Negative Mood Regulation Expectancies (NMRE) as a Moderator of the Association Between Stress and Treatment Outcomes in Interdisciplinary Chronic Pain Treatment.

OBJECTIVE: Negative mood regulation expectancies (NMRE) describe the expectancies of an individual regarding his or her ability to regulate or reduce negative mood states by certain cognitive or behavioral strategies. NMRE are closely associated with the actual emotion regulation and potentially buffer the negative psychological and physical health consequences of stress. In the context of chronic pain, stress plays a central role, as long-term stress can have additional negative consequences regarding pain and its progression. The present study investigated the relationship of NMRE with treatment outcome, and more importantly, its buffering role in the association between stress and treatment outcomes. METHOD: Two hundred six chronic pain inpatients (fulfilling the International Classification of Diseases, 10th Revision [ICD-10] diagnosis of F45.41) of an interdisciplinary treatment completed standardized self-report questionnaires at intake and discharge. Hierarchical linear regression analyses were used to test the main effects of the Negative Mood Regulation Scale-Short Form on pain intensity, pain-related disability, and psychological distress as treatment outcomes and its moderating role in the association of stress and the 3 outcome measures. RESULTS: A significant main effect of NMRE on treatment outcome was only found for psychological distress. However, for all 3 outcome measures, a significant moderating effect of NMRE on the association between stress level and treatment outcome was found. DISCUSSION: NMRE appear to play an important role for the outcome of inpatient treatment for chronic pain. Due to their buffering effect on the negative association between stress and therapy outcome, they should be targeted in the treatment of chronic pain.

Being Trapped and Seeing No Way Out - Effects of Entrapment on Treatment Outcome in an Interdisciplinary Pain Treatment.

BACKGROUND: Entrapment describes a feeling of being stuck in an inescapable aversive situation. This feeling often arises in the context of uncontrollable and/or chronic stress and is associated with various psychopathologies. OBJECTIVE: Owing to the nature of their disease, also chronic pain, patients might experience their situation as unremitting and inescapable. The aim of the present study was to examine the role of entrapment in patients with a chronic pain disorder and the association of entrapment with treatment outcome. METHODS: A total of 189 patients with a chronic pain disorder where psychological factors play a decisive role in its severity, exacerbation, and maintenance (International Classification of Diseases, ICD-10: F45.41, "Chronic pain disorder with somatic and psychologic factors") receiving inpatient care completed a set of standardized self-report questionnaires at intake and discharge of an interdisciplinary pain treatment. To analyze the effects of entrapment on pain-related interference and psychologic distress, hierarchical linear models were used. RESULTS: Over treatment, reduced levels of entrapment were observed, which were associated with decreases in psychologic distress and pain-related interference at discharge. CONCLUSION: Results support the relevance of entrapment in chronic pain and its treatment. To further improve interdisciplinary pain treatments, entrapment should be assessed and targeted by according interventions.

[The Coupling of Pain, Anxiety, and Stress]. / Die Kopplung von Schmerz, Angst und Stress.

The Coupling of Pain, Anxiety, and Stress Abstract. There is considerable neurobiological, clinical and epidemiological evidence that the systemic phenomena of anxiety and pain closely interact. Both perceptions trigger stress activation processes and are in turn modulated by long-term stress. This overview illustrates the coupling of pain, anxiety and stress with some clinical examples. The relations shown here should help us to gain a holistic view of the individual patient and his/her psychosocial reality, in which nociceptive, affective and vegetative symptoms are often interdependent and mutually reinforcing each other.

Alexithymia moderates effects of psychotherapeutic treatment expectations on depression outcome in interdisciplinary chronic pain treatment.

OBJECTIVE: Previous research has shown that patient's treatment expectations predict outcome in the multimodal therapy for chronic pain. Alexithymia, defined as the difficulty to identify, describe and express one's own feelings, may moderate treatment expectations and thereby effect treatment outcome. Accordingly, the aim of the current study is to examine the moderating role of alexithymia on the association of psychotherapeutic treatment expectation on depression outcome. METHOD: 213 chronic pain inpatients completed a set of standardized self-report questionnaires, assessing alexithymia, psychotherapeutic treatment motivation and depression. A hierarchical linear regression model tested the moderating effect of alexithymia on the relationship of psychotherapeutic treatment expectations with depression as outcome variable. RESULTS: Both, alexithymia and psychotherapeutic treatment expectations predicted treatment outcome independently, and alexithymia moderated the effect of psychotherapeutic treatment expectations on outcome, above and beyond the effects of control variables. DISCUSSION: This study supports the beneficial role of positive psychotherapeutic treatment expectations in an interdisciplinary chronic pain treatment, and suggest to consider difficulties in identifying and describing feelings (alexithymia) in clinical decisions.