Article

The Relation of Self‐Compassion to Functioning among Adults with Chronic Pain

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Abstract

Previous research has shown that self‐compassion is associated with improved functioning and health outcomes among multiple chronic illnesses. However, the role of self‐compassion in chronic pain‐related functioning is understudied. The present study sought to understand the association between self‐compassion and important measures of functioning within a sample of patients with chronic pain. Treatment‐seeking individuals (N= 343 with chronic pain) that were mostly White (97.9%) and female (71%) completed a battery of assessments that included the Self‐Compassion Scale (SCS), as well as measures of pain‐related fear, depression, disability, pain acceptance, success in valued activity, and use of pain coping strategies. Cross‐sectional multiple regression analyses that controlled for age, sex, pain intensity, and pain duration, revealed that self‐compassion accounted for a significant and unique amount of variance in all measures of functioning (r² range: .07 – .32, all p < .001). Beta weights indicated that higher self‐compassion was associated with lower pain‐related fear, depression, and disability, as well as greater pain acceptance, success in valued activities, and utilization of pain coping strategies. These findings suggest that self‐compassion may be a relevant adaptive process in those with chronic pain. Targeted interventions to improve self‐compassion in those with chronic pain may be useful. Significance Self‐compassion is associated with better functioning across multiple general and pain‐specific outcomes, with the strongest associations among measures related to psychological functioning and valued living. These findings indicate that self‐compassion may be an adaptive process that could minimize the negative impact of chronic pain on important areas of life. This article is protected by copyright. All rights reserved.

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... Each of the eight pain outcomes related with SC is presented in the following paragraphs. In most articles (Costa & Pinto-Gouveia, 2011;Edwards et al., 2019;Pielech et al., 2016;Purdie & Morley, 2015;Santerre-Baillargeon et al., 2018;Wren et al., 2012), SC was measured using the 26-item SCS (Neff, 2003). SCS has been used as a total score or as six subdomains (self-kindness, common humanity, mindfulness, self-judgment, isolation and overidentification). ...
... AE = activity engagement; CPAQ = Chronic Pain Acceptance Questionnaire; NRS = Numerical Rating Scale; PCS = Pain Catastrophizing Scale; PW = pain willingness; RCT = randomized controlled trial; SC = self-compassion; SCS = self-compassion scale; VAS = Visual Analogue Scale. 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 nine studies (Brotto et al., 2020;Carvalho et al., 2018;Edwards et al., 2019;Johannsen et al., 2018;Pielech et al., 2016;Purdie & Morley, 2015;Santerre-Baillargeon et al., 2018;Wren et al., 2012). To measure pain intensity, these studies used either the Numeric Rating Scale (NRS), from 0 (no pain) to 10 (worst pain possible) (Brotto et al., 2020;Carvalho et al., 2018;Edwards et al., 2019;Johannsen et al., 2018;Pielech et al., 2016;Santerre-Baillargeon et al., 2018), or the 0-100mm Visual Analogue Scale (VAS) (Purdie & Morley, 2015;Wren et al., 2012). ...
... 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 nine studies (Brotto et al., 2020;Carvalho et al., 2018;Edwards et al., 2019;Johannsen et al., 2018;Pielech et al., 2016;Purdie & Morley, 2015;Santerre-Baillargeon et al., 2018;Wren et al., 2012). To measure pain intensity, these studies used either the Numeric Rating Scale (NRS), from 0 (no pain) to 10 (worst pain possible) (Brotto et al., 2020;Carvalho et al., 2018;Edwards et al., 2019;Johannsen et al., 2018;Pielech et al., 2016;Santerre-Baillargeon et al., 2018), or the 0-100mm Visual Analogue Scale (VAS) (Purdie & Morley, 2015;Wren et al., 2012). ...
Article
Chronic pain (CP) is a common condition affecting millions of people worldwide. Compassion-related interventions are proving to be advantageous in CP, and self-compassion (SC) is hypothesized to be related with pain regulation physiological processes, as well as with psychological benefits in CP. We aimed to review scientific literature on: 1) Compassion-based psychological interventions and their changes in pain outcomes; and 2) associations between SC and pain-related outcomes. We performed a systematic research in four electronic databases: MEDLINE, EMBASE, PsycINFO and the Cochrane Library from inception until April 2020. In Question 1, we included studies involving adult patients with CP who participated in compassion-based psychological interventions. In Question 2, we included studies that examined the associations between SC and pain outcomes in adults with CP. We identified 16 studies. For Question 1, we included seven studies focused on different compassion-based interventions that assessed at least one pain outcome, in a total of 253 participants with CP associated with multiple conditions. For Question 2, we included nine studies, in a total of 1,430 participants, with eight different pain outcomes: Intensity, acceptance, catastrophizing, self-efficacy, disability, distress, pain related coping and anxiety. Considering the high heterogeneity between studies and the poor-quality assessment, we could not draw definitive conclusions on the efficacy of compassion-based interventions nor on the association between SC and pain outcomes. Studies are further discussed in detail. This review can be a starting point for large-scale and high-quality trials in this area as it provides an organized overview of the current literature on this topic.
... Acceptance has been considered as one of the most relevant action mechanisms of third-wave therapies, including MBIs (Day & Thorn, 2016;La Cour & Petersen, 2015). The MSC program proved effective in increasing acceptance and reducing avoidance in a couple of earlier studies (Edwards et al., 2019;Neff & Germer, 2013). It buffered the degree to which intolerable pain sensations were experienced and immediately avoided (Shapiro et al., 2006). ...
... Both aspects are essential to establish clinical guidelines. Previous literature pointed out that self-compassion alone improved functioning in CP patients (Edwards et al., 2019). Therefore, tailoring interventions that target self-compassion more directly may be warranted in the future, even if they are not compassionbased. ...
... Depue & Morrone-Strupinsky, 2005;Purdie & Morley, 2016), (c) promoting active attitudes, reducing helplessness and facilitating change providing encouragement through warm and supporting voices(Gardner-Nix, 2009;La Cour & Petersen, 2015), (d) facilitating the self-efficacy perception when approaching and managing emotions and difficulties, thereby reducing experiential avoidance, (e) promoting non-judgemental kindness, curiosity, openness, moment to moment attitude towards the whole experience (Kabat-Zinn & Hanh, 2009), especially to the experience of pain, suffering, and failures and understanding that these experiences are unavoidable and part of the human condition, thus improving connectedness(Edwards et al., 2019) and (f) facilitating the engagement in value-based activities and reducing the impact that CP has on important domains of life, rather than reducing pain intensity itself(Edwards et al., 2019). ...
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Background Although evidence‐based psychological treatments for chronic pain have been demonstrated to be effective for a variety of outcomes, modest effects observed in recent reviews indicate scope for improvement. Self‐compassion promotes a proactive attitude towards self‐care and actively seeking relief from suffering. Consequently, more compassionate people experience better physical, psychological, and interpersonal wellbeing. Methods We conducted a single‐blind, randomized, controlled trial to examine the effects of a Mindful Self‐Compassion program (MSC) on relevant clinical outcomes in patients with chronic pain. Patients were randomly assigned to one of the two intervention arms: MSC or Cognitive‐Behavioral Therapy (CBT). The protocols of both intervention arms were standardized and consisted of a 150‐minute session once every 8 weeks formatted to groups of no more than 20 participants. The primary outcome was self‐compassion, measured with the self‐compassion scale (SCS). The secondary outcomes were other pain‐related scores, quality‐of‐life measures, and anxiety and depression scores. Results Sixty‐two and sixty‐one patients were assigned to the MSC and CBT group, respectively. The MSC intervention was more effective than CBT for self‐compassion (ATE = 0.126, p < 0.05). The secondary outcomes, pain acceptance (ATE = 5.214, p < 0.01), pain interference (ATE = ‐0.393, p < 0.05), catastrophizing (ATE = ‐2.139, p < 0.10), and anxiety (ATE = ‐0.902, p < 0.05), were also favored in the experimental arm (MSC). No serious adverse events were observed. Conclusions MSC is an appropriate therapeutic approach for chronic pain patients and may result in greater benefits on self‐compassion and emotional well‐being than CBT.
... A growing number of studies have supported the relevance of self-compassion in chronic pain. In cross-sectional studies on chronic pain, self-compassion was associated with the following pain-related outcomes: worse functioning and higher pain catastrophizing as well as higher pain acceptance and lower pain-related anxiety (Edwards et al., 2019;Wren et al., 2012). Concerning negative emotions and emotion regulation, self-compassion was associated with positive and negative affect, depression, anxiety and distress (Costa & Pinto-Gouveia, 2011;Edwards et al., 2019;Wren et al., 2012). ...
... In cross-sectional studies on chronic pain, self-compassion was associated with the following pain-related outcomes: worse functioning and higher pain catastrophizing as well as higher pain acceptance and lower pain-related anxiety (Edwards et al., 2019;Wren et al., 2012). Concerning negative emotions and emotion regulation, self-compassion was associated with positive and negative affect, depression, anxiety and distress (Costa & Pinto-Gouveia, 2011;Edwards et al., 2019;Wren et al., 2012). One recent longitudinal study showed that self-compassion predicted future depressive symptoms in individuals with chronic pain, whereas mindful awareness did not (Carvalho, Trindade, Gillanders, Pinto-Gouveia, & Castilho, 2019). ...
... Our findings partially replicate prior research. In line with evidence from cross-sectional studies, self-compassion predicted catastrophizing (Wren et al., 2012) and pain-related anxiety (Edwards et al., 2019). However, those and other studies also demonstrated associations of self-compassion with disability, depression, anxiety, distress, positive affect or pain acceptance (Costa & Pinto-Gouveia, 2011;Edwards et al., 2019;Wren et al., 2012). ...
Article
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Self‐compassion is associated with disability, pain‐related anxiety as well as depression and anger in patients with chronic pain. However, the unique value of self‐compassion versus other concepts such as psychological flexibility and self‐esteem is unknown. The present study therefore aimed to clarify these relationships. Individuals with chronic pain (NCP =872) and without chronic pain (NNP = 356) took part in a longitudinal study. Participants completed self‐report instruments: Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptom Scale (PASS‐20), Patient‐Health‐Questionnaire (PHQ‐9), State‐Trait‐Anger‐Expression Inventory (STAXI), Self‐Compassion Scale (SCS), Psychological Inflexibility in Pain Scale (PIPS) and Rosenberg Self‐Esteem Scale (RSES). Assessments were repeated after eight weeks. We found differences in baseline‐levels of all relevant variables except for anger‐out and anger‐control between people with and without chronic pain. Subsequently, we computed a path model analysis regarding individuals suffering from chronic pain (N CP), addressing the predictive value of reduced uncompassionate self‐responding (RUS), compassionate self‐responding (CS), avoidance (PIPS), cognitive fusion (PIPS) and self‐esteem (RSES) regarding pain‐related (PDI, PCS, PASS) and emotional variables (PHQ‐9, STAXI). Avoidance predicted disability, catastrophizing, anxiety and depression. RUS predicted catastrophizing and pain‐related anxiety. Self‐esteem predicted depression. CS and cognitive fusion had no unique predictive value. The model explained 65.4%‐72.1% of the variance in pain‐related variables, 68.7% of the variance in depression and 38.7%‐60.7% in the variance of anger‐related variables. In conclusion, psychological flexibility, in terms of avoidance, seems to be more relevant for chronic pain than self‐compassion. Future research should focus on subgroups and tailored‐treatment approaches.
... Eight articles were further excluded, for reasons shown in the Appendix section ( Figure 1). Finally, 19 articles (n=2,713 patients, of which 73.3% were females) met our eligibility criteria and were included in this systematic review [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The baseline characteristics of the included studies are comprehensively described in Table 1. ...
... All included studies evaluated the correlation of self-compassion with other important psychosocial outcomes such as depression, anxiety, stress, resilience, shame, quality of life, and other outcomes as shown in Table 2. Nine studies evaluated the correlation between self-compassion and depression [16,18,[20][21][22][23]26,29,33]. All studies found that a higher self-compassion was correlated with lower levels of depression in individuals with a medical illness. ...
Article
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Studies about the role of self-compassion have focused primarily on psychological well-being, but there is solid evidence to suggest that self-compassion may have larger and more prominent implications in the medical world. Therefore, this systemic review aimed to investigate the effects of self-compassion on psychosocial and clinical outcomes in medically ill patients. A comprehensive search of several databases from their inception to August 10, 2020, was conducted, which included Ovid MEDLINE(R) and Epub Ahead of Print, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligible studies needed to include psychosocial or clinical outcomes of self-compassion in medically ill patients. Nineteen articles (n=2,713 patients; 73.3% females) met our eligibility criteria and were included in this systematic review. There was a negative correlation between self-compassion and psychosocial outcomes such as anxiety, depression, and stress. Moreover, based on self-compassion intervention, there was an improvement in clinical outcomes related to diabetes such as hemoglobin A1c (HbA1c) and blood glucose levels. This systematic review highlights the effect of self-compassion on psychosocial and clinical outcomes. Further studies are needed to evaluate long-term outcomes of a self-compassion-based-intervention to highlight its importance in the role of disease management.
... These variables include pain acceptance, depression, and pain intensity. Specifically, studies have found an association between higher levels of pain acceptance and higher levels of function and lower levels of impairment [11][12][13][14][15][16][17][18] . On the other hand, associations have been found between higher levels of depression and pain intensity and lower levels of physical activity [19][20][21] . ...
... This result is consistent with the results of previous studies, which view acceptance as individuals continuing to function and participate in daily activities even while they are experiencing pain 49 . Moreover, previous empirical studies have obtained the same result 11,12,15,17,18 . However, the relationship between pain acceptance and impairment was not statistically significant. ...
Article
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Background In spite of the relevance of daily function in individuals with chronic pain, few questionnaires have been designed to assess this domain in individuals with musculoskeletal pain. In addition, the Impairment and Functioning Inventory (IFI-R) is the only instrument that assesses perceived decreases in levels of daily activity after the onset of pain. Objective To evaluate the psychometric properties of the English version of the IFI-R. Design Cross-sectional study. Setting A database of individuals with medical conditions commonly associated with chronic pain maintained by the University of Washington. Patients A total of 470 individuals with chronic pain. Methods Factorial validity was analysed by conducting a confirmatory factor analysis via structural equation modelling. Internal consistency was evaluated by calculating Cronbach's α coefficients. Convergent validity was assessed by calculating Pearson correlation coefficients between the two scales of the IFI-R and the PROMIS Pain Interference Scale. Criterion validity was analysed by regression analysis via structural equation modelling. Main Outcome Measures The English version of the IFI-R (IFI-R-EV) for individuals with chronic pain. Results The IFI-R-EV consist of 30 items with two related subscales: The Daily Function subscale (α = .86). and the Impairment subscale (α = .89). A significant correlation was found between these subscales and a measure of pain interference (r´s = − .33, and .35 respectively; p´s < .01). We also found statistically significant associations (P < .05) between daily function and depression (β = −.14) and pain intensity (β = −.13), between impairment and depression (β = .14) and pain intensity (β = .16), and between daily function and pain acceptance (β = .14). Conclusions The findings indicate that the IFI-R-EV provides valid and reliable measures of daily function and impairment in English-speaking individuals with a disability and chronic pain. These results are consistent with those obtained with the Spanish version. This article is protected by copyright. All rights reserved.
... The self-compassion construct is commonly characterised as comprising three bipolar dimensions: self-kindness vs self-judgment, mindfulness vs avoidance and rumination and common humanity vs isolation (Neff, 2003). Previous pain studies have demonstrated that patients with higher levels of selfcompassion showed lower levels of distress, pain-related disability and pain catastrophizing, decreased experiential avoidance, and increased pain acceptance Pinto-Gouveia, 2011, 2013;Edwards et al., 2019;Wren et al., 2012). It has been postulated that self-compassion may improve pain management via enhanced emotion regulation (Wren et al., 2012) and coping (Sirois et al., 2015). ...
... This may reflect the fact that self-compassion does not aim to reduce physical pain but rather seeks to reduce ineffective or maladaptive responses to it (Scott and McCracken, 2015). Self-compassion scores have been found to show stronger relationships to measures pertaining to emotional and social functioning, pain acceptance and engagement in value-based activities, than to measures of physical function and coping strategies that aim to reduce pain intensity (Edwards et al., 2019). ...
Article
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Self-compassion has been associated with several positive pain-related outcomes. However, little is known about the impact of targeting self-compassion on pain management. This study assesses the feasibility of a self-compassion psychoeducation website among adults with chronic pain using a minimally monitored delivery model. Participants (N = 26) were recruited online and a single group pre-test and post-test design with a 3-month follow-up was used. The intervention was a 6- week program comprised of a video, writing exercises, guided meditations and automated emails. Feasibility outcome measures were grouped into the following categories: study engagement (ease of recruitment, attrition, adherence, satisfaction), self-compassion, pain vulnerability variables (intensity, interference, catastrophizing), protective pain variables (resilience and acceptance) and mood (anxiety, depression). Challenges pertaining to uptake were encountered. Attrition was higher (n = 11/26; 42%) and adherence to the full treatment protocol lower (n = 6/26; 23%) than expected. Treatment satisfaction was high with nearly all study completers (93%) reporting that they would recommend the program to a friend. Intent-to-treat mixed effects models showed a significant and large increase of self-compassion (d = 0.92) and a significant impact on several outcome variables (d from 0.24 to 1.15) with most gains either maintained or increased at follow-up. The recruitment strategy may have negatively impacted participant engagement. Methodological modifications are proposed to improve the feasibility of the program. Minimally monitored web-based programs targeting self-compassion may benefit adults with chronic pain who may have limited access to traditional psychological services or who prefer online-based interventions.
... For example, one study found that the subcomponents self-judgment, isolation and overidentification load into a fusion/avoidance psychological inflexibility process, and common humanity and mindfulness load into an underlying present moment awareness process [14]. Another recent study explored the role of selfcompassion in depression in CP, but did not report the unique contribution of its subcomponents nor controlled for the effect of related constructs [15]. It is particularly underexplored the relationship between self-compassion and valued living, even though tentative data seem to corroborate it by showing that self-compassion is related to the behavioral component of acceptance of pain [16]. ...
... This should be interpreted with caution, given that a more comprehensive analysis, with larger sample sizes, could provide evidence that compassionate self-responding indeed impacts on depressive symptoms not directly, but through other processes, such as behavior activation and/or commitment to valued action. Nonetheless, these results corroborate previous results showing that the SCS significantly predicts depressive Carvalho et al.: Self-compassion in chronic pain symptoms in CP (e.g., [11,15]), and furthers the results by examining the unique contribution of its subcomponents while controlling for intensity, disability and psychological (in)flexibility processes [14]. When looking thoroughly to the uncompassionate items of the SCS (particularly the isolation ones), it seems clear that decreasing uncompassionate self-responding does not merely equate to promoting behavioral activation nor valued based action, but rather decreasing a sense of social disconnection, downward comparative criticism and feelings of failure when experiencing setbacks. ...
Article
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Studies have shown that self-compassion plays a protective role against depression in women with chronic pain (CP). However, the majority of studies in CP have used the total score of the self-compassion scale (SCS), which have raised concerns due to potential overlap, not only between the uncompassionate self-responding factors and psychopathology, but also between self-compassion as a whole and other well-known psychological processes (e.g., mindfulness, acceptance, psychological flexibility). This calls for a more nuanced understanding of which components of (un)compassionate self-responding adds to better mental health in CP. This study explores the unique contribution of compassionate and uncompassionate self-responding to depressive symptoms in women with CP undergoing pain consultation (N=49). Correlation analyses suggest that compassionate self-responding only significantly correlates with progress in valued living, while the uncompassionate self-responding significantly correlates with pain fusion, pain avoidance, obstructions to valued living and depression. Multiple regression analysis showed that self-compassion contributes to depressive symptoms (R2 =8%) above and beyond pain intensity and disability (R2 =12%) and psychological (in)flexibility processes (R2 =31%), and uncompassionate (but not compassionate) self-responding uniquely contributes to depressive symptoms (sr2 =18%). Findings suggest that uncompassionate selfresponding is a stronger contributor to depressin in CP than compassionate selfresponding. Clinical implications are further discussed.
... Malheureusement la compassion a été peu étudiée chez ces sujets. Dans cette même rubrique, nous évoquions récemment (2019;20(4): 202-203) les résultats d'une étude très originale [3] mettant en évidence, chez les patients douloureux chroniques, des corrélations positives entre l'AC et : le recours à des stratégies de coping fonctionnelles : relaxation, exercice physique, détournement d'attention et pensées positives sur soi-même; et flexibles : pleine conscience du moment présent, acceptation de la douleur et de ses conséquences psychologiques, engagement dans des activités valorisées indépendamment de l'intensité douloureuse perçue. Les auteurs retrouvaient également des associations négatives entre l'AC et : la dépression, la peur de la douleur et l'incapacité fonctionnelle et psychosociale. ...
... Recent systematic reviews and meta-analysis have reported findings from various compassion-based interventions, whereby self-report measures were predominantly applied based on Neff's Self-Compassion Scale (SCS: Neff 2003) for assessing outcomes(Austin et al., 2020;Biber & Ellis, 2019;Phillips & Hine, 2019). Expanding research in the context of chronic illness has implicated that cultivating self-compassion serves as a positive psychological process of adaptive emotion-regulation strategy for effective coping with health-related daily challenges, and as a form of emotional resilience mechanism in sustaining mental health and positive health-related behaviours(Edwards et al., 2019;Phillips & Hine, 2019;Sirois, Kitner, & Hirsch, 2015;Trompetter et al., 2017). ...
Thesis
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Fibromyalgia has been reported as the most common and intractable chronic pain disorder that can have a substantial effect on people's quality of life, and often places a challenge in maintaining self-integrity. Previous resilience research has implicated psychological flexibility, self-compassion, and basic psychological needs fulfilment as modifiable resilience mechanisms to enable adjustment and sustainable engagement in meaningful life direction in the presence of chronic pain. The objective of this research was to explore and evaluate the theoretical and conceptual frameworks of self-determination theory, acceptance and commitment therapy (ACT), and self-compassion, and review empirical findings in the context of intervention applications involving the adult chronic pain population. An integrative review of selected literature was conducted, using thematic analysis approach to ascertain relationship framework of theoretical-, conceptual-, and empirical research. Four themes were identified in which self-integrity preservation was perceived as a contextual self-care process, linking with the roles of modifiable resilience mechanisms and related conceptual frameworks. An integration and relationship framework of review results were synthesized into a concept-model for discussion. The perspective of review findings indicated that self-compassion oriented psychological flexibility might serve as a potential resilience mechanism to nurture basic psychological needs for self-integrity preservation, and promote authentic self-determination, and sustainable life fulfilment. Future development of a self-compassion focussed ACT self-care intervention for people with fibromyalgia is recommended for further research.
... ; Pinto-Gouveia 2011, 2013;Edwards et al. 2019;Friis et al. 2015;Gillanders et al. 2015;Morrison et al. 2019;Przezdziecki et al. 2013;Przezdziecki and Sherman 2016) used the original 26-item version of this scale and eight (Eller et al. 2014; Kemppainen et al. 2013a, b; Harrison et al. 2017; Schellekens et al. 2017; Sherman et al. 2017; Skinta et al. 2019; Williams et al. 2019; Ventura et al. 2019; Zhu et al. 2019) the 12-item short form scale developed byRaes et al. (2011). All studies used total self-compassion scores, except one that analysed only subscale means for self-kindness, mindfulness and common humanity(Brown et al. 2020). ...
Article
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Objectives Anxiety and depression are common in chronic physical illness populations. Self-compassion, the motivation and the capacity to alleviate one’s own suffering, is associated with reduced anxiety and depression in mental health populations. This review aimed to collate available research showing links between self-compassion and anxiety and depression in chronic physical illness populations. Methods This study is a systematic review of English language studies investigating univariate and multivariate correlates of anxiety and depression by self-compassion constructs in adult chronic physical illness populations. Results Twenty papers, reporting data from 16 unique studies, were included. Half sampled cancer patients. Self-compassion scores consistently showed moderate to large inverse associations with anxiety and depression over both univariate ( r = −.37 to −.53 and r = −.38 to −.66, respectively) and multivariate analyses (β =.01 to β = −.55 and β = −.17 to β = −.59, respectively). Worry and depressive brooding, and shame, mediated relationships between self-compassion and anxiety and depression. Conclusions Although findings suggest that self-compassion processes may have a role in alleviating anxiety and depression in chronic physical illness populations, methodological limitations limit confidence in this proposition. Prospective studies that identify theoretically plausible mediators and moderators are required before the development or modification of therapeutic interventions.
... Interestingly, self-compassion appears be associated with important ACT processes (Costa and Pinto-Gouveia, 2013;Carvalho et al., 2018a;Edwards et al., 2019), and although ACT interventions do not specifically incorporate explicit selfcompassionate exercises, self-compassion was found to mediate the change in disability and psychopathological symptoms in an ACT intervention for CP (Vowles et al., 2014). This raises the possibility that self-compassion may be an underrecognized mechanism of change in ACT and that an explicit focus on self-compassion in ACT might increase the efficacy of ACT interventions. ...
Article
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Background: Chronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group. Methods: The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP’s impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions’ acceptability will also be assessed. Discussion: The iACTwithPain intervention is expected to improve CP patients’ psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP. Clinical Trial Registration: This trial has been registered at ClinicalTrials.Gov (NCT04200183; 16 December 2019; https://clinicaltrials.gov/ct2/show/NCT04200183). The current manuscript comprises the first version of this clinical trial’s protocol.
... • Compassion and forgiveness toward the self may contribute to reductions in stress, depressive symptoms, and sleep disturbances • In turn, individuals may experience less perceived functional disability -Attenuate secondary suffering from chronic pain (e.g., lower engagement in valued activities, depression), thus reducing perceived physical impairment (Edwards et al., 2019) -Improve ability to accept functional limitations without allowing them to prevent meaningful engagement in daily activities (Wren et al., 2012) ...
Article
Purpose: Operative treatment of trapeziometacarpal osteoarthritis (TMC OA) is discretionary. There is substantial surgeon-to-surgeon variation in offers of surgery. This study assessed factors associated with variation in recommendation of operative treatment to patients with TMC OA. Secondarily, we studied factors associated with preferred operative technique and surgeon demographic factors variability in recommendation for operative treatment. Methods: We invited all hand surgeon members of the Science of Variation Group to review 16 scenarios of patients with TMC OA and asked the surgeons whether they would recommend surgical treatment for each patient and, if yes, which surgical technique they would offer (trapeziectomy, trapeziectomy with ligament reconstruction and/or tendon interposition, joint replacement, or arthrodesis). Scenarios varied in pain intensity, relief after injection, radiographic severity, and psychosocial symptoms. Results: Patient characteristics associated with greater likelihood to recommend surgical treatment were substantial pain, a previous injection that did not relieve pain, radiograph with severe TMC OA, and few symptoms of depression. Practice region was the only factor associated with preferred surgical technique and trapeziectomy with ligament reconstruction and/or tendon interposition the most commonly recommended treatment. There was low agreement among surgeons regarding treatment recommendations. Conclusions: The notable variation in offers of operative treatment for TMC OA is largely associated with variable attention to subjective factors. Future studies might address the relative influence of surgeon incentives and beliefs, objective pathophysiology, and subjective patient factors on variation in surgeon recommendations. Clinical relevance: Surgeons' awareness of the potential influence of subjective factors on their recommendations might contribute to efforts to ensure that patient choices reflect what matters most to them and are not based on misconceptions.
Article
Objective: This study examined the cross-sectional associations among pain intensity, pain catastrophizing, and sleep disturbance among patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD) and reporting co-occurring chronic pain. Methods: Participants were 89 patients with OUD and chronic pain drawn from a larger cross-sectional study of 164 MMT patients who completed a battery of self-report measures. We conducted six mediation models to test all possible pathways (i.e., each variable tested as an independent variable, mediator, or dependent variable). Results: The only significant mediation effect was an indirect effect of sleep disturbance on pain intensity via pain catastrophizing. That is, greater sleep disturbance was associated with greater pain catastrophizing, which in turn was associated with greater pain intensity. Discussion: Altogether, findings suggest that the sleep disturbance to pain catastrophizing to pain intensity pathway may be a key mechanistic pathway exacerbating pain issues among MMT patients with OUD and chronic pain. These results suggest that interventions targeting sleep disturbance may be warranted among MMT patients with OUD and chronic pain. Future work in this area with longitudinal data is warranted.
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Purpose This study examined the association of self‐focus and self‐compassion with nursing competency. Design and Methods Data of 433 psychiatric nurses comprising demographics, other‐consciousness, self‐compassion, self‐focus, and nursing competency were analyzed using the Other‐Consciousness Scale (OCS), Self‐Compassion Scale (SCS), Japanese version of the Rumination‐Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN). Findings Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%. Practice Implications Psychiatric nursing education should facilitate other‐consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.
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Growing evidence indicates that self-compassion is associated with better physical health, but the pathways that mediate this relationship are not well understood. This study tested a serial mediation model that linked self-compassion, perceived stress, health behaviors, and a comprehensive index of physical health. A sample of 176 individuals completed an online survey posted on Amazon’s Mechanical Turk. Self-compassion had an indirect effect on physical health via both mediators and through the sequential pathway, suggesting that taking a kind, accepting and mindful stance toward one’s flaws and failures may have benefits for reducing stress and promoting health behaviors.
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Chronic widespread pain (CWP) is a significant burden in communities. Understanding the impact of population-dependent (e.g., age, gender) and contextual-dependent (e.g. survey method, region, inequality level) factors have on CWP prevalence may provide a foundation for population-based strategies to address CWP. Therefore, the purpose of this study was to estimate the global prevalence of CWP and evaluate the population and contextual factors associated with CWP. A systematic review of CWP prevalence studies (1990-2017) in the general population was undertaken. Meta-analyses were conducted to determine CWP prevalence, and study population data and contextual factors were evaluated using a meta-regression. Thirty-nine manuscripts met the inclusion criteria. Study CWP prevalence ranged from 1.4% to 24.0%, with CWP prevalence in men ranging from 0.8% to 15.3% and 1.7% to 22.1% in women. Estimated overall CWP prevalence was 9.6% (8.0-11.2%). Meta-regression analyses showed gender, United Nations country development status, and human development index (HDI) influenced CWP prevalence, while survey method, region, methodological and reporting quality, and inequality showed no significant effect on the CWP estimate. Globally CWP affects one in ten individuals within the general population, with women more likely to experience CWP than men. HDI was noted to be the socioeconomic factor related to CWP prevalence, with those in more developed countries having a lower CWP prevalence than those in less developed countries. Most CWP estimates were from developed countries, and CWP estimates from countries with a lower socioeconomic position is needed to further refine the global estimate of CWP. Significance: This systematic review and meta-analysis updates the current global CWP prevalence by examining the population-level (e.g. age, gender) and contextual (e.g. country development status; survey style; reporting and methodologic quality) factors associated with CWP prevalence. This analyses provides evidence to support higher levels of CWP in countries with a lower socioeconomic position relative to countries with a higher socioeconomic position.
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Growing evidence indicates that self-compassion is associated with better physical health, but the pathways that mediate this relationship are not well understood. This study tested a serial mediation model that linked self-compassion, perceived stress, health behaviors, and a comprehensive index of physical health. A sample of 176 individuals completed an online survey posted on Amazon’s Mechanical Turk. Self-compassion had an indirect effect on physical health via both mediators as well as through the sequential pathway, suggesting that taking a kind, accepting and mindful stance toward one’s flaws and failures may have benefits for reducing stress and promoting health behaviors.
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Pain has been defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Chronic pain is usually described as pain that has persisted for 3–6 months and/or beyond the expected time of healing. The numerical pain rating (NPR) is the customary metric and often considered as a proxy for the subjective experience of chronic pain. This definition of pain (chronic) has been of significant heuristic value. However, the definition and the models it has spawned tend to encourage the interpretation of pain as a measurable entity and implies that the patient’s experience of pain can be fully comprehended by someone other than the person in pain. Several major models of pain have been scrutinized and found to propagate the notion of pain as a ‘thing’ and fall prey to biomedical reductionism and Cartesian (mind-body) dualism. Furthermore, the NPR does not appear to capture the complexity of chronic pain and correlates poorly with other clinically meaningful outcomes. It, and other aspects of the current notion of chronic pain, appear to be an extension of our reliance on the philosophical principles of reductionism and materialism. These and other shortcomings identified in the IASP definition have resulted in an increased interest in a reexamination and possible updating of our view of pain (chronic) and its definition. The present paper describes an alternative view of pain, in particular chronic pain. It argues that chronic pain should be understood as a separate phenomenon from, rather than an extension of, acute pain and interpreted as a hypothetical construct (HC). HCs are contrasted to intervening variables (IV) and the use of HCs in science is illustrated. The acceptance of the principles of nonlinearity and emergence are seen as important characteristics. The practical implications and barriers of this philosophical shift for assessment, treatment, and education are explored. The patient’s narrative is presented as a potential source of important phenomenological data relating to their ‘experience’ of pain. It is further proposed that educational and academic endeavors incorporate a discussion of the process of chronification and the role of complexity theory.
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Objectives: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive behavioural program. Methods: A randomized controlled trial was carried out with three conditions: an internet-delivered positive psychology program, an internet-delivered cognitive behavioural program and waitlist control. A total of 276 patients were randomized to one of the three conditions and post treatment data were obtained from 206 patients. Primary outcomes were happiness, depression and physical impairments at post-treatment and at six months follow-up. Intention-to-treat analyses were carried out using mixed regression analyses. Results: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared to waitlist. Improvements in happiness and depression were maintained until six months follow-up. There were no overall differences in the efficacy of the two active interventions but effects appeared to be moderated by education. Patients with a higher level of education profited more from the positive psychology intervention than from the cognitive behavioural program. Discussion: The results suggest that an internet-based positive psychology self-help intervention for the management of chronic pain is clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.
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Previous research suggests that for people living with chronic pain, pain expectancy can undermine access to adaptive resources and functioning. We tested and replicated the unique effect of pain expectancy on subsequent pain through two daily diary studies. We also extended previous findings by examining cognitive and affective antecedents of pain expectancy and the consequences of pain expectancy for daily social enjoyment and stress. In Study 1, 231 individuals with rheumatoid arthritis completed 30-end of day diaries. Results of multi-level structural equation model (MSEM) showed that controlling for today's pain, pain expectancy predicted next day pain. In Study 2, diary assessments of affective, cognitive and social factors were collected during the morning, afternoon and evening for 21 days from a sample of 220 individuals with Fibromyalgia. Results showed that both positive affect and the extent to which pain interfered with daily activities in the afternoon predicted evening pain expectancy in the expected direction. However, negative affect and pain coping efficacy were not associated with pain expectancy. Consistent with Study 1, more than usual evening pain expectancy was related to greater next morning pain. We also found that next morning pain predicted next afternoon social enjoyment but not social stress. The findings of these two studies point to the importance of promoting positive affect and reducing pain expectancy as a way of decreasing the detrimental effect of chronic pain on enjoyable social experiences.
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This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.
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Employing a simple approach for coding pain severity, the present study describes self-reported pain in United States adults. Data are included for 8,781 adults who completed the Functioning and Disability Supplement of the 2012 National Health Interview Survey. An internationally piloted pain-severity coding system was used to group participants into five discrete ordered pain categories based on their pain persistence (days with pain in last three months) and bothersomeness (little, lot, somewhere in between): Pain Free and Categories 1(low) to 4(high). It is estimated that 126.1 million adults reported some pain in the previous 3 months, with 25.3 million adults (11.2%) suffering from daily (chronic) pain and 23.4 million (10.3%) reporting "a lot" of pain. Based on the persistence and bothersomenes of their pain, 14.4 million adults (6.4%) were classified as having the highest level of pain, Category 4, with an additional 25.4 million adults (11.3%) experiencing Category 3 pain. Individuals with Category 3 or 4 pain were likely to have worse health status, to use more healthcare, and to suffer from more disability than those with less severe pain. Associations were seen between pain severity and selected demographic variables including race, ethnicity, preferred language, sex and age. United States estimates of pain prevalence are presented using a simple approach for assigning pain severity developed by the Washington Group on Disability Statistics. Concurrent validity is assessed. While this approach is promising, additional work is required to determine the utility of the Washington Group pain categories for pain research or clinical practice. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
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A recent review suggested that self-compassion promotes use of adaptive rather than maladaptive coping. Less is known about how self-compassion is linked to stress and coping in the context of a chronic stressor. Across two primarily female chronic illness samples, inflammatory bowel disease (N = 155) and arthritis (N = 164), a model linking self-compassion to lower stress through coping styles and coping efficacy was tested. Path analyses revealed significant indirect effects for adaptive coping styles (active, positive reframing, and acceptance), and negatively for maladaptive coping styles (behavioral disengagement and self-blame) in both samples. Findings suggest that the relative balance of adaptive and maladaptive coping strategies used by self-compassionate people is associated with better coping outcomes in the context of chronic illness.
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Objective The present study tested the independent and interactive contributions of the somatosensory component of pain (pain intensity) and the affective component of pain (pain unpleasantness) on emotional, social, and daily functioning in chronic pain patients.SubjectsParticipants were 472 patients seeking treatment for chronic orofacial pain. Mean age of the sample was 46.0 years (standard deviation [SD] = 14.67, range 18–78), with 82.2% female. Average pain duration at the time of initial appointment was 75.7 months (SD = 106.66).Methods Participants completed self-report measures of pain intensity, unpleasantness, and functional outcomes at the time of their first appointment. These data were later extracted from participant's de-identified medical records. Multivariate linear regression was used to test the interaction of pain intensity and unpleasantness on outcome measures of emotional, social, and daily functioning.ResultsResults revealed that pain intensity contributed to poorer functional outcomes but higher levels of social support even after controlling for pain unpleasantness. After controlling for pain intensity, unpleasantness was associated with higher pain interference and affective distress. There was also pain intensity by unpleasantness interaction on pain interference. Specifically, at lower levels of pain unpleasantness, changes in pain intensity produced greater changes in pain interference than they did at higher levels of pain unpleasantness.Conclusions Results suggest that both intensity and unpleasantness contribute unique variance to functional outcomes. The results highlight the importance of interventions that not only try to reduce pain levels but also reduce levels of pain unpleasantness.
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Objective: Emerging theory and research suggests that self-compassion promotes the practice of health behaviors, and implicates self-regulation as an explanatory factor. However, previous investigations focused only on behavior intentions or health risk behaviors, and did not investigate the role of emotions. This study expands on this research using a small scale meta-analysis approach with our own data sets to examine the associations of self-compassion with a set of health-promoting behaviors, and test the roles of high positive affect and low negative affect as potential explanatory mechanisms. Methods: Fifteen independent samples (N = 3,252) with correlations of self-compassion with the frequency of self-reported health-promoting behaviors (eating habits, exercise, sleep behaviors, and stress management) were meta-analyzed. Eight of these samples completed measures of positive and negative affect. Results: Self-compassion was positively associated with the practice of health-promoting behaviors across all fifteen samples. The meta-analysis revealed a small effect size (average r = .25; p < .001) of self-compassion and health behaviors, with low variability. Tests of the indirect effects of self-compassion on health behaviors through positive and negative affect with multiple mediator analyses revealed small effects for each. Separate meta-analyses of the indirect effects (IE) were significant for positive (average IE = .08; p < .001) and negative affect (average IE = .06; p < .001), and their combined indirect effects (average IE = .15; p < .0001). Conclusions: Self-compassion may be an important quality to cultivate for promoting positive health behaviors, due in part to its association with adaptive emotions.
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In this article I explore how mindfulness-based techniques affect perceptions and management of back pain and discuss these findings in relation to embodiment theory and liminality. Sixteen volunteers attending Breathworks for persistent back pain took part in this study. The theme of "embodied awareness" formed the core category, as all participants reported a change in their experience of pain. Such embodied changes are described in relation to five subthemes: unpacking the pain experience, changing relationship to pain, letting go of the label, self-compassion and acceptance, and wellness within illness. Learning to respond rather than react, and living moment by moment enabled participants to replace a cycle of suffering with one of acceptance. Rather than fearing pain, participants found ways to move through it and live with it. Although some expressed finding a sense of wellness despite ongoing pain, all participants reported greater acceptance and a better quality of life.
Article
This study explored the efficacy of reflective writing tasks for reducing state body dissatisfaction and improving self-improvement motivation. Participants (N = 153) were exposed to a threatening body image scenario, after which they reported their state body dissatisfaction. Following randomisation to one of three interventions (self-esteem, self-compassion, or positive distraction control), participants completed the state body dissatisfaction measures again along with a measure of self-improvement motivation. At post-intervention, state weight dissatisfaction and appearance dissatisfaction were significantly lower and self-improvement motivation was significantly higher in the self-compassion group than in both the self-esteem and control groups. Trait body dissatisfaction moderated the efficacy of the intervention whereby the benefit of the self-compassion intervention became evident at moderate levels of trait body dissatisfaction, and was most apparent at high levels of body dissatisfaction. Self-compassion was a robust and efficacious method through which to promote immediate improvements to bodily feelings and desire to self-improve.
Article
Brief self-compassion training (BSCT) is a 4-session intervention designed to teach participants core self-compassion skills. The present study was a pilot study of the effects of BSCT on various mental health and well-being variables among individuals in intensive outpatient treatment for substance use. Fifty individuals initiated participation in the 4-week BSCT and completed measures of self-compassion, emotional intelligence, meaning in life, trauma-related guilt and shame, and posttraumatic stress disorder. Nineteen individuals completed both pre- and postassessments. Individuals who completed BSCT (n = 19) reported statistically significant increases in self-compassion (d = .66), emotional intelligence (d = .58), and presence of meaning in life (d = .64), and statistically significant reductions in trauma-related guilt (d = −.70) and shame (d = −.69). We also found trending significant changes in the negative alterations in cognitions and mood posttraumantic stress disorder symptom cluster (d = .63). We discuss feasibility for use of BSCT with individuals affected by mental health problems and highlight the importance for future studies to compare BSCT with control and active comparison interventions.
Article
Importance Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain. Objective To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects. Design, Setting, and Participants Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized. Interventions Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response. Main Outcomes and Measures The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19). Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]). Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain. Trial Registration clinicaltrials.gov Identifier: NCT01583985
Article
Despite the public health significance of nonsuicidal self-injury (NSSI) among adolescents, little is known about the possible overlaps or differences between individuals with NSSI thoughts and those with NSSI actions. The present study compared between individuals with different NSSI status on self-compassion. With a sample of 606 Chinese adolescents (38.8% females; Mage = 13.58, SD = 1.04), we investigated differences on the six subscales of the Self-Compassion Scale (i.e., self-kindness/self-judgment, common humanity/isolation, and mindfulness/over-identification) across three groups: NSSI-action group (n = 86), NSSI-thought group (n = 98), and no-NSSI group (n = 422). Results revealed that individuals with NSSI thoughts and NSSI actions shared greater self-judgment, isolation, and over-identification than those without NSSI, but differed from each other on self-kindness and common humanity, with individuals with NSSI thoughts reporting more self-kindness and common humanity than those with NSSI actions. Further empirical investigations into the influence of self-compassion on NSSI will benefit the development of interventions for adolescent NSSI.
Article
Strict adherence to a gluten-free diet (GFD) is the only treatment for preventing both short- and long-term consequences of celiac disease. Given that following a strict GFD can be difficult, evidence-based strategies are needed to improve the psychological experience of living with celiac disease and following the GFD. Self-compassion appears to be an important component of effectively self-regulating one's behavior to cope with a chronic disease. The main goal of this study was to examine the relationships between self-compassion and management of celiac disease as assessed by (a) adherence to a strict GFD and (b) celiac-specific quality of life (CQoL). The secondary goal of this study was to explore self-regulatory efficacy (i.e., confidence in one's ability to self-manage behavior to follow a strict GFD) and concurrent self-regulatory efficacy (i.e., one's confidence to self-manage other valued life goals while following a strict GFD) as mediators of the relationship between self-compassion and the primary outcomes (adherence and CQoL). In this prospective study, 200 North American adults diagnosed with celiac disease completed online questionnaires at two time points (baseline and 1 month later). Self-compassion at baseline directly predicted stricter adherence (at Time 2; b = −0.63, p = 0.006) and enhanced CQoL (at Time 2; b = −0.50, p = 0.001). Further, self-compassion (at Time 1) also indirectly predicted stricter Time 2 adherence through self-regulatory efficacy (at Time 1; b = −0.26, 95% CI [-0.58, -0.04], R² = 0.29) and enhanced Time 2 CQoL through concurrent self-regulatory efficacy (at Time 1; b = −0.07, 95% CI [-0.14, -0.03], R² = 0.33). This was the first study to assess the effects of self-compassion in relation to the psychological experience of coping with celiac disease and following a GFD. The findings indicate that self-compassion, self-regulatory efficacy and concurrent self-regulatory efficacy are important cognitions in understanding adherence to a GFD and CQoL among adults with celiac disease.
Article
This study examined the factor structure of the Self-Compassion Scale (SCS) using a bifactor model, a higher order model, a 6-factor correlated model, a 2-factor correlated model, and a 1-factor model in 4 distinct populations: college undergraduates (N = 222), community adults (N = 1,394), individuals practicing Buddhist meditation (N = 215), and a clinical sample of individuals with a history of recurrent depression (N = 390). The 6-factor correlated model demonstrated the best fit across samples, whereas the 1- and 2-factor models had poor fit. The higher order model also showed relatively poor fit across samples, suggesting it is not representative of the relationship between subscale factors and a general self-compassion factor. The bifactor model, however, had acceptable fit in the student, community, and meditator samples. Although fit was suboptimal in the clinical sample, results suggested an overall self-compassion factor could still be interpreted with some confidence. Moreover, estimates suggested a general self-compassion factor accounted for at least 90% of the reliable variance in SCS scores across samples, and item factor loadings and intercepts were equivalent across samples. Results suggest that a total SCS score can be used as an overall mesure of self-compassion.
Article
Importance Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.Objective To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.Process The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.Evidence Synthesis Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.Recommendations There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.Conclusions and Relevance The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
Article
Self-compassion is increasingly explored as a protective factor in relation to psychopathology. The Self-Compassion Scale (SCS) and its Short Form variant (SCS-SF) are the most widely used instruments for measuring this psychological construct, and previous studies have indeed shown that the total score of this scale is negatively associated with psychopathology. In this article, we point out that half of the items of the SCS and SCS-SF are positive indicators of self-compassion and directly refer to the three key components of self-kindness, common humanity and mindfulness, while the other half of the items are negative indicators of the construct and reflect the precise opposite of the key components, namely self-judgment, isolation and over-identification. A meta-analysis was conducted including 18 studies that reported on the positive and negative indicators of self-compassion as indexed by the SCS/SCS-SF and their relations to various types of psychopathology. Results showed that positive indicators of self-compassion were negatively associated with psychopathology, which confirms their hypothesized protective influence. However, the negative indicators were positively linked to psychopathology, suggesting that these scales tap increased vulnerability to mental health problems. Moreover, tests comparing the strength of the relations between various SCS/SCS-SF counterparts (i.e., self-kindness versus self-judgment, common humanity versus isolation and mindfulness versus over-identification) and psychopathology showed that the negative indicators were significantly stronger linked to mental health problems than the positive indicators. This provides support for the idea that the use of a total self-compassion score of the SCS or SCS-SF, which typically includes the reversely scored negative subscales, will probably result in an inflated relationship with symptoms of psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.
Article
Self-compassion describes a positive and caring attitude of a person toward her- or himself in the face of failures and individual shortcomings. As a result of this caring attitude, individuals high in self-compassion are assumed to experience higher individual well-being. The present meta-analysis examines the relationship between self-compassion and different forms of well-being. The authors combined k = 79 samples, with an overall sample size of N = 16,416, and analyzed the central tendencies of effect sizes (Pearson correlation coefficients) with a random-effect model. We found an overall magnitude of the relationship between self-compassion and well-being of r = .47. The relationship was stronger for cognitive and psychological well-being compared to affective well-being. Sample characteristics and self-esteem were tested as potential moderators. In addition, a subsample of studies indicated a causal effect of self-compassion on well-being. The results clearly highlight the importance of self-compassion for individuals' well-being. Future research should further investigate the relationship between self-compassion and the different forms of well-being, and focus on the examination of possible additional moderators. © 2015 The International Association of Applied Psychology.
Article
Chronic pain is highly prevalent in older adults and often negatively associated with health-related quality of life (HRQoL). This study compared HRQoL, including physical health and mental health, in persons of differing ethnicities, and identified factors associated with pain intensity and HRQoL in ethnically diverse older adults. Older adults with chronic pain from four ethnic groups (African Americans, Afro-Caribbeans, Hispanics, and European Americans) were recruited from the Florida Atlantic University Healthy Aging Research Initiative (HARI) registry. The Medical Outcomes Study Short Form-36 (SF-36) was used to evaluate HRQoL, including functional status, emotional well-being, and social functioning. Of 593 persons in the four ethnic groups in the registry, 174 met the inclusion criteria (pain level of four or higher on an 11-point scale, lasting 3 months or longer). Among these 174, African Americans reported the highest level of pain intensity, followed by Afro-Caribbeans, Hispanics, and European Americans. Hispanics reported the highest physical health scores and the lowest mental health scores. In contrast, African Americans reported the highest mental health scores and the lowest physical health scores. Multivariate linear regression analysis revealed that ethnicity, lower physical health scores, and lower mental health scores were significantly (p ≤ .01) associated with pain intensity. Understanding ethnic variations in response to pain intensity may address gaps in knowledge about HRQoL to reduce disparities in optimal care. Health care providers should consider ethnic norms and cultural diversity to provide optimal interventions for this population. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Article
This article defines the construct of self-compassion and describes the development of the Self-Compassion Scale. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one's experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Evidence for the validity and reliability of the scale is presented in a series of studies. Results indicate that self-compassion is significantly correlated with positive mental health outcomes such as less depression and anxiety and greater life satisfaction. Evidence is also provided for the discriminant validity of the scale, including with regard to self-esteem measures.
Article
Most clinicians and researchers with interest in cognitive behavioral therapy (CBT) will recognize a trend in current treatment developments, including in the area of chronic pain. These developments are loosely called mindfulness and acceptance-based treatments, although it is possible to be more precise about these developments, their theoretical models and treatment processes. One of the specific therapies here is acceptance and commitment therapy (ACT), based on the psychological flexibility model. ACT extends from previous developments of CBT and integrates many of the current CBT-related variables into a smaller number of core therapeutic processes. There are now 10 published RCTs that support the efficacy of ACT for chronic pain and many empirical studies of specific processes from the psychological flexibility model. There is a remarkable success story here that has played out over a rather short period. At the same time there are challenges for the future: establishing appropriate outcome measures for ACT trials, finding ways to more comprehensively assess therapy processes, meeting the challenge of wide access, and treatment fidelity. This article will provide a brief review of the evidence on ACT for chronic pain and will discuss current challenges and opportunities for progress.
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Published adult prevalence estimates of chronic pain in the United States vary significantly. A more consistent pain measure is needed to assess unmet need for pain management in the general population. In this study, secondary analyses of the 2010 Quality of Life Supplement of the National Health Interview Survey are used to calculate the point prevalence of “persistent pain,” which we defined as constant or frequent pain persisting for at least 3 months. Rates of persistent pain are also calculated by risk group, chronic condition, and disability status. Findings show that about 19.0% of adults in the United States report persistent pain. Rates of persistent pain are higher among women, adults aged 60 to 69, adults who rate their health as fair or poor, adults who are overweight or obese, and those who were hospitalized 1 or more times in the preceding year. Most adults who report conditions such as arthritis, carpal tunnel syndrome, or back or joint pain do not describe their pain as “persistent.” Of the estimated 39.4 million adults who report persistent pain, 67.2% say their pain is “constantly present,” and 50.5% say their pain is sometimes “unbearable and excruciating.” Perspective Persistent pain, defined as self-reported pain “every day” or “most days” in the preceding 3 months, is a useful way to characterize health-related quality of life in the general population, and policy makers should consider including this core measure in ongoing health surveys like the National Health Interview Survey and the Medical Expenditure Panel Survey, the authors conclude.
Article
The present study investigates the role of coping, experiential avoidance, and self‐compassion on psychological distress prediction (i.e., depression, anxiety, and stress symptoms). A battery of self‐report questionnaires was used to assess coping, experiential avoidance, self‐compassion, and psychological distress in 103 adults with chronic pain from Portuguese primary health care units. Hierarchical regression analyses were performed and showed that experiential avoidance and self‐compassion are the factors that mostly explain psychological distress. Our results suggest that when people with chronic pain are willing to remain in contact with particular private experiences without attempting to control them, they reported less depression, anxiety, and stress. Implications for clinical practice were discussed, suggesting the importance of helping people with chronic pain to increase their willingness to pain rather than avoiding it.
Article
Chronic pain is a significant and costly problem in the United States as well as throughout the industrialized world. Unfortunately, there have been concerns about the effectiveness of traditional medical interventions, suggesting the need for alternative chronic pain treatment strategies. However, the introduction of the biopsychosocial model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs. In the present article we briefly review the history of pain management, discuss the major components of a "true" interdisciplinary pain management program, focus on the evidence-based outcomes that have documented the effectiveness of such interdisciplinary pain management programs, and note the barriers that have blocked the wider use of such programs. Finally, we discuss future directions in interdisciplinary pain management. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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There is an emerging body of evidence regarding interdisciplinary acceptance and commitment therapy in the rehabilitative treatment of chronic pain. This study evaluated the reliability and clinical significance of change following an open trial that was briefer than that examined in previous work. In addition, the possible mediating effect of psychological flexibility, which is theorized to underlie the acceptance and commitment therapy model, was examined. Participants included 117 completers of an interdisciplinary program of rehabilitation for chronic pain. Assessment took place at treatment onset and conclusion, and at a 3-month follow-up when 78 patients (66.7%) provided data. At the 3-month follow-up, 46.2% of patients achieved clinically significant change, and 58.9% achieved reliable change, in at least 1 key measure of functioning (depression, pain anxiety, and disability). Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics. These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment. Further, improvements appear to be mediated by changes in the processes specified within the theoretical model. Outcomes of an abbreviated interdisciplinary treatment for chronic pain based on a particular theoretical model are presented. Analyses indicated that improvements at follow-up mediated change in the theorized treatment process. Clinically significant change was indicated in just under half of participants. These data may be helpful to clinicians and researchers interested in intervention approaches and mechanisms of change.
Article
Current models of chronic pain recognize that psychosocial factors influence pain and the effects of pain on daily life. The role of such factors has been widely studied in English speaking individuals with chronic pain. It is possible that the associations of between such factors and adjustment may be influenced by culture. This study sought to evaluate the importance of coping responses, self-efficacy beliefs, and social support to adjustment to chronic pain in a sample of Portuguese patients, and discuss the findings with respect to their similarities and differences from findings of studies with English speaking samples. Measures of pain intensity and interference, physical and psychological functioning, coping responses, self-efficacy, and satisfaction with social support where administered to a sample of 324 Portuguese patients with chronic musculoskeletal pain. Univariate and Multivariate analysis were computed. Findings are interpreted with respect to those from similar studies using English speaking samples. Coping responses and perceived social support were significantly associated with pain interference and both physical and psychological functioning; self-efficacy beliefs were significantly associated with all criterion variables. All coping responses, except for task persistence, were associated positively with pain interference and negatively associated with physical and psychological functioning, with the strongest associations found for catastrophizing, praying/hoping, guarding, resting, asking for assistance and relaxation. The findings provide support for the importance of the psychosocial factors studied in adjustment to chronic pain in Portuguese patients, and also suggest the possibility of some differences in the role of these factors due to culture.
Article
The role of coping in chronic pain management is well established. One challenge to the coping approach, however, is in identifying forms of coping that reliably lead to better functioning. An emerging approach to coping is based on the notion of psychological flexibility, a response pattern entailing openness to experience, awareness of specific behavioral options in a given situation, and persistence or alteration of activity according to personally held values and goals. A primary measure of psychological flexibility has been the Brief Pain Coping Inventory-2 (BPCI-2), and initial analyses have provided support for its utility in chronic pain treatment settings. The present study aimed to extend the previous work by examining relations of the BPCI-2 with measures of patient functioning, as well as with measures related to psychological flexibility, pain acceptance and valued activity in this case. A total of 324 individuals with chronic pain who completed a series of measures at an initial assessment appointment were included in the study. In correlation and regression analyses, the Psychological Flexibility subscale of the BPCI-2 achieved consistently significant relations with measures of disability, emotional functioning, pain acceptance, and valued activity, even after controlling for pain intensity and traditional coping methods. These results lend support to the adoption of psychological flexibility as a framework in future studies of coping with chronic pain.
Article
This article defines and examines the construct of self-compassion. Self-compassion entails three main components: (a) self-kindness—being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical, (b) common humanity—perceiving one's experiences as part of the larger human experience rather than seeing them as separating and isolating, and (c) mindfulness—holding painful thoughts and feelings in balanced awareness rather than over-identifying with them. Self-compassion is an emotionally positive self-attitude that should protect against the negative consequences of self-judgment, isolation, and rumination (such as depression). Because of its non-evaluative and interconnected nature, it should also counter the tendencies towards narcissism, self-centeredness, and downward social comparison that have been associated with attempts to maintain self-esteem. The relation of self-compassion to other psychological constructs is examined, its links to psychological functioning are explored, and potential group differences in self-compassion are discussed.
Article
Unlabelled: The importance of self-compassion in the context of medical problems has been highlighted in previous research. Its role in the psychological adjustment of cancer patients, however, has remained unexplored. The current study aimed at examining whether self-compassion and self-critical judgement would distinctively predict general psychopathological symptoms and quality of life in three distinct groups: a mixed sample of cancer patients (n = 63), patients with chronic illnesses (n = 68) and healthy subjects (n = 71). Correlation analyses revealed significant associations between lower self-compassion and increased depressive and stress symptoms, and lower scores in quality of life dimensions in the patients' samples. The opposite correlational pattern was found regarding self-critical judgement. In the case of healthy subjects, these correlations were weaker or nonsignificant. Regression analyses revealed that in patients with chronic illnesses, self-critical judgement emerged as the best predictor of depressive and stress symptoms, and quality of life dimensions. In patients with cancer, however, it was the affiliate dimension of self-compassion that was found to significantly predict lower levels of depressive and stress symptoms, and increased quality of life. These findings have important clinical implications by suggesting the relevance of nurturing a caring and kind relation with oneself in the face of challenging medical conditions, particularly in patients with cancer. Key practitioner message: The link between self-compassion and psychopathology and quality of life was examined in a mixed sample of cancer patients, in chronic patients, and in healthy subjects. Self-compassion is associated with decreased psychopathological symptoms of stress and depression, and better quality of life in patients with chronic illnesses, and especially in patients with cancer. Psychological supportive interventions targeting the development of self-compassionate attributes and skills may have beneficial effects in the psychological adjustment of medically ill patients, namely patients with cancer.
Article
The role of resilience, for adults facing ongoing adversity in the form of chronic medical conditions, has received little attention in the past. This research investigated the impact of resilience and coping strategies on the psychological functioning of 87 Australian adults with chronic pain, using a self-report questionnaire. It included the McGill Pain Questionnaire, the Connor-Davidson Resilience Scale, the Coping Strategies Questionnaire, the 36-item Short Form Health Survey, and the Depression, Anxiety and Stress Scale. Using hierarchical regression, after the effects of pain severity, catastrophizing, and ignoring the pain were controlled for, resilience was significantly associated with mental health-related quality of life (β = 0.18, P < 0.05), depression (β = -0.31, P < 0.01), and anxiety (β = -0.20, P < 0.05). In the final model for depression, resilience had a stronger association than pain severity. Resilience did not, however, influence individual's perceptions of their physical health-related quality of life. The link between resilience and mental health-related quality of life outcomes provides initial evidence for the potential application of resilience related interventions to pain management programs.
Article
Self-compassion entails qualities such as kindness and understanding toward oneself in difficult circumstances and may influence adjustment to persistent pain. Self-compassion may be a particularly influential factor in pain adjustment for obese individuals who suffer from persistent pain, as they often experience heightened levels of pain and lower levels of psychological functioning. The purpose of the present study was to examine the relationship of self-compassion to pain, psychological functioning, pain coping, and disability among patients who have persistent musculoskeletal pain and who are obese. Eighty-eight obese patients with persistent pain completed a paper-and-pencil self-report assessment measure before or after their appointment with their anesthesiologist. Hierarchical linear regression analyses demonstrated that even after controlling for important demographic variables, self-compassion was a significant predictor of negative affect (β=-0.48, P<0.001), positive affect (β=0.29, P=0.01), pain catastrophizing (β=-0.32, P=0.003), and pain disability (β=-0.24, P<0.05). The results of this study indicate that self-compassion may be important in explaining the variability in pain adjustment among patients who have persistent musculoskeletal pain and are obese.
Article
The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1°C, 3°C, 5°C, and 7°C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.
Article
The present study explores whether specific subgroups of patients could be identified based on Chronic Pain Acceptance Questionnaire scores. A battery of self-report questionnaire was used to assess acceptance of pain, self-compassion and psychopathology in 103 participants with chronic pain, from Portuguese health care units. K-Means cluster were performed and the results supported three subgroups of patients (low acceptance subgroup; high acceptance subgroup; intermediate subgroup with activity engagement near to the mean and low willingness to pain). One-way ANOVA's showed that the three subgroups identified differed significantly from each other on psychopathology and self-compassion. Results indicated that the intermediate subgroup presented less depression and stress, compared with the low acceptance subgroup. In what concerns self-compassion, the low acceptance subgroup reported higher self-judgment, isolation and over identification, compared with the intermediate subgroup. These subgroups also differed from each other in common humanity and mindfulness. Implications and clinical utility of the results were discussed, suggesting the increase of willingness to pain as an important key in chronic pain interventions. 
Article
Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.
Article
Theoretically, acceptance of chronic pain (CP) is an important determinant in the functional status and well-being of patients with CP. Several questionnaires that aim to measure acceptance of CP have been developed. An overview of the psychometric properties of these questionnaires is unavailable. A systematic review of the literature of the psychometric properties of questionnaires that aim to measure acceptance of CP was performed. Psychometric properties including content construct and criterion validity, internal consistency. agreement, reliability, responsiveness, floor/ceiling effects and interpretability, were assessed using a standardized protocol. All studies were assessed by two observers independent from each other. A total of 23 studies including 4 questionnaires or subscales were identified. The questionnaires/subscales included were the Chronic Pain Acceptance Questionnaire (CPAQ), Illness Cognitions Questionnaire (ICQ), Pain Solutions Questionnaire (PASOL) and Acceptance of Illness Scale (AIS) adapted to pain. When applying the criteria of the protocol, results indicate that none of the questionnaires are currently able to meet all 9 criteria for psychometric quality. Individual questionnaires met between 0 and 3 of the criteria. If strict psychometric quality criteria are applied, none of the questionnaires are currently able to meet all nine criteria for psychometric quality, but overlooking the cumulative results over all the studies conducted, especially for the CPAQ, it can be concluded that information on several important characteristics has been reported and a fairly clear picture emerges about the psychometric properties of the CPAQ.
Article
Fear of pain has been implicated in the development and maintenance of chronic pain behavior. Consistent with conceptualizations of anxiety as occurring within three response modes, this paper introduces an instrument to measure fear of pain across cognitive, overt behavioral, and physiological domains. The Pain Anxiety Symptoms Scale (PASS) was administered to 104 consecutive referrals to a multidisciplinary pain clinic. The alpha coefficients were 0.94 for the total scale and ranged from 0.81 to 0.89 for the subscales. Validity was supported by significant correlations with measures of anxiety and disability. Regression analyses controlling for measures of emotional distress and pain showed that the PASS made a significant and unique contribution to the prediction of disability and interference due to pain. Evidence presented here supports the potential utility of the PASS in the continued study of fear of pain and its contribution to the development and maintenance of pain behaviors. Factor analysis and behavioral validation studies are in progress.
Article
Although chronic pain may affect all facets of a patient's life, there is no generally accepted method of measuring the extent of the disability experienced. This component of a larger study examined changes in usual activities and relationships for patients experiencing chronic nonmalignant pain, in order to understand the impact of pain on an individual's life. The effect of pain intensity and depression on the performance of usual daily activities was assessed by the Sickness Impact Profile (SIP). The sample of 34 subjects, 17 women and 17 men, rated their pain as moderate to severe on a linear analogue scale (mean 64). Thirty percent of subjects were moderately to severely depressed as measured by the Beck Depression Inventory (mean 21). The SIP scores indicated severe disruption in daily activities and relationships for this sample. Significant correlations between the SIP and visual analogue scales measuring coping adequacy and activity levels were interesting and warrant further study.
Article
This investigation examines the utility of the Sickness Impact Profile (SIP) for assessing disability associated with chronic pain and presents normative data on a sample of 107 patients experiencing chronic low back pain (CLBP). The results support the validity of the SIP as a measure of functional status with CLBP patients. Specifically, the psychosocial dimension was significantly correlated with the emotional distress categories of the MMPI and the physical dimension score was inversely associated with standing/walking and positively correlated with time spent lying down. In addition, the SIP appears to be a measure with sufficient sensitivity to detect pre-/post-treatment changes. Patients suffering from CLBP show significant impairment in physical, psychosocial, and work and recreational activities. The greatest impairment reported was in the area of work, but disability ratings for recreation, home management, social interaction, emotional behavior, and sleep and rest were also comparatively high. Based upon its reliability, validity, breadth of assessment, and ease of administration, the SIP appears to be well suited for the assessment of patients suffering from chronic pain and evaluating the efficacy of multidisciplinary pain units.
Article
Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
Article
The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.
Article
This study investigated the factor structure and psychometric properties of the Pain Anxiety Symptoms Scale (PASS). The PASS assesses four components of pain-related anxiety: cognitive, fear, escape/avoidance, and physiological. Confirmatory factor analyses provided support for both the one-factor and the four-factor structures reported for samples of clinic-referred pain patients. The alpha coefficients were high for the PASS subscales. Significant gender differences were obtained on the PASS total and subscale scores. Convergent and divergent validity estimates of the PASS were also assessed. Results may be used to evaluate the responses of clinic-referred pain patients.
Article
This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change.
Article
Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals. Recent research suggests that pain-related acceptance leads to enhanced emotional and physical functioning in chronic pain patients above and beyond the influence of depression, pain intensity, and coping. In these studies, acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Preliminary analyses of the CPAQ have supported its psychometric properties. The present study sought to further refine the CPAQ by examining its factor structure and evaluating the relations of these factors to other indices of pain-related distress and disability. Although a previously demonstrated factor structure of the CPAQ was generally supported, only factors assessing (a) the degree to which one engaged in life activities regardless of the pain and (b) willingness to experience pain had adequate reliability and validity and were significantly related to the other measures of patient functioning. A revised version of the CPAQ is suggested.
Article
Patients and clinicians sometimes take coping with chronic pain primarily as a process of gaining more control over pain. An alternate approach might include helping the pain sufferer to discriminate parts of their situation that can be effectively controlled from those that cannot. When faced with situations that do not yield to attempts at direct control patients may gain better results from leaving those situations as they are and investing their efforts elsewhere. This study was designed to examine this type of expanded view of coping with pain, a view that includes both attempts at control and acceptance. 200 adults seeking treatment for chronic pain were the subjects of this investigation. They completed a number of self-report inventories including a measure called the Brief Pain Coping Inventory, an inventory assessing accepting responses to pain as well as pain management responses standardly targeted by cognitive-behavioral treatment methods. Preliminary results showed that the BPCI yields scores with adequate temporal consistency and validity. Further results showed that a number of the responses assessed by the BPCI were reliable predictors of patient functioning. In general less frequent struggling to control pain, fewer palliative and avoidant coping responses, and more explicit persistence with activity despite acknowledged pain were associated with less depression and anxiety and greater life functioning. These results demonstrate that, in some instances, attempts at avoidance and control of chronic pain may be less helpful compared with a willingness to experience pain and focus on functioning.
Article
Previous research suggests that to define the problem of chronic pain as a problem of coping may not be as useful as framing it as a problem of acceptance for some patients. The coping approach may encourage, or at least permit, a somewhat inflexible agenda of pain reduction or control while the acceptance approach may allow a more flexible agenda of willingness to have pain in some circumstances where that serves the goal of better life functioning. The purpose of this study was to continue to examine the relative utility of concepts of coping and acceptance of pain. Two hundred and thirty consecutive patients seeking assessment from a pain management service were the participants in the study. Patients completed the Coping Strategies Questionnaire (CSQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). A revised scoring method was used for the CSQ (to correct for technical limitations noted in the past) and recently developed subscales of the CPAQ were examined. Correlation results showed that the acceptance variables were reliably stronger predictors of distress and disability compared with coping variables. Regression analyses confirmed that, compared with coping variables, acceptance accounted larger unique increments in variance in measures of patient functioning regardless of whether the coping variables were given priority in the regression equations. Increasing data support the view that the pain management field may benefit from evolving toward incorporating a less control-oriented and more accommodating view of aversive private experiences in some circumstances.