The Silhouettes Fatigue Scale: further validation in Spanish-speaking university students and adults with chronic pain.

PURPOSE: The aim of this study was to evaluate the psychometric properties of the Silhouettes Fatigue Scale (SFS) when used to assess fatigue in undergraduates and middle-aged adults with chronic pain. MATERIALS AND METHODS: A total of 426 undergraduates and 207 middle-aged individuals with chronic pain participated in this study. Participants were asked to respond to a survey including the SFS as well as another validated measure of fatigue, questionnaires about pain catastrophizing and pain interference, and questions about pain (i.e., location, duration, and intensity). Convergent, discriminant, criterion and known-groups validity were evaluated. RESULTS: Convergent validity was supported by a strong association between the two scales measuring fatigue. Discriminant validity was supported by stronger associations between the two fatigue scales scores compared to those between the SFS and pain catastrophizing scores. Criterion validity was supported by moderate associations between the SFS and measures of pain intensity and pain interference. Finally, known-groups validity was supported by significant differences in the SFS scores between students without chronic pain, students with chronic pain, and middle-aged individuals with chronic pain. CONCLUSIONS: The findings support the validity of the SFS scores when used to assess fatigue in undergraduates and middle-aged adults with chronic pain.

Fatigue is a significant problem among people with chronic pain that can lead to disability.Assessing and treating fatigue in people with pain is essential.The Silhouettes Fatigue Scale (SFS) is a new single-item self-report of fatigue, fast and easy to use.Results support convergent and discriminant validity as well as sensibility to detect differences in fatigue between groups.

Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age.

ABSTRACT: The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.

School bullying and peer relationships in children with chronic pain.

ABSTRACT: Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.

Perceived Stress, Perceived Social Support, and Global Health in Adults with Chronic Pain.

BACKGROUND: Chronic pain is a common problem in adults that can have a significant impact on individuals' quality of life and on society. The complex pain experience emerges from a dynamic combination of biological, psychological, and social factors. Previous research has shown that social support has positive effects on health-related outcomes through two mechanisms: direct-effects and stress-buffering effects. The aim of this study was to investigate the role that perceived stress, perceived social support, and their interaction play as predictors of global physical health and global mental health in adults with chronic pain. METHOD: One hundred sixty-five adults with chronic pain completed measures of pain, perceived stress, perceived social support, global physical health, and global mental health. RESULTS: Perceived stress but not perceived social support made a significant and independent contribution to the prediction of global physical health; both perceived stress and perceived social support made independent contributions to the prediction of global mental health. The perceived stress × perceived social support interaction did not make a significant contribution to the prediction of either criterion variable. The results suggested that perceived stress has an impact on both global physical and mental health, whereas perceived social support associated mostly with global mental health. In addition, perceived social support does not appear to moderate the impact of stress on global physical and mental health. CONCLUSION: The findings are more consistent with a direct-effects model than a stress-buffering model of social support.

Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance.

OBJECTIVES: This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. METHODS: Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. RESULTS: Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. CONCLUSION: The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.

Validation of the pediatric version of the Graded Chronic Pain Scale Revised in school-aged children and adolescents.

ABSTRACT: The Graded Chronic Pain Scale (GCPS) was originally developed to grade the severity of chronic pain conditions in adults. A revised version of this instrument (ie, GCPS-R) has been developed for use with adults to account for advances in pain metrics and new operational definitions of chronic pain and high-impact chronic pain. The purpose of the current study was to adapt the GCPS-R for use with pediatric samples (P-GCPS-R) and evaluate the adapted measure's concurrent validity. One thousand five hundred sixty-four school-aged children and adolescents (55% girls; 8-18 years) completed the P-GCPS-R and provided responses to measures of physical health, anxiety and depressive symptoms, maladaptive pain coping strategies, and activity limitations. Results showed that 14% of participants had chronic pain, of which 37% (5% of the whole sample) had mild chronic pain, 45% (6% of the whole sample) bothersome chronic pain, and 18% (3% of the whole sample) high-impact chronic pain. Participants without chronic pain and those with mild chronic pain showed no significant between-group differences in any of the study measures. Participants with bothersome chronic pain and high-impact chronic pain reported worse physical health, more anxiety and depressive symptoms, pain catastrophizing, and activity limitations than those with mild chronic pain. Participants with high-impact chronic pain reported more activity limitations than those with bothersome chronic pain. The findings support the concurrent validity of the P-GCPS-R for use with pediatric samples.

Psychological factors and pain medication use in adolescents with chronic pain.

OBJECTIVE: The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS: Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS: Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS: Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.

Perceived barriers, facilitators and usefulness of a psychoeducational intervention for individuals with chronic musculoskeletal pain and depression in primary care.

Background and aims: Self-management interventions have the potential to improve patient' pain condition as they involve tasks aimed at managing symptoms and reducing interference with activities, mood and relationships due to pain. However, research on factors that facilitate or hinder pain self-management has overlooked patients with both chronic musculoskeletal pain and depression in primary care settings, also leaving unattended patient views on the usefulness of such programs. Thus, the main aim of this study was to gather meaningful information to help promoting adequate self-management. Specifically, it attempts to identify patients' perceptions of barriers and facilitators of group-based psychoeducational intervention and to explore its perceived usefulness in promoting self-management. Method: This qualitative study explored perceived barriers and facilitators of a psychoeducational intervention for the management of chronic musculoskeletal pain and depression previously tested in a Randomized Control Trial. We conducted focus groups and individual interviews with fifteen adult patients with both chronic musculoskeletal pain and depression recruited from primary care centres in Tarragona province (Catalonia, Spain). A content thematic analysis was carried out to examine the data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Findings revealed that perceived barriers included lack of motivation, time constraints, pain, depression, ineffectiveness of pain-relief strategies and activity avoidance. Facilitators were having a supportive family/friends, the positive effects of self-management, high motivation, being a proactive patient. Peer support and identification, the positive effect of sessions, and free expression were highlighted as key elements of the psychoeducational intervention. Conclusion: The psychoeducational intervention was perceived as useful in promoting self-management practices. Barriers and facilitators in using self-management strategies were related, mainly, to internal personal characteristics of the patients being similar among different cultural backgrounds and distinct chronic conditions. Implications: These findings can help to guide clinicians in the development and implementation of more effective pain self-management interventions for patients with chronic pain and depression by attending to their needs and preferences.

Short and long-term predictors of pain severity and interference in primary care patients with chronic musculoskeletal pain and depression.

BACKGROUND: Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain. OBJECTIVE: To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression. METHODS: Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes. RESULTS: 83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (ß = 0.53; 95% CI = 0.37-0.68) and at 12 months (ß = 0.48; 95% CI = 0.29-0.67). Also, pain > 2 years of evolution predicted long term pain severity (ß = 0.91; CI95%=0.11-1.71). Baseline pain interference predicted interference at 3 and 12 months (ß = 0.27; 95%CI = 0.11-0.43 and ß = 0.21; 95%CI = 0.03-0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (ß = 0.26; 95%CI = 0.10-0.42 and ß = 0.20; 95%CI = 0.02-0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (ß = 0.91; CI95%=0.11-1.71, and ß = 1.23; CI95%=0.41-2.04). Depression severity predicted more interference at 12 months (ß = 0.58; CI95%=0.04-1.11). Occupational status as active worker predicted less interference throughout the follow-up (ß=-0.74; CI95%=-1.36 to -0.13 and ß=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (ß=-0.77; CI95%=1.52 - 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (ß = 0.03; 95% CI = 0.00-0.05 and ß = 0.03; 95% CI = 0.00-0.05), but not at long term. CONCLUSION: In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02605278), registered 16/11/2015.

Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study.

The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8-18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals. PERSPECTIVE: This article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.

The Role of Resilience, Happiness, and Social Support in the Psychological Function during the Late Stages of the Lockdown in Individuals with and without Chronic Pain.

There is mounting evidence to suggest that individuals with chronic pain adjusted poorly to and were impacted negatively by social distancing measures during the lockdown. However, there is limited data on the factors that might protect against the negative effects associated with social distancing measures, as most research has been conducted in the general population and in the initial stages of the lockdown. The aim of this study was to improve the understanding of the role that resilience, happiness, and social support, all factors that are thought to have a protective role, played in the psychological function (measured as anxiety, depression, and stress) to the social distancing measures during the late stages of the lockdown in a sample of adults with and without chronic pain living in Spain. A group of 434 adults responded to an online survey and provided information on sociodemographic issues, which included measures of pain, perceived health and quality of life, depression, anxiety, stress, resilience, happiness, and social support. The data showed that individuals with chronic pain (N = 200; 46%) reported statistically significant worst psychological function, that is to say, they reported higher levels of anxiety, depression, and stress (all ps < 0.001). Resilience, social support, and happiness proved to be significant predictors of anxiety, depression, and stress, after controlling for the effects of age, gender, and chronic pain. Although the effect sizes were small to medium, they are consistent with the findings of other studies. The findings from this study provide important additional new information regarding the associations between resilience, happiness, and social support and the adjustment to the social distancing measures during the late stages of the lockdown. These findings can be used to develop programs to improve adjustment to and coping with the demands of social distancing measures.

COVID-19 Pandemic in Portugal: Psychosocial and Health-Related Factors Associated with Psychological Discomfort.

The COVID-19 pandemic is a stressful long-lasting event with an increasingly negative impact upon individuals. This study aimed at assessing the magnitude of depression, anxiety, and stress among adults living in Portugal during the first mandatory lockdown of 2020, and the psychosocial and health-related factors associated with these symptoms. A sample of 484 adults (73% women) with an average age of 40 years old (Standard Deviation, SD = 14.03) responded to an online survey. The survey included measures of depression, anxiety, stress, social support, COVID-19 interference in daily life, attitudes towards COVID-19, and health perception. The impact of the lockdown on psychological well-being was large, with up to 36% of the participants showing signs of at least mild psychological discomfort (i.e., depression, anxiety, and stress). Social support, COVID-19 interference on daily life, health perception, and age, explained all the dependent variables. Education level, income, attitudes towards COVID-19, and gender explained some of the dependent variables. These results suggest that the COVID-19 pandemic has a serious impact on the psychological health of Portuguese adults. The role of the procedures to control the pandemic on the mental health of Portuguese adults should not be underestimated.

Translation, adaptation and psychometric properties of the Arabic version of the numerical rating scale when used with children and adolescents.

OBJECTIVE: The 0-10 Numerical Rating Scale (NRS-11) is widely used with Arabic-speaking pediatric populations. However, there is no data about its validity or reliability. Thus, the aims of this research were to translate the NRS-11 into Arabic and study its dimensionality and construct (convergent and discriminant) validity, and reliability. METHODS: A group of 190 Lebanese students between 8 and 18 years old participated. Participants were interviewed online and asked to imagine themselves in a hypothetical painful situation and rate the expected pain intensity using the NRS-11-Arabic and an Arabic version of the Visual Analogue Scale (VAS-Arabic). They were also requested to respond to the pediatric Arabic version of the Pain Catastrophizing Scale (PCS-Arabic). Data collection lasted for a month. RESULTS: Data showed that the NRS-11-Arabic and the VAS-Arabic scores measure the same common construct. In addition, they showed strong statistically significant correlations between NRS-11 and VAS (ranging from 0.83 for the whole sample and 0.83 and 0.84 for the 8-12-year-olds and the 13-18-year-olds, which support its construct validity). These correlations were higher than those between the NRS-11-Arabic and the PCS-Arabic, which support the discriminant validity of NRS-11-Arabic scores. Test-retest reliability was 0.86 for the whole sample, and 0.89 and 0.82 for the 8-12-year-olds and the 13-18-year-olds, respectively, which shows the reliability of the NRS-11-Arabic scores. CONCLUSIONS: The data provide preliminary evidence of the unidimensionality, validity and reliability of the NRS-11-Arabic scores, thus supporting its use in clinical and research activities involving Arabic-speaking pediatric samples.

Mental, Physical and Socio-Economic Status of Adults Living in Spain during the Late Stages of the State of Emergency Caused by COVID-19.

Research has shown that the confinement measures implemented to curb the spread of COVID-19 can have negative effects on people's lives at multiple levels. The objective of this cross-sectional study was to better understand the mental, physical, and socio-economic status of adults living in Spain during the late stages of the state of emergency caused by COVID-19. Five hundred and forty-four individuals responded to an online survey between 3 June and 30 July 2020. They were asked to report data about their mental and physical health, financial situation, and satisfaction with the information received about the pandemic. Means, percentages, t-test, ANOVAs, and logistic regressions were computed. A third of the participants reported symptoms of anxiety, depression, and stress, and worries about their health and the future. Participants also described mild levels of fatigue and pain during lockdown (66%), and a reduction in household income (39%). Respondents that were female, younger, single, and with lower levels of education reported experiencing a greater impact of the COVID-19 pandemic. The data showed that the negative effects of lockdown were present in the late stages of the state of emergency. The findings can be used to contribute to the development of programs to prevent or mitigate the negative impact of confinement measures.

The Associations Between Sleep Disturbance, Psychological Dysfunction, Pain Intensity, and Pain Interference in Children with Chronic Pain.

OBJECTIVES: This study aimed to better understand the associations between both sleep disturbance and psychological dysfunction (i.e., anxiety and depressive symptoms, and anger), and pain intensity and pain interference, in a sample of children with chronic pain. DESIGN: Cross-sectional design. METHODS: Three hundred and forty-two children with chronic pain (8-18 years) completed measures assessing pain intensity, pain interference, sleep disturbance, anxiety, depressive symptoms, and anger. Regression analyses examined the direct, interaction (with sex), and mediation effects of sleep quality and psychological dysfunction on pain intensity and interference. RESULTS: Sleep disturbance was significantly associated with both pain intensity and pain interference. However, measures of psychological dysfunction were associated significantly only with pain interference. Sex did not moderate these associations. The measures of psychological dysfunction mediated the associations between sleep disturbance and pain interference but not those between sleep disturbance and pain intensity. CONCLUSIONS: The results confirmed significant cross-sectional associations between both sleep disturbance and psychological dysfunction and pain outcomes in children with chronic pain. Future research to test for causal associations is warranted.

Cross-National Trends of Chronic Back Pain in Adolescents: Results From the HBSC Study, 2001-2014.

Chronic back pain is a common problem that negatively impacts the wellbeing of many adolescents. Prior research suggests that the prevalence of chronic back pain has increased over the last decades, but research on this issue is scarce, single country-based, and has yielded inconsistent results. This study aimed to examine trends in the prevalence of chronic back pain over time in adolescents aged 11, 13 and 15, using data from the Health Behavior in School-aged Children (HBSC) survey. We conducted a secondary analysis of data from 650,851 adolescents, retrieved from four waves (2001/02, 2005/06, 2009/10 and 2013/14) of HBSC data from 33 countries or regions.  The prevalence of back pain was higher (1) in each successive survey over time (18.3% in 2001/02, 19.3% in 2005/06, 20.4% in 2009/10 and 21.6% in 2013/14), (2) in girls (21.9%) compared to boys (17.8%), and (3) in older adolescents compared to younger ones (14.5% in 11-year-olds, 19.6% in 13-year-olds and 25.5% in 15-year-olds). The increase in prevalence from 2001/02 to 2013/14 was more marked in older girls compared to younger girls, and in older boys compared to younger boys, and it ranged between 1% for 11-year-old boys and 7% for 15-year-old girls. More resources should be allocated to the prevention and treatment of chronic back pain in adolescents, especially for older girls. PERSPECTIVE: The prevalence of chronic back pain in adolescents has increased from 2001-2002 to 2013-2014, especially in older adolescent girls. These findings underline the need of further research to understand the reason behind the increasing trend, and what programs are better suited to prevent chronic back pain among adolescents.

The Arabic Version of the Faces Pain Scale-Revised: Cultural Adaptation, Validity, and Reliability Properties When Used with Children and Adolescents.

The Faces Pain Scale-Revised (FPS-R) is widely used to assess pain intensity in young people. The aims of this research were to study the convergent and discriminant validity and reliability properties of a culturally adapted version of the FPS-R for its use with Arabic-speaking individuals. The sample consisted of 292 students living in Lebanon. They were interviewed online, asked to imagine themselves in one of two given situations based on their age (8-12 and 13-18 years old), and then asked rate the intensity of pain they would experience using the FPS-R-Arabic and a Numerical Rating Scale (NRS-11-Arabic). They were also asked to respond to the Pain Catastrophizing Scale (PCS-C-Arabic). Two weeks later, participants were asked to repeat the same procedure. The data showed strong associations between the scores of the FPS-R-Arabic and NRS-11-Arabic (r = 0.72; p < 0.001), which were higher than the associations of the scores of the FPS-Arabic with the PCS-C-Arabic scores (z = 7.36, p < 0.001). The associations between the FPS-R-Arabic scores on the two measurements were also strong (r = 0.76; p < 0.001). The findings support the convergent and discriminant validity and reliability of the FPS-R-Arabic scores when used to measure pain intensity in young people aged 8 to 18 years old.

Electronic Health Literacy in Individuals with Chronic Pain and Its Association with Psychological Function.

Electronic health literacy skills and competences are important for empowering people to have an active role in making appropriate health care decisions. The aims of this cross-sectional study were to (1) examine the frequency of use of the Internet for seeking online information about chronic pain, (2) determine the level of eHealth literacy skills in the study sample, (3) identify the factors most closely associated with higher levels of eHealth literacy, and (4) examine self-efficacy as a potential mediator of the association between eHealth literacy and measures of pain and function in a sample of adults with chronic pain. One-hundred and sixty-one adults with chronic pain completed measures assessing internet use, eHealth literacy, pain interference, anxiety, depression, and pain-related self-efficacy. Results indicated that 70% of the participants are active users of the Internet for seeking information related to their health. The level of eHealth literacy skills was not statistically significantly associated with participants' age or pain interference but was significantly negatively associated with both anxiety and depression. In addition, the findings showed that self-efficacy fully explained the relationship between eHealth literacy and depression and partially explained the relationship between eHealth literacy and anxiety. Self-efficacy should be considered as a treatment target in eHealth literacy interventions, due to its role in explaining the potential benefits of eHealth literacy.

Effects of COVID-19 Social Distancing Measures in Individuals with Chronic Pain Living in Spain in the Late Stages of the Lockdown.

Social distancing measures during the lockdown have had a negative impact on chronic pain patients' function. Research, however, has only focused on the early stages of the first lockdowns. The aim of this study was to improve the understanding of the effects of COVID-19 social distancing measures on individuals with chronic pain living in Spain during the late stages of the lockdown. A group of 361 adults with pain participated in this study. They responded to an online survey and provided information on sociodemographic issues, pain, fatigue, perceived health, and quality of life. The data showed that most participants suffered moderate to severe pain and interferences with pain treatment and an increase in pain intensity during the lockdown. Most participants also informed us that fatigue had worsened during the lockdown (62%). Importantly, females with lower monthly family income and lower education have been found to be associated with greater levels of pain and fatigue. Despite this, participants perceived themselves as having good health and good quality of life. The findings from this study can be used to inform policy and specific responses for future COVID-19 waves and future pandemics where social distancing measures must be implemented.

Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals With Chronic Pain?

OBJECTIVES: Pain catastrophizing and pain acceptance are psychological factors that have been shown to be associated with pain-related outcomes and predict multidisciplinary pain treatment outcomes. However, they are rarely examined in the same study. This study aimed to: (1) assess the independent roles of pain catastrophizingand pain acceptance as predictors of pain intensity, pain interference, and depression; and (2) evaluate the potential moderating role of pain acceptance on the association between pain catastrophizing and both pain and function. MATERIALS AND METHODS: A sample of 467 adults with chronic pain completed an online survey including measures of pain intensity, pain interference, depression, pain catastrophizing, and pain acceptance. RESULTS: Pain catastrophizing and pain acceptance were independent predictors of pain interference. Only pain catastrophizing and the activity engagement domain of pain acceptance were independent predictors of pain intensity and depression. Activity engagement moderated the association between pain catastrophizing and depression, indicating a buffering effect on the negative effects of catastrophizing on depression. Pain willingness moderated the association between pain catastrophizing and pain interference, such that endorsing low pain willingness may override any negative effects of pain catastrophizing. DISCUSSION: The findings suggest that pain catastrophizing and pain acceptance are independently important to adjustment to chronic pain. Research is needed to determine if treatments that target both for change are more effective than treatments that target only one.