience and financial literacy. Financial experience was the only significant contributor. We discuss implications for improving financial decision-making across adulthood.
Assuntos
Envelhecimento , Tomada de Decisões , Adulto , Idoso , Humanos , ConhecimentoRESUMO
BACKGROUND: Older age (60+ years) increases the risk of contracting and dying from coronavirus disease 2019 (COVID-19), which might suggest worse mental health for those in this age range during the pandemic. Indeed, greater worry about COVID-19 is associated with poorer mental health. However, older age is generally associated with better emotional well-being, despite increased likelihood of negative events (e.g. death of a spouse) with age. This study examined whether age moderated the relation between COVID-19 worries and mental health. METHODS: A national sample of U.S. adults (N = 848; aged 18-85 years) completed an online survey from March 30 to April 5, 2020. The survey assessed anxiety, depression, general concern about COVID-19, perceived likelihood of contracting COVID-19, social distancing, self-quarantining, current mood, health, and demographics. RESULTS: Older age was associated with better mental health (i.e. lower levels of anxiety and depression). Greater perceived likelihood of contracting COVID-19 was related to higher anxiety. However, this effect was moderated by age. At younger ages (18-49 years), the positive association between perceived likelihood of contracting COVID-19 and anxiety was significant, but the association was not significant at older ages (50+ years). CONCLUSION: Older age may buffer against the negative impact of the COVID-19 pandemic on mental health. More research is necessary to understand the potential protective nature of age during the pandemic, as well as the recovery period.
Assuntos
COVID-19 , Pandemias , Idoso , Ansiedade , Depressão , Humanos , Saúde Mental , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
Empathy is an affective and cognitive event in which an organism experiences an approximation of the physical or psychological state of another organism. The phenomenon has been well-studied in humans but is not as widely researched in other animals. Burkett and colleagues in a 2016 article published in Science measured empathy in prairie voles (Microtus ochrogaster) and meadow voles (Microtus pennsylvanicus) by observing consolation behavior between non-stressed and stressed individuals. Their data from behavioral analyses and histochemistry support their hypothesis that consolation behavior in prairie voles shares similar behavioral characteristics and conserved biological mechanisms with human empathy. Prairie voles match anxiety and fear states as well as groom stressed familiar conspecifics to lessen their stress. An oxytocin receptor antagonist abolished this empathetic response. This research impacted the field of neuroscience by demonstrating human-like empathy in rodents, and thereby supporting the value of animal models to investigations of higher order human experiences. The paper is also a valuable and accessible resource to undergraduate neuroscience students-from introductory courses to advanced seminars. In the classroom, this research provides a foundational look at the expanding field of social neuroscience. Empathy in prairie voles raises thought-provoking discussion concerning emotions, social behavior, and human nature.