Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons.

BACKGROUND: Objectively measured differences in physical activity (PA) and sleep have been documented among people with osteoarthritis (OA) and rheumatoid arthritis (RA) compared to non-arthritic controls. However, it is not clear whether OA and RA subgroups also differ on these indexes or the extent to which distinct arthritis subgroups versus controls can be accurately identified on the basis of objective PA and sleep indexes compared to self-report responses on questionnaires. This study addressed these gaps. METHODS: This case-control study comprised Chinese adults with OA (N = 40) or RA (N = 40) diagnoses based on physician assessments as well as a control group of adults without chronic pain (N = 40). All participants wore a Sensewear Armband (SWA) for consecutive 7 days and completed the International Physical Activity Questionnaire Short Form-Chinese as well as Pittsburgh Sleep Diary to obtain objective and subjective PA and sleep data, respectively. RESULTS: There were no differences between the three groups on any self-report indexes of PA or sleep. Conversely, OA and RA subgroups displayed significantly lower PA levels and more sleep problems than controls did on a majority of SWA indexes, though arthritis subgroups were not differentiated from one another on these measures. Logistic regression analyses indicated four non-multicollinear SWA indexes (i.e., steps, active energy expenditure, vigorous activity, time awake after sleep onset) correctly identified the subgroup membership of 75.0-82.5% of participants with RA or OA while classification accuracy results were attenuated for controls. CONCLUSIONS: Where possible, objective measures should be used to assess PA and sleep of adults with OA and RA while particular self-report PA questionnaires should be used sparingly.

Identifying At-Risk Subgroups for Acute Postsurgical Pain: A Classification Tree Analysis.

Objective: Acute postsurgical pain is common and has potentially negative long-term consequences for patients. In this study, we evaluated effects of presurgery sociodemographics, pain experiences, psychological influences, and surgery-related variables on acute postsurgical pain using logistic regression vs classification tree analysis (CTA). Design: The study design was prospective. Setting: This study was carried out at Chongqing No. 9 hospital, Chongqing, China. Subjects: Patients (175 women, 84 men) completed a self-report battery 24 hours before surgery (T1) and pain intensity ratings 48-72 hours after surgery (T2). Results: An initial logistic regression analysis identified pain self-efficacy as the only presurgery predictor of postoperative pain intensity. Subsequently, a classification tree analysis (CTA) indicated that lower vs higher acute postoperative pain intensity levels were predicted not only by pain self-efficacy but also by its interaction with disease onset, pain catastrophizing, and body mass index. CTA results were replicated within a revised logistic regression model. Conclusions: Together, these findings underscored the potential utility of CTA as a means of identifying patient subgroups with higher and lower risk for severe acute postoperative pain based on interacting characteristics.

Pre-surgery beliefs about pain and surgery as predictors of acute and chronic post-surgical pain: A prospective cohort study.

BACKGROUND: Chronic pain post-surgical pain (CPSP) is common and has far-reaching negative consequences for patients, yet relatively few studies have evaluated the impact of both deficit- and resource-based beliefs about pain and surgery on subjective intensities of acute and chronic post-surgical pain. To address this issue a prospective cohort study was performed. METHOD: 259 consecutive surgery patients from general surgery, gynecology, and thoracic departments completed a self-report battery of demographics, pain experiences, and psychological factors 24 h before surgery (T1) and provided follow-up pain intensity ratings 48 h-72 h after surgery (T2), and at a 4-month follow-up (T3). RESULTS: In the hierarchical regression model for acute post-operative pain intensity, pre-surgery pain self-efficacy beliefs made a significant unique contribution independent of all other pre-surgery and surgery-related factors (i.e., age, presence of pre-surgical pain, type of anesthesia, surgery duration). In the prediction model for intensity of chronic post-surgical pain, beliefs about long-term effects of surgery had a unique impact after controlling other significant pre-surgery and surgery influences (gender, education, surgery time). CONCLUSION: Results underscored the potential utility of considering specific pre-surgery pain- and surgery-related beliefs as factors that predict patient experiences of acute and chronic post-operative pain.

Toward Identifying Moderators of Associations Between Presurgery Emotional Distress and Postoperative Pain Outcomes: A Meta-Analysis of Longitudinal Studies.

UNLABELLED: Presurgery emotional distress has had variable associations with outcomes of surgery in past narrative reviews. This meta-analysis was designed to evaluate the overall strengths of relations between presurgical emotional distress and key postsurgical pain outcomes (ie, pain intensity, analgesic use, functional impairment) and to identify moderators that might explain effect size heterogeneity between studies. PubMed, Web of Science, PsychINFO, Google Scholar, and Science Direct databases were searched to identify studies subjected to meta-analysis. Forty-seven studies of 6,207 patients met all 10 inclusion criteria. High presurgery emotional distress levels were associated with significantly more postsurgical pain, analgesic use, and impairment after surgery, with small to medium average effect sizes. Moderator analyses for relations between distress and pain intensity indicated effect sizes were larger in studies that assessed catastrophizing, anxiety, and/or depression than other types of emotional distress as well as those with lower rather than higher quality scores. Associations between presurgery distress and postoperative impairment were moderated by type of surgery. Heterogeneity in these relations was reduced or no longer significant after statistically controlling for moderators. Moderator analyses also supported the role of presurgery emotional distress as a risk factor for, rather than simply a correlate of, elevations in postoperative pain and disability. PERSPECTIVE: This meta-analysis indicates presurgery emotional distress has significant associations with postoperative outcomes but specific methodological factors and sample characteristics contribute to effect size variability in the literature. Considering emotional distress within presurgical assessment protocols may aid in identifying vulnerable patients who can benefit from interventions targeting distress reductions.

Gender, interpersonal transactions, and the perception of pain: an experimental analysis.

UNLABELLED: Two experiments assessed how interpersonal transactions influence responses to cold pressor pain in women versus men. In Experiment 1, 91 young adults (57 women, 34 men) were randomly assigned to either a no transaction (NT) condition in which they coped alone with the cold pressor test or a transaction opportunity (TO) condition in which they also had the option of interacting with an empathetic, reflecting experimenter. Compared to men, women had lower pain tolerance and reported more pain and catastrophizing, although there were no gender differences in support seeking or other ways of coping. Within the TO condition, women were no more likely than men to initiate a transaction, but female speakers were more pain-focused than male speakers, and speaking with the empathetic interaction partner had generally negative effects on pain perception and coping. In Experiment 2, 126 young adults (76 women, 50 men) were randomly assigned to NT, TO, or experimenter-directed (1) Distraction (DT), (2) Reinterpretation (RT), or (3) Encouragement (ET) conditions. Although men had similar levels of pain tolerance across the 5 transaction conditions, women in NT and TO conditions exhibited reduced tolerance compared with those in the DT, RT, and ET conditions. Pain tolerance times among women in DT, RT, and ET conditions were equal to or exceeded those of men in these conditions. Together, findings suggest the nature of interpersonal transactions exerts a greater influence on women's responses to noxious stimulation than those of men. PERSPECTIVE: This study adds to literature indicating that women exhibit reduced tolerance for experimentally induced pain compared with men. These results suggest that the nature of interpersonal transactions also affects women's responses to noxious stimulation, more than those of men.

Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims.

OBJECTIVE: There has been little research examining chronic pain and posttraumatic stress symptoms in persons injured in motor vehicle accidents. The purpose of this study was to evaluate differences in physical injury and impairment, psychological distress, and pain coping strategies in litigating chronic pain patients low and high in motor vehicle accident-related posttraumatic stress symptoms. DESIGN: A total of 160 consecutive chronic pain patients referred for psychological-legal assessment underwent semistructured interview and testing. The testing battery included the Minnesota Multiphasic Personality Inventory-2, the Multidimensional Pain Inventory, the Sickness Impact Profile, and the Coping Strategies Questionnaire. Using the sample-specific median split of 18 posttraumatic stress symptoms on the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder scale, chronic pain patients were categorized as evidencing low or high levels of posttraumatic stress symptoms. RESULTS: The findings indicate that participants evidencing high posttraumatic stress symptoms had more physical impairment, psychological distress, and maladaptive pain coping strategies and were more likely to be treated with antidepressants, other medications, and psychological management than participants evidencing low posttraumatic stress symptoms. A discriminant function analysis was performed using the full combination of physical injury and impairment, psychological distress, and pain coping variables in the prediction of posttraumatic stress symptom-defined group membership. The resulting discriminant function accounted for 61% of the between-group variance and correctly classified 92% of participants who were low in posttraumatic stress symptoms and 88% of participants who were high in posttraumatic stress symptoms. CONCLUSIONS: Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims are associated with increased physical and psychological morbidity.

The impact of threatening information about pain on coping and pain tolerance.

This study examined the impact of threatening information on coping and pain tolerance in a healthy adult sample. Prior to engaging in a Cold Pressor Test (CPT), 121 college students were randomly assigned to one of three conditions: a threat condition in which they read an orienting passage warning them about symptoms and consequences of frostbite (pain as a signal for nociception), a reassurance condition in which they read an orienting passage about the safety of the CPT (pain independent of nociception), or a control condition in which no orienting passage was read before the experimental task. Only 15.6% of participants in the threat group completed the CPT to its 4-minute duration, compared with 55.6% in the reassurance group and 45.2% of those in the control group. Even though groups did not differ on level of reported pain, threatened participants catastrophized more about the pain and reported less use of cognitive coping strategies (reinterpreting pain sensations, ignoring pain, diverting attention away from pain to other experiences, and using coping self-statements) than other respondents. A path analysis indicated that the relation between threat and pain tolerance was fully mediated by catastrophizing and cognitive coping. Together, findings suggest that pain appraised as threatening contributes to a specific pattern of coping responses associated with a reduced capacity to bear pain.

Prevalence and correlates of chronic pain in a random population study of adults in Chongqing, China.

OBJECTIVE: Numerous studies have documented rates of chronic pain in developed western nations; however, little is known about its prevalence or correlates in rapidly developing countries, where much of the world's population lives. This study was designed to assess the prevalence of chronic pain among adults in Chongqing, China and the correlates of chronicity among respondents with pain and degree of impairment within the subgroup reporting chronic pain. DESIGN: A structured telephone interview was used within a cross-sectional design. Chronic pain was defined as the pain that had persisted for ≥3 months. PARTICIPANTS: Adults from a random sample of 1003 Chongqing households completed a structured telephone interview on pain experiences of themselves and other family members over the past 6 months. RESULTS: Overall, 42.2% of interviewees reported pain for at least 1 day during the past 6 months and 25.8% experienced pain lasting for at least 3 months. The most common complaints were back pain (17.6%), headache (14.2%), joint pain, (10.5%), and abdominal pain (10.4%). Among those who reported pain, correlates of a chronic duration included older age, presence of back pain, heightened impairment, use of Chinese medicine, and greater numer of interventions used for pain management. For interviewees whose pain was chronic, increased functional impairment was related to older age, presence of pain every day, and increased likelihood of consulting physicians and using Chinese medicine to manage pain. CONCLUSIONS: Rates of chronic pain in Chongqing appear to approximate to those reported in western countries. A significant minority of those affected report substantial or severe impairment and are more likely than less impaired cohorts to have sought medical interventions to manage pain.

MPI profile classifications and associated clinical findings among litigating motor vehicle collision patients.

OBJECTIVES: The purpose of this study was to examine differences in precollision, pericollision, and postcollision clinical variables across litigating motor vehicle collision (MVC) patients who were classified as Dysfunctional (DYS), Interpersonally Distressed (ID), or Adaptive Copers (ACs) based on Multidimensional Pain Inventory (MPI) profile classifications. MATERIALS AND METHODS: A sample of 240 MVC patients who sustained serious physical injuries and experienced MVC-related chronic pain completed the MPI and provided responses to a semistructured psycholegal interview designed to elicit injury-related and pain-related symptoms and treatments, determine the presence and impact of precollision experiences, and render psychiatric diagnoses and ratings of psychological disability. RESULTS: A significant multivariate effect of MPI profile group on postcollision variables was revealed, with the DYS and ID groups reporting more pain sites than the AC group and the DYS group receiving more recommendations for treatment than the AC group. Larger proportions of the DYS and ID groups were diagnosed as experiencing major depressive disorder than the AC group. A rating of total psychological disability was applied most often to members of the ID group, with partial psychological disability applied most often to members of the DYS group, and no psychological disability applied most often to members of the AC group. DISCUSSION: This study extends the MPI literature by establishing the usefulness of the measure in determining those reports of MVC-related pain and emotional distress that are most likely to be associated with postcollision psychological disability. The current study supports the usefulness of MPI profile classifications in identifying MVC patients who are likely to require and benefit from intensive psychological and other rehabilitative interventions.

Predictors of neurocognitive performance in chronic pain patients.

In a sample of 70 chronic pain patients, hierarchical multiple regression analyses were utilized to assess the additive and interactive contributions of pain severity and psychological distress variables to neurocognitive performance across attention and concentration, memory, and reasoning ability domains. Although the full model predicting attention and concentration was found to be significant, there was no significant contribution of pain severity, psychological distress, or the Pain Severity x Psychological Distress interaction to the prediction of attention and concentration scores after controlling for the effect of years of formal education. After controlling for the effect of years of formal education, pain severity and psychological distress did make separate and significant contributions to the prediction of memory scores; however, the Pain Severity x Psychological Distress interaction did not significantly affect memory scores. After controlling for the effect of years of formal education, there was no significant contribution of pain severity, psychological distress, or the Pain Severity x Psychological Distress interaction to reasoning ability scores. Results suggest the importance of assessing memory function when managing psychologically distressed chronic pain patients.