Vulnerability Factors, Adjustment, and Opioid Misuse in Chronic Noncancer Pain Individuals.

Several person variables predate injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of 2 diathesis variables (impulsiveness and anxiety sensitivity [AS]) in the adjustment of individuals with chronic noncancer pain and opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modeling analyses. The results show a significant association between impulsiveness and AS and all the maladjustment variables, and between impulsiveness and AS and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the structural equation modeling analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and AS are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including AS and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.

Protocol for a multi-phase, multi-center, real-world, hybrid effectiveness-implementation study of a digital intervention for pediatric chronic pain co-designed with patients (Digital SPA).

Background: Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain. Methods: (Phase 1) Focus groups with patients, parents, and clinicians (n = 5-6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness-implementation trial. Participants (n = 195) will be adolescents aged 12-17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation. Discussion: This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation. Trial registration number TRN and date of registration: ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful.In this study, we expect that assessing users' needs and co-designing an intervention with them will improve adherence.Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts.This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care.

Psychometric Properties of the Spanish Version of the Pain Anxiety Symptoms Scale-20 (PASS-20-SV) / Propiedades Psicométricas de la Versión Española de la Pain Anxiety Symptoms Scale-20 (PASS-20-SV)

Background: The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations. Methods: Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23 men). The dimensionality of the PASS-20-SV items was evaluated using Exploratory Factor Analysis and an optimal implementation of Parallel Analysis (robust maximum likelihood). Data from sample 1 was used to analyse internal consistency and convergent validity. Estimated test-retest stability and predictive validity were based on data from the sample 2 participants, who completed the first administration (T1) and a second administration (T2, 6 months later). Results: The PASS-20-SV comprises two factors: pain-related anxiety and apprehension, and pain-related fear and avoidance. It has good to excellent reliability and adequate test-retest stability. The results support its convergent and predictive validity. Conclusions: The Spanish Version of the PASS-20 is a valid, reliable measure of pain-related anxiety and pain-related fear in Spanish-speaking patients. (AU)

Antecedentes: el PASS-20 es una medida general de la ansiedad y el miedo relacionados con el dolor. El objetivo del presente estudio fue adaptar el cuestionario para su uso en población española. Método: la muestra 1 incluyó 216 personas con dolor crónico de espalda (114 mujeres y 102 hombres); la muestra 2 comprendió 85 personas con dolor agudo de espalda (62 mujeres y 23 hombres). La estructura factorial del PASS-20-SV se evaluó mediante un análisis factorial exploratorio y un análisis paralelo (máxima verosimilitud). Los datos de la muestra 1 se utilizaron para analizar la fiabilidad y la validez convergente. La estabilidad estimada de la prueba y la validez predictiva se basaron en los datos de los participantes de la muestra 2, que completaron el instrumento en dos momentos (T1 y T2, 6 meses después). Resultados: la versión española del PASS-20 se compone de dos factores: ansiedad y aprehensión al dolor, y miedo y evitación del dolor, con buena consistencia interna y adecuada estabilidad. Los resultados apoyan la validez convergente y predictiva del instrumento. Conclusiones: la versión española del PASS-20 es una medida válida y fiable para evaluar la ansiedad y el miedo al dolor. (AU)

Pesimismo defensivo, optimismo y adaptación al dolor crónico / Defensive pessimism, optimism and adaptation to chronic pain

El objetivo principal de este estudio fue contrastar empíricamente si el pesimismo defensivo en interacción con la ansiedad rasgo se asociaba con una mejor adaptación al dolor crónico (operacionalizada como mayor bienestar), mejor nivel de funcionamiento cotidiano y menor deterioro en 258 pacientes con dolor crónica musculoesqueletico. Se realizaron tres análisis de regresión jerárquica por pasos. Los resultados mostraron que el pesimismo defensivo en interacción con la ansiedad rasgo presentaba una asociación estadísticamente significativa con el bienestar. Por otra parte, se observó que el optimismo disposiciones se asociaba significativamente con un mejor funcionamiento y mayor bienestar. Se discute el papel fundamental que juega el optimismo disposicional en la adaptación al dolor crónico y se plantea como el pesimismo defensivo y el optimismo podrían convivir en un mismo individuo, entendiendo el pesimismo defensivo como una estrategia cognitiva para enfrentar una tarea concreta y el optimismo disposicional como expectativas positivas generalizadas. Se reflexiona sobre las implicaciones clínicas de estos hallazgo

The main aim of this study was to investigate whether defensive pessimism in interaction with trait anxiety was associated with better adaptation to chronic pain operationalized as greater well-being, a higher level of daily functioning, and less disability. The sample comprised 276 patients with chronic musculoskeletal pain. Three hierarchical stepwise regression analyses were performed. Statistically significant associations were found between defensive pessimism in interaction with trait anxiety and well-being, and between dispositional optimism and better functioning and greater well-being. The central role of dispositional optimism in adaptation to chronic pain is discussed. We speculate that defensive pessimism and optimism could coexist in the same individual, understanding defensive pessimism as a cognitive strategy aimed at managing a specific task, and dispositional optimism as generalized positive expectations. The clinical implications of these findings are discussed

Validation of the child ptsd symptom scale (cpss) in spanish adolescents / Validación española de la Child PTSD Symptom Scale (CPSS) en adolescentes

Background: One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. Objective: To provide data on the psychometric properties of the CPSS in a sample of Spanish adolescents, to establish the internal consistency of the measure, and to examine its criterion validity. Method: The participants were 339 adolescents (172 boys and 167 girls, mean age 13.95) exposed to peer violence during the previous year. Results: Confirmatory factor analysis demonstrated a good fit to the four-factor dysphoria model. The alpha reliabilities for the overall measure and its subscales were suitable. Discussion: The Spanish version of the scale has sound psychometric properties with good reliability and validity. Moreover, it integrates the four-factor structure corresponding to the dimensions of PTSD described in the DSM-V (AU)

Antecedentes: la Child PTSD Symptom Scale es uno de los cuestionarios más utilizados para evaluar el estrés postraumático en niños y adolescentes. Sin embargo, es escasa la investigación acerca de la validez de constructo de la versión en español de este instrumento, a pesar de tratarse de uno de los idiomas más hablados en el mundo. Objetivo: validar la versión española de esta escala en una muestra de adolescentes. Método: los participantes fueron 339 adolescentes (172 varones y 167 mujeres, con una media de edad de 13,95 años) que cumplían los criterios de haber sufrido violencia por parte de sus iguales durante el año previo al estudio. Resultados: el análisis confirmatorio mostró un buen ajuste del modelo de cuatro factores de disforia. Los coeficientes de fiabilidad para la medida global y sus subescalas fueron adecuados. Discusión: la versión española la escala presenta buenas propiedades psicométricas y una estructura factorial que se corresponde a los criterios para el trastorno de estrés postraumático del DSM-V (AU)

Spanish version of the avoidance-endurance questionnaire: factor structure and psychometric properties

To analyze the factorial structure and psychometric properties of the Spanish adaptation of the AEQ, and to validate it by reporting relevant pain-related variables, which were not investigated in the original study. One hundred and fifty Spanish patients diagnosed with chronic back and neck pain were referred by physicians from different pain clinics in Spain; all the patients filled out the questionnaires at their clinic. A series of principal components analyses (PCA) was performed to develop the Spanish version of the AEQ. Reliability and validity were also calculated. The PCAs revealed five fear-avoidance scales (Kaiser-Meyer-Olkin measures were between .60 and .88, and Bartlett’s tests were significant, p < .01): the Depression scale (DS), Anxiety scale (AS), Catastrophizing scale (CS), Helplessness/hopelessness scale (HHS), and Avoidance of Social and Physical Activities scale (ASPAS), and three endurance-related responses scales: Pain Persistence Behaviour and Distraction scale (PPDS), Ignoring Pain scale (IPS), and Humor scale (HS). All the scales showed high internal consistency (α > .73) and suitable validity (p < .05). New results associated with pain-related cognitive/affective and behavioural responses are discussed. This instrument will probably help clinicians to identify Spanish patients at a high risk of chronicity and to develop treatments tailored to the different profiles in order to improve secondary and tertiary prevention in back and neck pain (AU)

No disponible