Effectiveness of spontaneous pain coping strategies for acute pain management: A laboratory study.

The aim of the present study has been to analyze the relationship between the use of not previously trained, diverse acute pain coping strategies and levels of pain intensity and pain tolerance in a group of healthy participants. Previous research has analyzed the usefulness of the training of these strategies after several training sessions, but adequate patient training requires a great deal of time. Two hundred and forty healthy people participated in the study. Pain coping strategies was evaluated with a version of CSQ-S. Subsequently, the participants completed a cold pressor test and tolerance test. After that, subjects filled in the adaptation of the CSQ-S about the strategies which they had employed throughout the test. Correlation analyses showed a positive relationship between pain intensity and catastrophizing, distractor behaviors, hoping and ignoring the pain. Pain tolerance correlated with self-instructions, ignoring the pain, reinterpreting the pain, catastrophizing and faith and praying. Regression analyses showed that catastrophizing was found to be the strategy that most predicts the variance of pain intensity, and catastrophizing (negative) and ignoring the pain (positive) and praying (negative) were the most predictive ones for pain tolerance. This is the first laboratory study that identifies the more useful pain coping strategies which can be used by patients without previous training in an acute pain context. The results of this study could be useful in the development of protocols for nurses and other health professionals, especially for situations where potentially painful techniques are to be applied to patients.

An Exploration of the Psychometric Properties of the PASS-20 in Older Adults with Chronic Pain: Preliminary Development and Validity.

OBJECTIVES: The Pain Anxiety Symptoms Scale (PASS-20) is well validated in adults and younger populations, but not in older adults. This study aimed to analyze the psychometric properties of the PASS-20 in Spanish older adults who experience chronic pain. METHODS: Participants were 111 older adults with chronic pain living in nursing homes (mean age = 83.36; SD = 6.53; 78.6% female). Face-to-face interviews were conducted which included assessment of pain anxiety (PASS-20), chronic pain acceptance (CPAQ), depression symptoms (GDS), catastrophizing beliefs (PCS), pain severity, and sociodemographic information. An Exploratory Structural Equation Modeling (ESEM) approach was used to refine the scale. RESULTS: The final scale was composed of seven items, measuring two factors that could be labeled "Internal experiences" and "Escape/Avoidance behaviors". The two factors explained 60.98% of the total variance. PASS-7 version fit properly: χ2/df = 14.57/13, CMIN/df = 1.121, CFI = 0.99, RMSEA = 0.033, TLI = 0.98, GFI = 0.96, AGFI = 0.92. Good validity indices were found and acceptable reliability results in the scale and its subscales (Chronbach´s α; Internal Experiences = 0.70; Escape/Avoidance Behaviors= 0.73; Total Scale = 0.77). CONCLUSIONS: The short version of the PASS-7 has good psychometric properties. CLINICAL IMPLICATIONS: The brevity of the PASS-7 increases the feasibility of this instrument which could potentially be utilized in a variety of clinical settings and research studies with older people with chronic pain samples, specially institutionalized older adults.

Cardiovascular Responses of Women with Fibromyalgia to a Laboratory Stressor: Does Post-traumatic Stress Disorder Comorbidity Matter?

OBJECTIVES: This study compared cardiovascular responses to a laboratory trauma-unrelated stressor of two groups of women diagnosed with fibromyalgia (FM), one of them with comorbid post-traumatic stress disorder (PTSD), with a group of healthy controls in order to detect the possible existence of differences linked to comorbidity. DESIGN: Case-controls. METHODS: Eighteen women diagnosed with FM and comorbid PTSD, 18 women diagnosed with FM and no PTSD, and 38 healthy women were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure and recovery. RESULTS: Although heart rate response evidenced a general blunted reactivity for both groups of FM patients, only those with comorbid PTSD presented lower levels of reactivity in terms of their systolic blood pressure response. In addition, systolic blood pressure response was sensitive to the presence of depression in both groups of FM patients and controls. Finally, although both groups of FM patients showed significantly slower rates of recovery, their final recovery state was not worse after twelve minutes of recording. CONCLUSIONS: Results of this study point to comorbid PTSD as a significant contributor to the blunted cardiovascular reactivity observed in FM patients, which may be dependent to a great extent on depressive symptomatology. As some degree of cardiovascular response to stress is functional in that it mobilizes energy and triggers the necessary compensatory mechanisms to manage stressors, this study supports the well-recognized clinical strategies of detection and treatment of PTSD and concomitant depression in the management of FM.

Stress, Coping, and Personality in Patients with Epicrania Fugax, and Their Relation to the Clinical Characteristics of Pain.

Objective: The aim of the present work is to analyze certain psychological features in a group of patients diagnosed with Epicrania fugax (EF; that has been recently included in the appendix of the International Classification of Headache Disorders, third edition, beta version), as well as their association with diverse demographic and clinical characteristics of the sample. Design: Case-control. Method: Perceived Stress Scale (PSS), Stress Coping (COPE), Big Five Personality Traits (NEO-FFI), Depression (BDI-II), and Trait Anxiety (STAI) were evaluated in 23 patients with EF and 23 matched healthy controls. Differences between EF patients and controls were analyzed using the Mann-Whitney U test. Differences in psychological features as a function of the demographic and clinical characteristics were examined using one-way Analysis of Variance (ANOVA), Mann-Whitney U test, or Pearson's correlations. Results: The two groups differed significantly from each other in Denial, Trait anxiety, and Depression. Low-frequency epicrania patients scored significantly higher than controls in Perceived stress, Neuroticism, Denial, Self-blame, Trait anxiety, and Depression and higher than high-frequency EF in Venting. Conclusions: The results initially suggest the absence of substantial differences between patients suffering of EF and healthy controls. On the contrary, low-frequency EF patients show a distinctive "negative (unhealthy) psychological profile," in opposition to high-frequency EF patients. This circumstance highlights the potential need to consider low- frequency EF patients as a target for psychological intervention in combination with the most common medical procedures. Longitudinal studies are necessary to correctly elucidate the influence of these psychological variables on the course of EF.

Comparison Between Chronic Migraine and Temporomandibular Disorders in Pain-Related Disability and Fear-Avoidance Behaviors.

OBJECTIVE: To compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups. DESIGN: Descriptive, cross-sectional study. SETTINGS: A neurology department and a temporomandibular disorders consult in a tertiary care center. SUBJECTS: A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications. METHODS: The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11). RESULTS: Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI (P < 0.001), PCS (P = 0.03), and HIT-6 (P < 0.001); however, there were no differences between the CM group and the VAS, NDI, and TSK-11 groups (P > 0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R2 = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R2 = 0.19). CONCLUSIONS: Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance).

Acceptance and Commitment Therapy and Selective Optimization with Compensation for Institutionalized Older People with Chronic Pain.

OBJECTIVE: Recent studies support the efficacy of Acceptance and Commitment Therapy (ACT) with people with chronic pain. In addition, Selective Optimization with Compensation strategies (SOC) can help the elderly with chronic pain to accept their chronic condition and increase functional autonomy. Our aim was to analyze the efficacy of an ACT treatment program combined with training in SOC strategies for elderly people with chronic pain living in nursing homes. METHODS: 101 participants (mean age = 82.26; SD = 10.00; 78.6% female) were randomized to the intervention condition (ACT-SOC) or to a minimal support group (MS). Complete data are available for 53 participants (ACT-SOC: n = 27; MS: n = 26). Assessments of functional performance, pain intensity, pain acceptance, SOC strategies, emotional well being and catastrophizing beliefs were done preintervention and postintervention. RESULTS: Significant time by intervention changes (P = 0.05) were found in acceptance, pain related anxiety, compensation strategies, and pain interference in walking ability. Simple effects changes were found in acceptance (P = 0.01), selection strategies (P = 0.05), catastrophizing beliefs (P = 0.03), depressive symptoms (P = 0.05), pain anxiety (P = 0.01) and pain interference in mood and walking ability (P = 0.03) in the ACT-SOC group. No significant changes were found in the MS group. CONCLUSIONS: These results suggest that an ACT intervention combined with training in SOC strategies could help older people with pain to improve their emotional well being and their functional capability.

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

BACKGROUND: The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). METHODS: A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). RESULTS: A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (ß = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (ß = 0.40; p < 0.001) and kinesiophobia (ß = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability. CONCLUSION: Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

SOURCES OF STRESS AND RECOVERY AS CONCURRENT PREDICTORS OF THE AFFECT BALANCE OF PATIENTS WITH FIBROMYALGIA.

This study examined sources of stress and recovery in a group of 107 patients with fibromyalgia (M age = 50.4 yr., SD = 11.8), in comparison to a control group of 68 healthy participants (M age = 47.8 yr., SD = 8.1) of equivalent age and marital status. Between-group differences in sources of stress and recovery were examined by means of an independent samples t test. In addition, between-groups differences in the relationship between sources of stress and recovery and affect balance were explored through a multi-group SEM analysis. The results provided evidence in support of the hypothesis that fibromyalgia patients find fewer sources of recovery and that the contribution of such sources for improving their affective well-being is lower than in healthy individuals. Relevant clinical implications were discussed.

Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point.

OBJECTIVES: To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity. DESIGN: A 72-hour follow-up, single-blind randomized controlled trial. SETTING: University community. PARTICIPANTS: Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle. INTERVENTION: All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention. MAIN OUTCOME MEASURES: Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised. RESULTS: Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F3,204.8=3.19; P<.05; ηp(2)=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F2.6,175=1.9; P=.131; ηp(2)=.02). CONCLUSIONS: The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.

Pain and symptoms of depression in older adults living in community and in nursing homes: the role of activity restriction as a potential mediator and moderator.

BACKGROUND: Chronic pain is likely to lead to depressive symptoms, but the nature of this relationship is not completely clear. The aim of the present study is to analyze the role of activity restriction in the pain-depression relationship in older people, and to test the hypothesis that this role is more relevant in community-dwelling older people than in nursing home residents. METHOD: Depressive symptoms, pain intensity, and activity restriction were measured in a sample of 208 older adults with osteoarthritis, 102 living in nursing homes (NH), and 106 in the community. Analyses were carried out using moderation and moderated mediation analyses approach, treating activity restriction as a confounder. RESULTS: RESULTS showed a significant confounding effect of activity restriction, interaction effect between pain intensity and activity restriction on depression, and modifying effect of pain intensity on depression by adding activity restriction into the model. These results suggest a potential mediating and moderating effects of activity restriction. Moreover, analyses suggest that, surprisingly, the strength of the mediation could be higher in nursing homes. CONCLUSIONS: Overall, it may be that what is really important to emotional well-being is not so much pain itself, but rather the way in which the pain alters older people's lives. The greater strength of the mediation in NH might be understood within the scope of self-determination theory. Generally speaking, the NH context has been considered as a coercive setting, promoting non-autonomous orientation. In this context, when events are objectively coercive, people may lack perceived autonomy and hence be at greater risk of depression.

Effectiveness of cognitive reappraisal and distraction for induced acute pain: A laboratory study.

OBJECTIVE: Cognitive reappraisal and distraction modulate pain; however, little is known about their effectiveness at different levels of pain intensity. Thus, the aim of this study has been to analyze the differential efficacy of both strategies to reduce perceived pain intensity and pain unpleasantness in low and moderate pain levels. METHOD: 3 (emotion regulation strategy: cognitive reappraisal, distraction, and control) × 2 (intensity of the painful stimuli: low and moderate intensity) × 2 (time: pretest and posttest) mixed factorial design. Ninety healthy adults were randomly assigned to one of six experimental conditions. Pain-heat stimuli were administered with an advanced thermal stimulator. All participants completed the experimental pretest and posttest phases; in each phase, 12 pain stimuli were administered. Participants received brief training on how to apply cognitive reappraisal, distraction, and the control condition for the posttest phase. Data were collected from May 2022 to November 2022. RESULTS: Analyses of repeated-measure analysis of variance showed that at posttest cognitive reappraisal and distraction were equally effective in reducing perceived pain intensity in low pain levels, while distraction was more effective than cognitive reappraisal in decreasing perceived pain intensity in moderate pain levels. Both distraction and cognitive reappraisal were effective in decreasing pain unpleasantness regardless of the intensity of the painful stimuli. CONCLUSION: These findings highlighted the beneficial use of both strategies in the short term for pain relief, distraction being more effective in moderate pain levels. Applying both strategies to everyday situations that may cause short-term acute pain could be of great clinical relevance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early maladaptive schemas as a risk factor for fibromyalgia: A case-control study.

OBJECTIVE: There is evidence supporting the relationship between early stress and childhood trauma and the development of fibromyalgia (FM). Early maladaptive schemas (EMSs) are considered a consequence of early stress. Previous research has shown their role in maintaining stress responses and their relevance in other populations with pain. The main aim of this study has been to analyze the presence of EMSs in patients with FM compared to healthy adult women. In addition, the relationship between the strength of EMSs and pain intensity was tested. METHOD: The total sample consisted of 167 women: 83 patients with FM and 84 healthy controls. RESULTS: Chi-square analyses showed that the percentage of participants with clinically significant scores is higher for patients with FM in 11 of the 18 EMSs evaluated. Moreover, discriminant analyses revealed that these EMS are useful to discriminate between FM and healthy controls, classifying 74.2% of original cases. In relation to the second aim, the mean pain intensity correlated with the strength of several EMSs: approval seeking, unrelenting standards, insufficient self-control, and mistrust/abuse. CONCLUSIONS: The current study highlights that a high rate of patients with FM have clinically significant EMSs compared to healthy matched controls, as has been found in other populations with pain. Besides, this study provides initial evidence that EMSs are positively associated with the pain experienced by patients with FM, suggesting the existence of a possible association between early stress and pain. Therefore, taking EMSs into account could be of great relevance to clinicians. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stressors and uplifts of confinement due to covid-19: A longitudinal study on mental health in a sample of academic and administrative university staff in Spain.

The rapid spread of COVID-19 caused many countries to decide to enter full lockdown, a circumstance that impacted all aspects of life, including mental health. The present longitudinal study aimed to analyse how stressors and uplifts of confinement were linked to psychological symptoms at three different time points: during the full lockdown (wave 1), after the gradual lifting of restrictions (wave 2) and after confinement (wave 3). The sample was made up by one hundred and twenty academic and administrative staff from a big University in Spain, they all completed an online survey. Results showed that psychological status did not change over time, but a significant interindividual variability was found throughout. Some stressors were only linked to symptoms at wave 1, but others maintained their associations during waves 2 and 3. Uplifts were, for the most part, inversely (and exclusively) linked to symptoms at wave 1. However, some of them, although enjoyable, were paradoxically linked to worse mental health at wave 1, and even at waves 2 and 3. These findings highlight the importance of providing preventive psychological strategies for mental distress before, during and after confinement.

Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients.

Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1-S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.

Discrepancy between radiographic damage and functional disability in elderly people with osteoarthritis: the role of pain coping strategies.

The aim of this study is twofold. First, to assess the level of agreement between radiographic damage and functional disability in older people with osteoarthritis. And second, to assess the role of coping skills and sensory pain parameters as sources of disagreement between these variables. To achieve this objective we assess, in a sample of 104 older people with osteoarthritis, the following variables: functional capacity, radiographic damage, pain coping strategies, pain intensity, pain frequency and pain duration. The results show a non-linear relationship between radiographic damage and functional disability, modified by the levels of the two variables. There was maximum agreement between low levels of radiographic damage and of functional impairment, whilst agreement decreased for moderate and high levels of radiographic damage. Certain coping strategies may help to explain this disparity.

Stress-Recovery State in Fibromyalgia Patients and Healthy People. Relationship with the Cardiovascular Response to Stress in Laboratory Conditions.

The current study´s objective was to determine the relationship between stress-recovery state and cardiovascular response to an acute stressor in a sample of female fibromyalgia patients in comparison with a control group of healthy participants. The laboratory procedure was completed by 36 participants with fibromyalgia and by 38 healthy women who were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure.

Depression and anxiety are not related to nummular headache.

Nummular headache (NH) is a clinical picture characterized by head pain that is exclusively felt in a round, elliptical, or oval area of the head. Although there is evidence supporting an organic origin for NH, some authors question this origin, hypothesizing a potential role for psychological factors. Our aims were to investigate the differences in anxiety and depression between NH patients and healthy controls, and to analyse if these conditions were related to pain parameters in NH patients. The Beck depression inventory (BDI-II) and the trait anxiety scale from state-trait anxiety inventory (STAI) were administered to 26 patients with NH and 34 comparable matched controls. No significant interactions between group (NH patients, controls) in either depression (U = 391; p = 0.443) or anxiety levels (U = 336; p = 0.113) were found. Both groups showed similar scores in the BDI-II (patients: 3.9 +/- 2.9; controls: 3.46 +/- 3.15) and STAI (patients: 17.23 +/- 10.3; controls: 13.5 +/- 7.9). Moreover, neither depression nor anxiety showed association with mean pain intensity, pain intensity in exacerbations, size of pain area, or pain frequency. Our study demonstrated that self-reported depression and anxiety were not related to the presence of NH. Further, longitudinal studies are still needed to elucidate the role of mood state in the course of NH.

[Cognitive resources of perceived control, stress-recovery processes and affective discomfort in fibromyalgia]. / Recursos cognitivos de percepción de control, procesos de estrés/recuperación y malestar afectivo en fibromialgia.

This study evaluates a structural equation model (SEM) of linkages among cognitive control resources (illness-specific efficacy beliefs and internal pain control expectancies), stress/recovery state, and affective discomfort in women with fibromyalgia (n=130). Results were consistent with the proposal that stress/recovery balance mediates the relationship between cognitive resources and affective discomfort. In addition, direct effects of cognitive resources on function limitation were observed, and pain intensity and symptoms were direct predictors of the affective discomfort. Based on the results, the possible interpretation of several cognitive-behavioural techniques commonly employed in the treatment of fibromyalgia are indicated as strategies aimed at finding the correct equilibrium between stress and recovery, and the modification of self-efficacy beliefs and pain control expectancies are fundamental.

The role of psychological variables in explaining depression in older people with chronic pain.

OBJECTIVES: Depression is commonly associated with chronic pain, and is also a common condition in the elderly. However research in the area of depression and pain is scarce. The aim of the present work was to analyse how cognitive-behavioural and perceptual variables help to explain the presence or absence of depression in older people with chronic pain caused by osteoarthritis. METHOD: A total of 104 older adults were evaluated using a protocol that measured depression, perceptual characteristics of pain (intensity, frequency and duration), beliefs about pain, self-efficacy beliefs, coping style, coping strategies and pain behaviours. RESULTS: Using Student's t-tests and discriminant analysis, we found that psychological variables such as catastrophizing, passive coping, complaint behaviour, avoidance, coping self-statements, ignoring pain sensations and stability and mystery beliefs help to explain depressive symptomatology. CONCLUSION: The present study confirms the important role of cognitive-behavioural variables in the discrimination between older adults who suffer pain with and without symptoms of depression. Moreover, certain variables that in young adults had been seen to play a non-adaptive role, such as ignoring pain sensations, were seen to have an adaptive function in the elderly. Also, our results are in support of depression models - such as Abramson's Hopelessness Model - proposing that depression in chronic pain patients, unlike in other groups of depressed people, is characterized by absence of self-blame feelings.

Hypoalgesic effects of three different manual therapy techniques on cervical spine and psychological interaction: A randomized clinical trial.

OBJECTIVE: The purpose of this study was to evaluate the extent to which psychological factors interact with a particular manual therapy (MT) technique to induce hypoalgesia in healthy subjects. METHODS: Seventy-five healthy volunteers (36 female, 39 males), were recruited in this double-blind, controlled and parallel study. Subjects were randomly assigned to receive: High velocity low amplitude technique (HVLA), joint mobilization, or Cervical Lateral glide mobilization (CLGM). Pressure pain threshold (PPT) over C7 unilaterally, trapezius muscle and lateral epicondyle bilaterally, were measured prior to single technique MT was applied and immediately after to applied MT. Pain catastrophizing, depression, anxiety and kinesiophobia were evaluated before treatment. RESULTS: The results indicate that hypoalgesia was observed in all groups after treatment in the neck and elbow region (P < 0.05), but mobilization induces more hypoalgesic effects. Catastrophizing interacted with change over time in PPT, for changes in C7 and in manipulation group. CONCLUSIONS: All the MT techniques studied produced local and segmental hypoalgesic effects, supporting the results of previous studies studying the individual interventions. Interaction between catastrophizing and HVLA technique suggest that whether catastrophizing level is low or medium, the chance of success is high, but high levels of catastrophizing may result in poor outcome after HVLA intervention. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT02782585.