Multidimensional visualization and analysis of chronic pain variables of patients who attended a chronic pain program.

Psychologically-based chronic pain variables measure multiple domains of the pain experience such as anxiety, depression, catastrophizing, acceptance and stages of change. These variables measure specific areas such as emotional and cognitive states towards chronic pain and its management, acceptance towards the chronic pain condition, and an individual's readiness to move towards self-management methods. Conceptually, these variables appear to be interrelated to each other, and also form groupings of similar underlying themes. Groupings that have been previously discussed for these variables include positive and negative affect, and improved and poor adjustment. Psychological experience of chronic pain as a whole is mostly understood through conceptually consolidating individual scores across different measures covering multiple domains. A map of these variables in relation to each other can offer an overview for further understanding and exploration. We hereby visualize highlights of relationships among 11 psychosocial chronic pain variables including measures examining physical and somatic aspects, using three-dimensional biplots. Variables roughly form two groupings, with one grouping consisting of items of negative affect, cognition, and physical state ratings, and the other grouping consisting of items of acceptance and the later three stages of change (contemplation, action, maintenance). Also, we follow up with canonical correlation as a complement to further identify key relationships between bimodal groupings. Key variables linking bimodal relationships consist of catastrophizing, depression and anxiety in one grouping and activity engagement in the other. Results are discussed in the context of existing literature.

Experiences of Veteran and Civilian Patients in Exploratory Yoga Sessions for Chronic Pain: A Qualitative Study.

Background: Yoga integrates all aspects of self, with biological, mental, intellectual, and spiritual elements. The practice of yoga aligns with the biopsychosocial model of health and, as such, it can be instrumental in pain treatment. Aims: The purpose of this qualitative study was to explore perceptions regarding the yoga sessions for chronic pain through thematic content analysis with comparison of gender, veteran or civilian status, and delivery methods. Methods: Patients with chronic pain attended a 5-week intensive interdisciplinary chronic pain management program at the Michael G. DeGroote Pain Clinic. Participants were asked to complete six open-ended questions following four weekly 1-h yoga classes, through in-person or virtual delivery. Survey responses were thematically and separately analyzed by reviewers. Results: Forty-one (N = 41) participants (56% males, 71% veterans) with an average age of 50.87 (SD 10.10) years provided comments. Nine themes emerged: (1) mind and body are one through yoga practices; (2) meaningful practice of yoga basics is productive for range of motion/movement, tension in joints, and chronic pain; (3) yoga classes provide an enjoyable process of learning; (4) yoga reminds patients of their physical capabilities; (5) routine practices lead to improvements; (6) yoga improved on strategies for chronic pain; (7) yoga can be adapted for each patient; (8) mindset improves to include positive thinking, better focus, and willingness to try new things; and (9) improvements exist for the current yoga programming. Conclusion: Findings of the current study were nine qualitative themes that present the experience of patients with chronic pain in the yoga sessions.

Contexte: Le yoga intègre tous les aspects de la personne et comporte des éléments biologiques, mentaux, intellectuels et spirituels. La pratique du yoga s'aligne sur le modèle biopsychosocial de santé et, à ce titre, elle peut jouer un rôle déterminant dans le traitement de la douleur.Objectifs: Le but de cette étude qualitative était d'explorer les perceptions concernant les séances de yoga pour la douleur chronique grâce à une analyse thématique du contenu avec comparaison entre les sexes, entre le statut de civil ou celui d'ancien combattant, et entre les modes de prestation.Méthodes: Les patients souffrant de douleur chronique ont suivi un programme interdisciplinaire intensif de prise en charge de la douleur chronique d'une durée de cinq semaines à la Clinique de la douleur Michael G. DeGroote. Les participants ont été invités à répondre à six questions ouvertes à la suite de quatre cours de yoga hebdomadaires d'une heure, en personne ou virtuellement. Les réponses à l'enquête ont été analysées de manière thématique et séparée par les évaluateurs.Résultats: Quarante et un (N = 41) participants (56 % d'hommes, 71 % d'anciens combattants), dont l'âge moyen était de 50,87 ans (ET 10.10) ans, ont fourni des commentaires. Neuf thèmes ont émergé : (1) l'esprit et le corps ne font qu'un grâce à la pratique du yoga; (2) la pratique significative des bases du yoga est productive pour l'amplitude des mouvements, la tension dans les articulations et la douleur chronique; (3) les cours de yoga offrent un processus d'apprentissage agréable ; (4) le yoga rappelle aux patients leurs capacités physiques ; (5) la pratique routinière conduit à des améliorations; (6) le yoga a amélioré les stratégies face à la douleur chronique; (7) le yoga peut être adapté à chaque patient; (8) l'état d'esprit s'améliore et inclut la pensée positive, une meilleure concentration et la volonté d'essayer de nouvelles choses; et (9) le programme de yoga actuel peut être amélioré.Conclusion: Le résultat de la présente étude était la recension de neuf thèmes qualitatifs présentant l'expérience des patients souffrant de douleur chronique lors des séances de yoga.

East Meets West in Therapeutic Approaches to the Management of Chronic Pain.

Yoga as a holistic principle, not only practice of asanas or poses, integrates all aspects of the self, with biological, mental, intellectual, and spiritual elements. Yoga encompasses the biopsychosocial medical perspective, which regards pain as a dynamic interaction between physiological, psychological, and social factors. The purpose of this perspective article is to compare and contrast psychological practices such as mindfulness meditation, relaxation response (RR), and cognitive behavioral therapy (CBT) with Yoga in their management of chronic pain. The use of these practices is explored through history, literature, and research studies. Results from scientific studies on Yoga show changes in health-related pain outcomes for patients with chronic pain. The key aspects of Yoga, notably relaxation, positive thinking, and mindfulness, are discussed in relation to mindfulness meditation, RR, and CBT.

A Qualitative Study of the Impact of the COVID-19 Pandemic on a Sample of Patients With Chronic Pain.

This qualitative phenomenological study examined the impact of the COVID-19 pandemic on the lives of patients living with chronic pain. Patients referred to an intensive interdisciplinary pain management program between June 2020 to June 2021 were asked, "How did the COVID-19 pandemic affect your life?" as part of their interdisciplinary assessment. Ninety patients (50 Veterans, 40 civilians) provided comments to this question, which were independently organized into themes using an inductive approach by 4 researchers. Nine main themes emerged: (1) changed psychological state, (2) minimal to no effect, (3) affected personal life activities, (4) changes in accessing care, (5) changes in work/education situation, (6) changes in family dynamics, (7) experiencing more annoyances, (8) COVID-19 pandemic is a barrier to making positive changes, and (9) got COVID-19. Themes are consistent with topics of interest in light of this ongoing, global stressor. Most commonly reported themes reflected changes in psychological well-being and changes in access to care, highlighting similarities between life with chronic pain and life under the pandemic for this group.

Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement.

Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients' perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (ß = -0.188, P < .001) and the maintenance stage of change (ß = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (ß = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.

Pain management program outcomes in veterans with chronic pain and comparison with nonveterans.

Background: In Canada, 41% of veterans experience chronic pain compared to the general population (20%). Many veterans with chronic pain also have comorbid disorders such as depression and posttraumatic stress disorder (PTSD), causing increased pain interference and disability. Aim: This study aims to investigate the effectiveness of a 4-week interdisciplinary pain management program at the Michael G. DeGroote Pain Clinic in Hamilton, Ontario, Canada, and to explore differences in pain experience and treatment outcomes between veterans and nonveterans in the program. Methods: Data were obtained from psychometric measures completed by 68 veterans and 68 nonveterans enrolled in the pain management program. By matching groups for age and gender, scores were compared between veterans and nonveterans. Outcomes investigated include catastrophizing, pain traumatization, stages of change, acceptance of pain, and program satisfaction. Multivariate analysis of variance (MANOVA) was conducted to examine session (admission-discharge) and group (veteran-nonveteran) differences, and independent t tests were used to examine differences in satisfaction measures. Results: Results showed that the program was effective for all participants, with significant differences between admission and discharge on several measures. However, veterans experienced significantly greater improvements in pain catastrophizing, kinesiophobia, pain traumatization, pain acceptance, stages of change, and pain coping, compared to nonveterans (P < 0.05). Though no significant differences in program satisfaction were found between groups, case managers evaluated veterans as having achieved greater benefits from the program. Conclusion: This study presents evidence supporting the effectiveness of an interdisciplinary pain management program in addressing pain-related variables in veterans and nonveterans and provides insight into how pain management is experienced differently by veterans.

Contexte: Au Canada, 41 % des anciens combattants souffrent de douleur chronique, comparativement à 20 % au sein de la population en général. De nombreux anciens combattants souffrant de douleur chronique sont également atteints de troubles comorbides tels que la dépression et le syndrome de stress post-traumatique, qui entraînent une augmentation de l'interférence de la douleur et de l'incapacité.Objectif: Cette étude porte sur l'efficacité d'un programme de prise en charge interdisciplinaire de la douleur d'une durée de quatre semaines à la Clinique de la douleur Michael G. DeGroote à Hamilton, Ontario, Canada, ainsi que sur les différences dans l'expérience de la douleur et les résultats des traitements entre les anciens combattants et d'autres patients qui n'étaient pas des anciens combattants inscrits au programme. Méthodes: Les données ont été obtenues à partir de mesures psychométriques recueillies auprés de 68 anciens combattants et de 68 patients qui n'étaient pas des anciens combattants, tous inscrits au programme de prise en charge de la douleur. En faisant correspondre les groupes selon l'âge et le sexe, les scores obtenus par les anciens combattants ont été comparés à ceux des autres patients qui n'étaient pas des anciens combattants. Les résultats étudiés comprenaient la catastrophisation, le traumatisme lié à la douleur, les étapes du changement, l'acceptation de la douleur et la satisfaction à l'égard du programme. Une analyse multivariée de la variance (MANOVA) a été effectuée pour examiner les différences entre les sessions (admission-sortie) et entre les groupes (anciens combattants et patients qui n'étaient pas des anciens combattants), et des tests t indépendants ont été utilisés pour examiner les diff'rences dans les mesures de satisfaction.Résultats: Les résultats ont montré que le programme était efficace pour tous les participants, et que des différences entre l'admission et la sortie étaient observées pour plusieurs mesures. Cependant, les anciens combattants ont connu des améliorations nettement plus importantes en ce qui concerne la catastrophisation de la douleur, la kinésiophobie, le traumatisme lié à la douleur, l'acceptation de la douleur, les stades de changement et la prise en charge de la douleur, comparativement aux patients qui n'étaient pas des anciens combattants (P < 0,05). Bien qu'aucune différence significative dans la satisfaction à l'égard du programme n'ait été constatée entre les groupes, les chargés de cas ont évalué que les anciens combattants avaient tiré plus d'avantages du programme.Conclusions: Cette étude présente des preuves de l'efficacité d'un programme interdisciplinaire de lutte contre la douleur en abordant les variables liées à la douleur chez les anciens combattants et chez des patients qui n'étaient pas des anciens combattants. Elle donne aussi un aperçu de la maniére dont la prise en charge de la douleur est vécue différemment par les anciens combattants.

Factors involved in patients' perceptions of self-improvement after chronic pain treatment.

BACKGROUND: Patients' self-reported levels of improvement after having attended a chronic pain management program can provide a subjective rating of how successful they perceive they were at accomplishing their goals in the program. Past studies have demonstrated that successful patients differ from less successful ones on several cognitive-behavioral factors such as coping strategies over physical characteristics such as pain intensity. AIMS: This study explored factors that determine patients' perceptions of self-improvement after undergoing chronic pain treatment in a pain management program. METHODS: Participants (n = 174) underwent a 4-week, interdisciplinary, multimodal, chronic pain management program at a hospital located in southern Ontario. Questionnaire packages that evaluate pain intensity, pain-related disability, emotional distress (e.g., depression, anxiety, catastrophizing), acceptance of pain (activity engagement and pain willingness), readiness to change, and use of adaptive or maladaptive coping strategies were completed by patients at admission and discharge. Participants were grouped into one of three categories depending on their rating of self-improvement on the Self-Evaluation Scale (SES). The groups were compared on the magnitude of change they reported on the variables mentioned above. RESULTS: Changes in emotional distress, general health, readiness to change, activity engagement, and adaptive coping strategies (e.g., task persistence, pacing, and seeking social support) were significantly associated with differences in ratings of self-improvement. CONCLUSIONS: This study provided insight into what patients value most when rating their self-improvement, which can then be used to facilitate increased patient success and satisfaction with treatment.

Contexte : Le niveau d'amélioration autodéclaré par les patients après avoir participé à un programme de gestion de la douleur chronique peut fournir une évaluation subjective du succès qu'ils perçoivent avoir obtenu pour atteindre leurs objectifs dans le cadre de ce programme. Des études effectuées par le passé ont démontré que les patients qui ont eu du succès différent de ceux qui ont eu moins de succès en ce qui concerne plusieurs facteurs cognitivo-comportementaux comme les stratégies d'adaptation, plutôt que des caractéristiques physiques comme l'intensité de la douleur.But : Cette étude portait sur les facteurs qui déterminent les perceptions des patients en ce qui concerne l'amélioration de leur état après avoir été soumis à un traitement pour la douleur chronique dans le cadre d'un programme de gestion de la douleur.Méthodes : Les participants (n = 174) ont participé à un programme de gestion de la douleur chronique interdisciplinaire et multimodal d'une durée de quatre semaines dans un hôpital situé dans le Sud de l'Ontario. Au moment de leur admission au programme et au terme de celui-ci, les patients ont répondu à des questionnaires évaluant l'intensité de la douleur, l'incapacité liée à la douleur, la détresse émotionnelle (ex.: dépression, anxiété, dramatisation), l'acceptation de la douleur (engagement dans des activités et volonté de ressentir la douleur), la disposition au changement et l'utilisation de stratégies pour s'adapter ou ne pas s'adapter. Les participants ont été répartis en trois catégories selon l'évaluation qu'ils faisaient de l'amélioration de leur état à l'aide d'une échelle d'autoévaluation. L'ampleur du changement déclaré par chacun des groupes a été comparé pour chacune des variables susmentionnées.Résultats : Les changements dans la détresse émotionnelle, la santé générale, la disposition au changement, l'engagement dans des activités et les stratégies d'adaptation (ex. : la persistance dans les tâches, le rythme et le recours à du soutien social) ont été associés de manière significative à des différences dans l'évaluation de l'amélioration personnelle.Conclusions : Cette étude a permis de mieux comprendre ce que les patients valorisent le plus lorsqu'ils évaluent l'amélioration de leur état, ce qui peut par la suite être utilisé pour accroître le succès du patient et sa satisfaction à l'égard du traitement.Abbreviations PSOCQ: Pain Stages of Change Questionnaire; CPAQ: Chronic Pain Acceptance Questionnaire; PIS: Pain Intensity Scale; PDI: Pain Disability Index; PCS: Pain Catastrophizing Scale; PRIME-MD PQ: Patient Questionnaire of the Primary Care Evaluation of Mental Disorders; CAS: Clinical Anxiety Scale; CES-D: Center for Epidemiological Studies­Depressed Mood Scale; CPCI: Chronic Pain Coping Inventory; SES: Self-Evaluation Scale.

Learning to Manage Chronic Pain: The Patients' Perspective.

INTRODUCTION: The objective of the present study was to gain insight into patients' experiences in a 4-week interdisciplinary chronic pain management program by determining major themes from patients' written comments on exit questionnaires. METHODS: Upon completion of the program at the Chronic Pain Management Unit (CPMU), patients fill out program satisfaction (Pain Program Satisfaction Questionnaire) and evaluation of goal accomplishment (Self-Evaluation Scale) forms, sections of which are open-ended. Questionnaire data from 50 patients, admitted into the CPMU between May 2013 and December 2014, were randomly selected for this study. Written responses to open-ended sections were obtained. Comments were stratified by gender and coded using an inductive approach. Codes were grouped into categories which were further combined into several major themes. RESULTS: Six main themes extracted from comments were (1) impact of a strong interdisciplinary team, (2) learning to adapt in order to manage, (3) the Program as a stepping stone, (4) positive effects of a group effort, (5) improved mental health, and (6) benefits of the program. CONCLUSION: The results of this analysis reinforce the effectiveness of the interdisciplinary CPMU program at improving patients' quality of life. Findings may assist in the promotion of the program to stakeholders such as referral sources. The outcomes may also assist in the development of future programs that have similar goals. Concerns that arise within patients' comments may assist clinicians in this program to make adjustments such that all unique needs are met.

Sensitivity to cold pressor pain in dysmenorrheic and non-dysmenorrheic women as a function of menstrual cycle phase.

Pain responses (threshold, tolerance, and visual analog ratings) to the cold pressor task were studied in 46 normally menstruating dysmenorrheic and non-dysmenorrheic women during 2 phases of the menstrual cycle. Twenty-six women provided measurements during the follicular (days 8-14) and 20 during the luteal (days 15-21) phases of the menstrual cycle. A significantly lower pain threshold was obtained during the luteal as compared to the follicular phase. Pain tolerance showed a similar but non-significant trend. Visual analog ratings were significantly lower in dysmenorrheic women during the follicular than the luteal phase. Also, these ratings were lower than those of non-dysmenorrheic women in the follicular phase. This finding may support an adaptation-levels model, in that dysmenorrheic women report less pain than do non-dysmenorrheic women because they compare cold pressor pain with internal menstrual pain.

Responsiveness to laboratory pain in women as a function of age and childbirth pain experience.

Pain responsiveness was investigated experimentally as a function of age and childbirth pain experience. Sensitivity to cold pressor-induced pain was assessed through threshold, tolerance, and visual analog pain ratings. It was hypothesized that childbirth pain experience would mostly modify experimental pain judgment, in accordance with the adaptation-levels model. That is, childbirth pain would be used as an "anchor" in evaluating other painful events. Fifteen parous women were compared to 12 nulliparous women of the same age (mean age: 35 years) as well as to 15 nulliparous younger women (mean age: 24 years). This comparison was undertaken in order to distinguish the effects of age, which was found to correlate with pain threshold. Analysis of variance comparing the three groups of women was performed on each of the three cold pressor measures. A significant effect was found for pain threshold. Multiple comparisons indicated that parous women had a higher pain threshold than both groups of nulliparous women which did not differ from one another. Thus, painful childbirth experience is sufficient to raise cold pressor pain threshold. This finding has never before been reported in the pain literature. It is consistent with anecdotal reports from parous women who, when providing cold pressor pain judgments, say that "nothing compares to labor pain."

Menstrual cycle modulation of tender points.

Changes in pain sensitivity throughout the menstrual cycle were assessed in 36 normally menstruating women and 30 users of oral contraceptives. Pain sensitivity was measured with palpation of rheumatological tender points and with pressure dolorimetry. The number of tender points identified by palpation was greater in the follicular (postmenstrual) phase of the cycle as compared to the luteal (intermenstrual) phase in normally cycling women but not in users of oral contraceptives. These findings are related to previously described physiological and psychological features of the menstrual cycle, with particular emphasis on the role of hormonal events in modulating pain perception, particularly in musculoskeletal disorders such as fibromyalgia.

Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11).

PURPOSE: To determine the psychometric properties of the 11-item Tampa Scale for Kinesiophobia (TSK-11) in patients with heterogeneous chronic pain. METHODS: The study evaluated test-retest reliability (intra-class correlation coefficient), cross-sectional convergent construct validity (Pearson product-moment correlation between TSK-11 and the Pain Catastrophizing Scale [PCS] scores at admission), and sensitivity to change of the TSK-11 (area under the receiver operating characteristic [ROC] curve) in patients (n=74) with heterogeneous chronic pain. We used two data sets (retrospective, n=56; prospective, n=18). All patients attended the 4-week interdisciplinary chronic pain management programme at Chedoke Hospital, Hamilton Health Sciences, Hamilton, Ontario. RESULTS: The test-retest reliability of the TSK-11 was 0.81 (95% CI, 0.58-0.93), the standard error of measurement was 2.41 (90% CI, 1.47-2.49), and the minimal detectible change score was 5.6. The correlation between TSK-11 and PCS at admission was 0.60 (95% CI, 0.43-0.73). The area under the ROC curve was 0.73 (95% CI, 0.57-0.88). CONCLUSIONS: The study results provide evidence for the test-retest reliability, cross-sectional convergent construct validity, and sensitivity to change of the TSK-11 in a population with heterogeneous chronic pain.

Objectif: Déterminer les propriétés psychométriques des 11 jalons de l'échelle de Tampa de kinésiophobie (TSK-11) chez les patients avec douleur chronique hétérogène. Méthode: L'étude actuelle a évalué la fiabilité test-retest (coefficient de corrélation intraclasse), la validité du construit et la validité convergente croisée (corrélation de Pearson produit­moment entre le score de la TSK-11 et celui de l'échelle des pensées catastrophiques (PCS) à l'admission et la sensibilité au changement de la TSK-11 (section située sous la courbe ROC (caractéristique de fonctionnement du récepteur) chez les patients (n=74) avec douleur chronique hétérogène. Nous avons utilisé deux ensembles de données récoltées de façon rétrospective (n=56) et prospective (n=18). Tous les patients ont suivi le programme interdisciplinaire de quatre semaines pour la gestion de la douleur chronique de l'hôpital Chedoke du Hamilton Health Sciences. Résultats: La fiabilité test-retest de la TSK-11 était de 0,81 (IC de 95 %, 0,58­0,93), l'erreur de mesure normale était de 2,41 (IC de 90 %, 1,47­2,49) et le changement de score minimal détectable était de 5,6. La corrélation entre la TSK-11 et la PCS à l'admission était de 0,60 (IC de 95 %, 0,43­0,73). La section situé sous la courbe ROC était de 0,73 (IC de 95 %, 0.57­0.88). Conclusions: Les résultats de l'étude font la preuve de la fiabilité test-retest, de la validité du construit et de la validité convergente croisée et de la sensibilité au changement dans la TSK-11 chez une population aux prises avec de la douleur chronique hétérogène.