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A Randomized Clinical Trial of Targeted Cognitive Behavioral Treatment to Reduce Catastrophizing in Chronic Headache Sufferers
Abstract
Unlabelled:
This randomized clinical trial (RCT) examined the efficacy of a cognitive-behavioral treatment (CBT) specifically targeted toward reducing pain catastrophizing for persons with chronic headache. Immediate treatment groups were compared with wait-list control groups. Differential treatment gains based on the order of presentation of 2 components of CBT (cognitive restructuring and cognitive/behavioral coping) and the role of catastrophizing in treatment outcome were examined. Thirty-four participants enrolled in a 10-week group treatment and 11 completed a wait-list self-monitoring period. Participants reported significant reductions in catastrophizing and anxiety and increased self-efficacy compared with wait-list control subjects, and these were maintained at follow-up. Although we did not find overall differences in the reduction of headache frequency or intensity compared with wait-list control subjects, calculation of clinical significance on headache indicators suggest that approximately 50% of treated participants showed meaningful changes in headache indices as well. Order of treatment modules was not related to gains during treatment or at follow-up; however, almost all changes occurred during the second half of treatment, suggesting that duration of treatment participation is important.
Perspective:
Cognitive-behavioral treatment targeting reduction of catastrophizing for chronic headache pain reduced negative cognitive and affective variables associated with recurrent headache, increased headache management self-efficacy, and in half of the participants, produced clinically meaningful reductions in headache indicators. Length of treatment is an important factor to consider when providing CBT for chronic pain.
... Thorn et al. [48] cited several studies that illustrated that migraineurs, as well as individuals suffering from tension-type headaches, endorsed more catastrophic thoughts when coping with painful events than individuals who did not suffer from either condition. Thorn et al. [48] evaluated the efficacy of CBT in 40 participants who had been diagnosed with either tension-type headaches or migraines and, among other measures, monitored changes in pain catastrophizing. ...
... Thorn et al. [48] cited several studies that illustrated that migraineurs, as well as individuals suffering from tension-type headaches, endorsed more catastrophic thoughts when coping with painful events than individuals who did not suffer from either condition. Thorn et al. [48] evaluated the efficacy of CBT in 40 participants who had been diagnosed with either tension-type headaches or migraines and, among other measures, monitored changes in pain catastrophizing. A total of 31 participants completed their RCT, and in this instance, treatment was not found to influence pain catastrophizing. ...
... The researchers suggested that this may be because the mean PCS score for their patients was lower than the average reported by O'Sullivan et al. for patients enrolled in a multidisciplinary treatment program. Thorn et al. [48] explained that none of their participants scored in the 80th percentile, which, according to Sullivan et al., was indicative of patients who showed poor progress in pain rehabilitation programs. ...
Although studies to understand the pathogenesis of migraines are in progress, no theory has adequately explained the etiology and pathophysiology of migraines to date. This has affected the development of treatment strategies for migraineurs. Currently, the pharmacological treatment for migraines provides both acute and prophylactic options to patients based on a biomedical model of pain. However, patients’ adherence to oral migraine preventive medication (OMPM) is poor, and their persistence is even lower when they cycle through a variety of OMPMs [1]. Although our understanding of the pathophysiology of migraines within the context of the current biopsychosocial model of pain has advanced in recent years, there is a need to better understand the role of social and psychological factors in the pathophysiology of this debilitating disease, which would pave the way for the development and acceptance of more diverse and inclusive treatments. In this review, we provide an overview of the various theories that purport to explain the pathogenesis of the headache phase of migraines, examine the usefulness and shortcomings of these theories, and investigate how psychological considerations may help develop treatments to assist migraine sufferers in managing their headaches better.
... The effectiveness of psychological interventions including CBT has also been evaluated in spinal cord injury patients and showed a significant reduction in depression and anxiety [8]. CBT has also been evaluated and found to be an efficacious adjunct in integrated management of various chronic pain conditions such as orofacial pain [9], musculoskeletal pain [10,11], multiple sclerosis-related pain [12], osteoarthritis [13] temporomandibular disorder (TMD) [14], fibromyalgia [15], and headache [16]. ...
... It showed a significant decrease in pattern of catastrophizing with CBT along with pregabalin in PHN patients. The finding is in concordance to a study by Thorn et al., which demonstrated significant reductions in catastrophizing and increased selfefficacy compared with wait-list control subjects with chronic headache after 10 weeks of CBT [16]. ...
Objective
This study was designed to explore the efficacy and feasibility of cognitive behavioural therapy(CBT) along with pregabalin and compare it with pregabalin monotherapy for the management of neuropathic pain in post-herpetic neuralgia (PHN) patients and to explore the modulation of mRNA expression of interleukin (IL)-6 and mammalian target of rapamycin-1 (mTORC1) genes in these patients.
Design
Randomized controlled pilot study
Methods
The patients aged >18 years of age with an established diagnosis of PHN with evident allodynia and hyperalgesia who had pain for at least 3 months after healing of rash with pain intensity ≥4/10 on NRS-Pain Scale were enrolled. The trial was registered with the Clinical Trials Registry-India (CTRI/2019/03/018014). A detailed baseline assessment regarding type and duration of pain and disability using pain-relevant self-report questionnaires was done. Two ml venous blood samples were collected for gene expression studies at base line and at end of 12 weeks of treatment. Patients were randomized into one of the two groups. Group PR received pregabalin and Group CP received CBT along with pregabalin. The pain intensity was measured using numeric rating scale (NRS)-Pain scale, neuropathic component of the pain by using Neuropathic Pain Symptom Inventory (NPSI) and Pain Detect Questionnaire (PDQ), sleep interference by NRS-Sleep, pain-related catastrophic thoughts by using Pain Catastrophizing Scale (PCS), depression and quality of life using Beck Depression Inventory-II (BDI-II) and Short Form-12 (SF-12), respectively. The research funding was supported by the intramural grant from the institution.
Results
A total of 40 patients with 20 in each group were included. Following integrated approach encompassing CBT and Pregabalin, group CP had significant downregulation of mRNA expression of IL-6; however, no such correlation was observed with mTOR expression. A significant decline in the intensity of pain, NPSI scoring for burning, allodynia, and pain-related catastrophizing were observed; also a significant improvement in depressive symptoms and quality of life were observed with the use of CBT.
Conclusions
A significant downregulation of mRNA expression of IL-6 was observed; however, no significant correlation was observed between NRS pain score and ΔCt values of mRNA expression of both mTORC1 gene and IL-6 gene at baseline and at the end of 12th week. In addition, we note a significant decrease in pain intensity, depressive symptoms, and pain-related catastrophizing while improving QOL was observed with the use of CBT as a clinical adjunct along with pregabalin in PHN patients.
... All study procedures were piloted and developed in preliminary work by the investigative team. Specifically germane to this proposal, we have conducted numerous clinical trials examining psychological interventions based on the techniques investigated in this study for CLBP and other pain conditions [19][20][21][22], including telehealth assessment and treatment delivery [23][24][25][26][27]. We have also published multiple studies examining treatment mechanisms and have a great deal of experience in implementing EMA, with compliance rates exceeding 85% [14,15,21,. ...
... Specifically germane to this proposal, we have conducted numerous clinical trials examining psychological interventions based on the techniques investigated in this study for CLBP and other pain conditions [19][20][21][22], including telehealth assessment and treatment delivery [23][24][25][26][27]. We have also published multiple studies examining treatment mechanisms and have a great deal of experience in implementing EMA, with compliance rates exceeding 85% [14,15,21,. This study is pre-registered on clinicaltrials.gov ...
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim).
We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4-week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762).
This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
... CBT emphasizes modifying maladaptive thinking and behavioral responses to pain, and typically either avoids patient's negative emotional experiences, or attempts to reduce negative emotions as directly as possible [16]. ...
... Thorn's CBT Programme[16] . ...
Background: Fibromyalgia (FM) is a ceaseless musculoskeletal torment, which remains a troublesome clinical entity worldwide and the administration of this condition is a challenge for the health providers. Various treatment options are available to improve the symptoms of fibromyalgia, but a specificity tailored to particular patient is still missing. Thus, in this study we tested the combination of cognitive behavioral therapy with physiotherapy techniques would bring any changes on the fibromyalgia symptoms. Method: A 21 year male reported to the psychiatry department with complaints of continuous pain at the back and neck area, with more than 8 months history of stiffness and functional disability. The patient met the 2010 fibromyalgia diagnostic criteria. Visual analogue scale, Pain pressure algometer, revised fibromyalgia impact questionnaire, general anxiety disorder(GAD-7) and shortform-36 health surveys were used as the outcome measures to document the changes. The patient was managed for a period of 3 months using cognitive behavioral therapy along with Physiotherapy techniques. Results: After three months we found positive results on the management of fibromyalgia. Conclusion: Cognitive behavioral therapy combined with integrated Physiotherapy techniques may have an effect to reduce the severity of pain, depression, anxiety, improvement on the pain pressure threshold and quality of life on fibromyalgia.
... 33 Many studies have also suggested that pain catastrophizing is a mediator of the relation between treatment effects and chronic pain states. 34,35 The correlation analysis also indicated that the decrease in catastrophic thoughts is significantly correlated with improvements in clinical pain experiences. However, our multiple regression analysis indicated that only negative emotions had a significant positive correlation with changes in pain intensity that resulted from CBT treatment, suggesting the importance of appropriately addressing the role of negative emotions, especially when working with CBT programs for PSPD patients. ...
... However, various studies on chronic pain have also indicated the importance of pain catastrophizing from a clinical perspective. [33][34][35] Therefore, further studies are needed to validate these associations. ...
Aims
Cognitive behavioral therapy (CBT) is known to be effective for patients with persistent somatoform pain disorder (PSPD). Improvement of negative emotions in interpersonal stressful situations has been reported to reduce PSPD‐related clinical pain. However, these associations in CBT remain unclear. Therefore, we examined the relationship between changes in negative emotions and clinical pain symptoms after CBT by using a multiple regression analysis that included pain catastrophizing.
Methods
We analyzed negative emotional intensity scores in stressful situations of 38 patients with PSPD who had completed CBT treatment and all the daily worksheets. Negative emotional intensity scores were recorded in daily worksheets during 12 weekly CBT sessions. Pain Catastrophizing Scale (PCS), Visual Analogue Scale (VAS) as clinical pain intensity, Beck Depression Inventory‐Second Edition (BDI‐II), and State‐Trait Anxiety Inventory (STAI) were also assessed at pre‐ and post‐treatment. A multiple regression analysis was conducted using changes in VAS scores after CBT as the dependent variable, and changes in negative emotional intensity scores, PCS, BDI‐II, and STAI scores after CBT, age, and sex, as independent variables.
Results
Negative emotional intensity scores decreased after CBT. In a multiple regression analysis, the emotional changes resulting from CBT depicted a modest positive relationship with changes in VAS scores (β = 0.37; p < 0.05), but there was no relationship between changes in PCS scores after CBT and changes in VAS scores after CBT (β = 0.03).
Conclusion
The results show that negative emotions play an important role in the treatment effects of CBT for PSPD.
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... The 13 items are summed to arrive at a total PCS score, which reflects an individual's trait disposition toward pain catastrophizing. Pain catastrophizing is a malleable construct that is responsive to both longer course Seminowicz et al., 2013;Turner et al., 2016) and brief, targeted psychological treatment (Darnall, Sturgeon, Kao, Hah, & Mackey, 2014;Thorn et al., 2007). ...
... Cognitive behavioral therapy for chronic pain (pain-CBT) effectively reduces pain catastrophizing and increases pain self-efficacy; that is, the belief in one's ability to engage in various life activities despite living with ongoing pain Stewart et al., 2015;Thorn et al., 2007;Williams, Eccleston, & Morley, 2012). Pain-CBT is typically delivered by a trained psychologist either individually or in group classes. ...
Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.
... В некоторых случаях авторы не разделяют катастрофизацию и депрессию или катастрофизацию и тревогу как разные психологические феномены, оценивая их в совокупности [57]. Во многих вошедших в обзор работах, направленных на изучение влияния когнитивно-поведенческой терапии, шкала катастрофизации боли используется для подтверждения эффективности проводимого лечения и гипотезы о влиянии катастрофизации на восприятие боли [24,25,56,64,65,69,70,77]. ...
... Virtual reality (VR) has been used in many clinical settings, predominantly for short-term pain reduction. [38][39][40][41][42][43][44][45][46][47] Distraction-based VR (VR-D) redirects patients' attention during acutely painful procedures to reduce pain. Our prior pilot study assessing the impact of VR-D in children, 67 along with other studies using VR in adults, 68 69 found VR-D useful for transient reductions in pain but insufficient for treating sustained pain after surgery. ...
Introduction
Current clinical applications of virtual reality (VR) provide patients with transient pain relief during acutely painful events by redirecting attention. Biofeedback (BF) is a mind–body therapy that effectively produces sustained pain reduction, but there are obstacles to its routine use. Combined, BF-based VR (VR-BF) may increase accessibility while enhancing the benefits of BF. VR-BF has yet to be employed in perioperative care, and as such, no defined treatment protocol for VR-BF exists. The primary aim of this study is to assess the feasibility of the perioperative use of VR-BF in children and adolescents. The secondary aims are to assess the acceptability of VR-BF and to collect pilot efficacy data.
Methods and analysis
This is a single-centre, randomised controlled pilot clinical trial. A total of 70 patients (12–18 years) scheduled for surgery anticipated to cause moderate to severe pain with ≥1 night of hospital admission will be randomised to one of two study arms (VR-BF or control). Participants randomised to VR-BF (n=35) will use the ForeVR VR platform to engage their breathing in gamified VR applications. Participants randomised to control (n=35) will interact with a pain reflection app, Manage My Pain . The primary outcome is feasibility of VR-BF use in adolescents undergoing surgery as assessed through recruitment, enrolment, retention and adherence to the protocol. Secondary outcomes are acceptability of VR-BF and pilot efficacy measures, including pain, anxiety and opioid consumption.
Ethics and dissemination
The protocol was approved by the Nationwide Children’s Hospital Institutional Review Board (IRB #STUDY00002080). Patient recruitment begins in March 2023. Written informed consent is obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals. Data will be available per request and results will be posted on ClinicalTrials.gov.
Trial registration number
ClinicalTrials.gov Registry ( NCT04943874 ).
... Cognitive factors, such as fear and avoidance of pain and pain catastrophizing, have demonstrated strong relationships with pain interference and quality of life [6][7][8]. Interventions that focus on identifying and restructuring maladaptive pain cognitions have demonstrated efficacy in improving pain-related quality of life [9][10][11][12]. Incorporating behavioral management of chronic pain and headache disorders improves outcomes beyond medical management alone [13][14][15]. ...
Purpose of Review
The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments.
Recent Findings
Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care.
Summary
Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.
... Currently, the management of CTTH focuses especially on the symptomatic pharmacological treatment of pain, anxiety and depression comorbidity, and their repercussions (with analgesics, anxiolytics and muscle relaxants, and antidepressants); it may also be associated with other types of pharmacological and non-pharmacological options, such as: physiotherapy (electrotherapy, myofascial trigger point treatment, cervical manipulation) [52][53][54], psychological therapy (biofeedback, relaxation techniques) [55], or botulinum toxin [56], with uncertain efficacy in the medium and long terms. We believe that re-education and emotional support techniques that reinforce positive affect can contribute to a sustained supportive benefit for these patients; it has been observed that it is possible to re-educate negative thinking, and this implies better coping with pain, preventing pain chronification and catastrophizing conditions [24,[57][58][59]. ...
Background:
Chronic tension-type headache (CTTH) is frequently associated with a psychiatric comorbidity of depression and anxiety. Most studies focus their attention on this association, and only few link CTTH with psycho-affective emotional regulation disorders.
Objective:
To evaluate the association of CTTH with anxiety, depression, positive and negative affectivity, and emotional management in CTTH patients with neither a previous diagnosis of psychiatric disorder nor use of psychoactive drugs or abuse of analgesics.
Design:
Case-control study.
Methods:
Validated scores for state and trait anxiety, depression, positive and negative state and trait affect, cognitive reappraisal, and expressive suppression were assessed in 40 subjects with CTTH and 40 healthy subjects. Associations between CTTH and psychological status were assessed through linear multivariate regression models.
Results:
CTTH was associated with higher scores for depression (Beta = 5.46, 95% CI: 1.04-9.88), state and trait anxiety (Beta = 12.77, 95% CI: 4.99-20.56 and Beta = 8.79, 95% CI: 2.29-15.30, respectively), and negative state affect (Beta = 5.26, 95% CI: 0.88-9.64).
Conclusions:
CTTH is directly associated with depression, anxiety, and negative affectivity signs despite the absence of a previously diagnosed psychiatric disorder or psychopharmacological intake. The recognition of these comorbid and psycho-affective disorders is essential to adapt the emotional management of these patients for better control.
... The outcomes of behavioral treatments have been shown to differ by type of treatment. For example, cognitive behavioral therapies lead to reductions in attack frequency and disability, [3][4][5][6] whereas mindfulness-based therapies have usually reduced only disability (with one recent exception, which included a four-session migraine-focused behavioral intervention). 7-9 Even within a modality, such as CBT for depression, effect sizes become larger as therapist interaction increases. ...
... This is particularly important given that the experience of pain is multidimensional, involving affective and cognitive components (Melzack, 1999). Indeed, cognitive behavioral strategies aimed at targeting negative cognitions, such as catastrophizing, are frequently employed in multidisciplinary pain treatment settings (Thorn, 2020;Thorn et al., 2007;Turk & Gatchel, 2018) and assessment of individuals may often include how one is appraising their pain . Further, updated definitions of pain (Williams & Craig, 2016) have highlighted the inherently social nature of the pain experience, suggesting the need to attend to sociocultural contributors to pain outcomes and expanding the scope of assessment and intervention. ...
This study examined the negative impact of social discrimination on the time to pain tolerance during experimentally induced cold pressor pain among healthy individuals. It was hypothesized that the degree to which one catastrophized about pain would exacerbate the negative impact of a history discriminatory experiences on pain tolerance, and that this interaction would be different between individuals of a racial and ethnic minority and non-Hispanic white individuals (thus testing catastrophizing as a moderated moderator). Higher levels of discrimination were positively related to catastrophic thinking about pain, and there was a significant negative relationship between the level of experienced discrimination and time to pain tolerance. Pain catastrophizing emerged as a significant moderator in that when pain catastrophizing levels were high, there was no association between social discrimination and pain tolerance. A history of social discrimination was significantly associated with reduced pain tolerance at low and moderate levels of pain catastrophizing. Racial minority status did not significantly alter this moderating relationship. Implications for the importance of assessing sociocultural variables, such as experiencing social discrimination in the clinical assessment of the individual with pain are outlined.
... Interventions that target pain catastrophizing using cognitive and behavioral approaches have been shown to be effective in reducing pain catastrophizing, but improvement in pain and pain-related outcomes have been mixed (Buhrman et al., 2011;Burns et al., 2003;Smeets et al., 2006;Thorn et al., 2007;Turner et al., 2006). The authors of a recent meta-analysis found that multimodal treatment approaches (e.g., combined cognitive-behavioral therapy and exercise) ...
Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting-state functional connectivity in pain-related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non-Hispanic black (NHB) compared with non-Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting-state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community-dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting-state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self-reported greater clinical pain and pain catastrophizing (ps < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting-state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting-state functional connectivity.
... Therefore, it is necessary to support smoking cessation. Cognitive behavioral therapy is known to have an effect on both pain catastrophizing and smoking cessation and may be a helpful strategy in the future.[21][22][23] Similarly, the HAQ score and a history of falls were also associated with PCS. ...
Aim
This study aimed to assess the relationship between pain catastrophizing and achievement of 28-joint Disease Activity Score-defined remission of rheumatoid arthritis (RA), considering the presence or absence of systemic inflammation, and to evaluate associated factors for pain catastrophizing.
Method
This cross-sectional study included 421 RA outpatients. The relationship between pain catastrophizing and remission was analyzed by adjusting several confounding factors. Univariable and multivariable analyses were performed to determine the relationship between pain catastrophizing and RA-related factors, comorbidities, and lifestyle habits.
Results
The prevalence of pain catastrophizing was 26%. Pain catastrophizing was negatively associated with remission (odds ratio 0.62, 95% confidence interval 0.38-1.00, P = .048). A multinomial logistic analysis showed that the presence of pain catastrophizing was an independent factor that was negatively correlated with the achievement of remission in the absence of systemic inflammation (odds ratio 0.51, 95% confidence interval 0.28-0.93, P = .029). Factors associated with elevated ratings on the Pain Catastrophizing Scale were a history of falls within the past year, a Health Assessment Questionnaire score >0.5, and smoking habit. Further, patients' subjective symptoms, including patient global assessment minus evaluator global assessment values ≥20 and high tender joint count minus swollen joint counts, were associated with elevated pain catastrophizing.
Conclusion
Pain catastrophizing is a major obstacle to achieving remission in RA patients with normal C-reactive protein levels. Advanced physical disability, smoking habit, and history of falls were associated with pain catastrophizing, in addition to patients' subjective symptoms.
... x Skill use (ER group only) ER group will answer 5 questions assessing the frequency of skills use learned in class over the past week, from "not at all" to "several times a day." [50,51], but we believe that the digital format and single-session nature of the intervention will be less burdensome and lead to lower attrition rates. We hope to achieve 80% power to detect medium-large treatment effects on the primary outcome (i.e., pain catastrophizing). ...
Background
Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain.
Methods
Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment.
Discussion
This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options.
Trial registration
ClinicalTrials.govNCT04546685. Registered on 04 September 2020.
... Pain catastrophizing, a passive strategy, is a pain-related cognition susceptible to being modified and an important psychological predictor of adaptation to pain [26,27]. Catastrophizing during old age is related with depressive symptoms, which in turn affects older adults' HRQoL, functional impairment, and chronic illness [28,29]. ...
Background:
Active aging is aimed at promoting quality of life in older adults. Nevertheless, the relationship between physical role and the practice of physical activity (PA) can be influenced by bodily pain feeling and by a low level of health-related quality of life (HRQoL). Passive and active strategies are susceptible to being modified and constitute an important psychological predictor of adaptation to pain. This cross-sectional study (1) analyzed the differences between inactive/active older adult women in terms of clinical and sociodemographic characteristics, pain coping strategies, and HRQoL; (2) studied the associations between pain coping strategies, the dimensions of the HRQoL questionnaire, and physical role; and (3) determined if passive strategies, bodily pain, physical function, and general health were significant mediators in the link between being inactive/active and physical role.
Methods:
Participants of the present cross-sectional study completed measures of clinical and sociodemographic characteristics, HRQoL using the Short-Form Health Survey-36, and active and passive strategies using the Vanderbilt Pain Management Inventory (VPMI).
Results:
A total of 157 inactive (69.9 ± 7.1 years) and 183 active (68.8 ± 5.3 years) women from rural areas were included in the study. Both groups significantly differed in the majority of the clinical and sociodemographic characteristics measured, pain coping strategies, and HRQoL. Bodily pain, physical function, and general health predicted physical role. Moreover, passive strategies, bodily pain, physical function, and general health mediated the link between inactive/active participants and physical role.
Conclusions:
Being physically active or inactive contributes to a better understanding of the link between PA, pain coping strategies, and physical role in older women.
... In this sense, previous literature has shown the effectiveness of cognitive behavioral therapies for pain reduction. Specifically, for magnification thoughts in the context of pain, Cognitive Behavioral Therapy and in particular Rational Emotive Behavior Therapy [65] have obtained very good results in different populations with pain [66][67][68][69]. By contrast, for cognitive fusion, Acceptance and Commitment Therapy has been argued to be a more effective intervention [26,29]. ...
Objective
This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by fibromyalgia patients across different levels of pain severity (i.e. moderation).
Methods
The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (SD = 8.94; range = 30 to 78 years).
Results
Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all p <.001). A moderation effect was also found in the relationship between cognitive fusion and fibromyalgia impact on functioning (B = -0.12, t = -2.42, p = .016, [-0.22, -0.02]) and between magnification and fibromyalgia impact (B = -0.37, t = -2.21, p = .028, [-0.70, -0.04]). This moderation was not observed for rumination and helplessness.
Conclusions
The results suggest that some maladaptive forms of thought management (i.e., cognitive fusion and magnification) should be preferably challenged at milder levels of pain severity when attempting to improve functioning in people with fibromyalgia. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity, therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions with fibromyalgia patients experiencing more severe pain levels.
... Meantime a variety of non-specific short-term cognitive treatments have been shown to be e ective in reducing catastrophizing by pain patients. Although not specifically intended to reduce catastrophizing, certain cognitive therapy techniques that instructed patients to de-catastrophize, were e ective in a cognitive-behavioral approach for pain management (James et al., 1993;Thorn et al., 2002Thorn et al., , 2007. ...
A new review from @CNAP_AAU exploring pain catastrophizing as an important psychological factor that influences pain response and disability. It presents an integrated view of the complex interplay of biological and psychosocial factors that shape pain vulnerability.
... Such barriers may include few skilled local therapists, poor insurance coverage, copayments associated with clinic visits, travel costs, and treatment time [10]. Even when delivered to participants at no cost, in-person behavioral medicine treatments can have poor patient engagement [11], thereby suggesting that new methods of treatment delivery are required to meet the needs of a broad range of patients. Accordingly, research has demonstrated preliminary efficacy for an ultrabrief, single-session, skills-based behavioral treatment class for chronic pain [12] as well as for mobile health teleconference-delivered multisession behavioral pain treatment [13]. ...
Background
Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back pain typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed.
Objective
In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a nonpharmacological home-based pain management treatment for people with chronic low back pain (cLBP).
Methods
We will randomize 180 individuals with cLBP to 1 of 2 VR programs: (1) EaseVRx (8-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a VR headset to minimize any biases related to the technology’s novelty. The Sham VR group had 2D neutral content in a 3D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months posttreatment using an approach suitable for the longitudinal nature of the data.
Results
The study was approved by the Western Institutional Review Board on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020, and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020.
Conclusions
Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain’s societal burden. Our study could help shape future research and development of these innovative approaches.
Trial Registration
ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177
International Registered Report Identifier (IRRID)
RR1-10.2196/25291
... Modalities of counseling centered around acceptance, such as acceptance and commitment therapy (ACT), are effective in helping individuals adjust to living with chronic pain; partaking in ACT is associated with increased physical and social functioning, decreased pain-related medical visits, less depression and mood disturbances, and lower perceived pain levels (McCracken & Vowles, 2014). Likewise, CBT is an effective approach for addressing thought patterns that reinforce pain catastrophizing (Smeets et al., 2006;Thorn et al., 2007). A push for patient-centered, collaborative treatments (Salsbury et al., 2018) along with tailoring interventions to address the psychological features of the pain experience is a promising step toward alleviating distress and reducing feelings of helplessness. ...
Background and objectives:
Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP.
Research design and methods:
Using van Manen's phenomenological method, semi-structured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding.
Results:
Findings dually illustrate how participants were living a battle between helplessness and perseverance; final thematic structure revealed five subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going.
Discussion and implications:
This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.
... Since the primary impetus of opioid dose reduction is long-term risk reduction, there is a persistent knowledge gap of factors besides providing a time-limited controlled environment for change that are important for achieving long-term changes in opioid use and thus opioid-related harms. Self-efficacy may be an important mechanism for achieving this kind of long-term change [104] as has been demonstrated in comparable populations such as those living with chronic pain, multiple chronic diseases, polypharmacy, substance dependence and those aiming to create positive lifestyle changes [127][128][129][130][131]. ...
Context
Opioid related deaths are at epidemic levels in many developed nations globally. Concerns about the contribution of prescribed opioids, and particularly high-dose opioids, continue to mount as do initiatives to reduce prescribing. Evidence around opioid tapering, which can be challenging and potentially hazardous, is not well developed. A recent national guideline has recognized this and recommended referral to multidisciplinary care for challenging cases of opioid tapering. However, multidisciplinary care for opioid tapering is not well understood or defined.
Objective
Identify the existing literature on any multidisciplinary care programs that evaluate impact on opioid use, synthesize how these programs work and clarify whom they benefit.
Study design
Systematic rapid realist review.
Dataset
Bibliographic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library), grey literature, reference hand search and formal expert consultation.
Results
95 studies were identified. 75% of the programs were from the United States and the majority (n = 62) were published after 2000. A minority (n = 23) of programs reported on >12 month opioid use outcomes. There were three necessary but insufficient mechanisms common to all programs: pain relief, behavior change and active medication management. Programs that did not include a combination of all three mechanisms did not result in opioid dose reductions. A concerning 20–40% of subjects resumed opioid use within one year of program completion.
Conclusions
Providing alternative analgesia is insufficient for reducing opioid doses. Even high quality primary care multidisciplinary care programs do not reduce prescribed opioid use unless there is active medication management accomplished by changing the primary opioid prescriber. Rates of return to use of opioids from these programs are very concerning in the current context of a highly potent and lethal street drug supply. This contextual factor may be powerful enough to undermine the modest benefits of opioid dose reduction via multidisciplinary care.
... Such barriers may include few skilled local therapists, poor insurance coverage, copayments associated with clinic visits, travel costs, and treatment time [10]. Even when delivered to participants at no cost, in-person behavioral medicine treatments can have poor patient engagement [11], thereby suggesting that new methods of treatment delivery are required to meet the needs of a broad range of patients. Accordingly, research has demonstrated preliminary efficacy for an ultrabrief, single-session, skills-based behavioral treatment class for chronic pain [12] as well as for mobile health teleconference-delivered multisession behavioral pain treatment [13]. ...
Background: Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management
strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy
for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.
Objective: The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content
and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary
efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep,
and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT)
and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program,
thereby informing potential mechanisms of effect.
Methods: We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported
chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain
duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based
VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included
participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35).
Results: The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants
(n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio
(n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results
strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain
intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain
catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups.
Conclusions: High engagement and satisfaction combined with low levels of adverse effects support the feasibility and
acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day
treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide
enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future
research on VR behavioral interventions for chronic pain.
(JMIR Form Res 2020;4(7):e17293) doi: 10.2196/17293
... Additionally, members of the team will be trained to use and complete Case Report Forms (CRFs), how to review them for completeness, as well as how to maintain participant confidentiality. Patient flow will be reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines [40]. ...
Background:
Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids.
Methods/design:
Our study is a randomized, double-blind clinical trial testing the superiority of our 2-h, single-session skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.
Discussion:
This study aims to test the utility of a single-session, 2-h skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce the need for opioids and prevent misuse effectively, efficiently, and economically. Further, elucidation of the mechanisms of opioid use can facilitate refinement of more targeted future treatments.
Trial registration:
ClinicalTrials.gov, ID: NCT03950791. Registered on 10 May 2019.
... In addition to techniques designed to increase participants' involvement in purposeful activities of daily living, the behavioral activation intervention was supplemented by risk-targeted techniques to yield reductions in symptom catastrophizing. Research suggests that techniques such as education (Lee et al., 2016), guided disclosure (Sullivan et al., 1999), thought monitoring and reappraisal (Thorn et al., 2007), and activity planning can reduce symptom catastrophizing or reduce the negative impact of symptom catastrophizing (Wideman & Sullivan, 2011). Participants first viewed an introductory video that provided them with information about PTSD and oriented them to the procedures and objectives of treatment. ...
Catastrophizing has been discussed as a cognitive precursor to the emergence of posttraumatic stress disorder (PTSD) symptoms following the experience of stressful events. Implicit in cognitive models of PTSD is that treatment-related reductions in catastrophizing should yield reductions in PTSD symptoms. The tenability of this prediction has yet to be tested. The present study investigated the sequential relation between changes in a specific form of catastrophizing-symptom catastrophizing-and changes in PTSD symptom severity in a sample of 73 work-disabled individuals enrolled in a 10-week behavioral activation intervention. Measures of symptom catastrophizing and PTSD symptom severity were completed at pre-, mid-, and posttreatment assessment points. Cross-sectional analyses of pretreatment data revealed that symptom catastrophizing accounted for significant variance in PTSD symptom severity, β = .40, p < .001, sr = .28 (medium effect size), even when controlling for known correlates of symptom catastrophizing, such as pain and depression. Significant reductions in symptom catastrophizing and PTSD symptoms were observed during treatment, with large effect sizes, ds = 1.42 and 0.94, respectively, ps < .001. Cross-lagged analyses revealed that early change in symptom catastrophizing predicted later change in PTSD symptoms; early changes in PTSD symptom severity did not predict later change in symptom catastrophizing. These findings are consistent with the conceptual models that posit a causal relation between catastrophizing and PTSD symptom severity. The clinical implications of the findings are discussed.
... I have used aspects of this treatment approach in my clinical re-VHDUFK ZLWK D PL[HG JURXS RI SDWLHQWV ZLWK FKURQLF SDLQ -RKQ-VRQ 7KRUQ LQ D VSHFL¿FWUHDWPHQWFRPSRQHQW DQDO\VLV study of patients with headache (James et al., 1993), in a clinical trial for patients with headache (Thorn et al., 2007), in a trial of mindfulness-based cognitive therapy for patients with headache , and in clinical trials of literacy-adapted group therapy for multiply disadvantaged patients with chronic pain at low income community health centers (Eyer & Thorn, 2015;Thorn et al., 2011, Thorn et al., in press). These studies have been funded by The National Institutes of Health, The Marchionne Foundation, the National Headache Foundation, and the Patient Centered Outcomes Research Institute. ...
Over one-third of Americans report chronic pain of one type or another. The causes of chronic pain are multi-faceted, and often do not involve identifiable tissue damage. Opioid therapy for chronic pain has a high risk for opioid dependency, addiction, and possible death. CBT is a proven alternative intervention. This article describes a 10-session CBT program for the treatment of chronic pain.
... This treatment is based on existing mind-body and cognitive-behavioral treatments that have been developed for treating adults with other pain problems [34][35][36][37]. All treatment sessions were audio-recorded to monitor adherence. ...
Objective:
To evaluate the feasibility, acceptability, and preliminary efficacy of a mind-body intervention for moderate to severe primary dysmenorrhea (PD).
Design:
Open trial (single arm).
Setting:
Academic medical school.
Subjects:
A total of 20 young adult women with moderate to severe primary dysmenorrhea were included across four separate intervention groups.
Methods:
All participants received five 90-minute sessions of a mind-body intervention and completed self-report measures of menstrual pain, depression, anxiety, somatization, and pain catastrophizing at baseline, post-treatment, and at one-, two-, three-, and 12-month follow-up. Self-report of medication use and use of skills learned during the intervention were also collected at all follow-up points.
Results:
Participants reported significantly lower menstrual pain over time compared with baseline. No changes in anxiety, depression, or somatization were observed, although pain catastrophizing improved over time. Changes in menstrual pain were not associated with changes in medication use or reported use of skills.
Conclusions:
A mind-body intervention is a promising nondrug intervention for primary dysmenorrhea, and future research should focus on testing the intervention further as part of a randomized clinical trial.
... Such barriers may include few skilled local therapists, poor insurance coverage, copayments associated with clinic visits, travel costs, and treatment time [10]. Even when delivered to participants at no cost, in-person behavioral medicine treatments can have poor patient engagement [11], thereby suggesting that new methods of treatment delivery are required to meet the needs of a broad range of patients. Accordingly, research has demonstrated preliminary efficacy for an ultrabrief, single-session, skills-based behavioral treatment class for chronic pain [12] as well as for mobile health teleconference-delivered multisession behavioral pain treatment [13]. ...
BACKGROUND
Chronic pain management is optimized with a multidisciplinary biopsychosocial treatment approach. However, patients have limited access to comprehensive care that includes behavioral medicine for chronic pain. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapeutic with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.
OBJECTIVE
The primary goal of this study was to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based cognitive behavioral treatment for chronic pain. The secondary goal was to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary goal was to conduct a randomized controlled trial to compare the VR treatment to an audio-only treatment; this comparison isolated the immersive effects of the skills-based VR program, thereby informing potential mechanisms of effect.
METHODS
We conducted a randomized controlled trial involving an online convenience sample of adults (N=97) 18-65 years of age with self-reported chronic non-malignant chronic low back pain or fibromyalgia with an average pain intensity > 4 over the past month, and chronic pain duration > 6 months. Enrolled participants were randomly assigned to one of two treatment groups: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) Audio: an audio-only version of the 21-day VR program. The analytic dataset included participants who completed at least one of eight surveys administered during the intervention period: VR (n=39) and Audio (n=35).
RESULTS
The VR group launched a total of 1047 sessions vs. 946 sessions for Audio group. The majority of VR participants (76%) reported no nausea or motion sickness. High satisfaction ratings were reported for both groups (84% for VR and 72% for Audio). For VR efficacy, we observed a significant declining trend in for each pain variable over time (all P<.001) with results strengthening after two weeks. Comparing VR to Audio, we found significant time x group effects for average pain intensity (P= .036), and pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003), with significant reductions in pain catastrophizing and pain self-efficacy for both groups. Overall, results suggest that immersive VR yields superior treatment effects relative to audio only content.
CONCLUSIONS
High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability for at-home skills-based VR for chronic pain. Significant reduction in pain outcomes over the course of the 21-day treatment both within VR group and compared to an audio-only version suggests VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.
... Furthermore, pain catastrophizing is hypothesized to impact health behaviours such as physical activity, and the fear avoidance model describes how catastrophic thoughts about pain might result in further pain-related fear, avoidance and disability [15]. Because pain catastrophizing and fear avoidance can be related to these negative patient outcomes, clinicians need to be aware of these behaviours and research suggest that cognitive behavioural therapy is associated with significant reductions in pain catastrophizing [16,17]. ...
Background:
Pain catastrophizing contributes to acute and long-term pain after knee arthroplasty (KA), but the association between pain catastrophizing and physical function is not clear. We examined the association between preoperative pain catastrophizing and physical function one year after surgery, as well as differences in physical function, pain and general health in two groups of patients with high and low preoperative pain catastrophizing score.
Methods:
We included 615 patients scheduled for KA between March 2011 and December 2013. Patients completed The Pain Catastrophizing Scale (PCS) prior to surgery. The Oxford Knee Score (OKS), Short Form-36 (SF-36) and the EuroQol-5D (EQ-5D) were completed prior to surgery, and 4 and 12 months after the surgery.
Results:
Of the 615 patients, 442 underwent total knee arthroplasty (TKA) and 173 unicompartmental knee arthroplasty (UKA). Mean age was 67.3 (SD: 9.7) and 53.2% were females. Patients with PCS > 21 had statistically significantly larger improvement in mean OKS for both TKA and UKA than patients with PCS < 11; 3.2 (95% CI: 1.0, 5.4) and 5.4 (95% CI: 2.2, 8.6), respectively. Furthermore, patients with preoperative PCS > 21 had statistically significantly lower OKS, SF-36 and EQ-5D and higher pain score than patients with PCS < 11 both preoperatively and 4 and 12 months postoperatively.
Conclusions:
Patients with high levels of preoperative pain catastrophizing have lower physical function, more pain and poorer general health both before and after KA than patients without elevated pain catastrophizing.
... Problem solving has also been tested in other populations, such as patients with personality disorders [68], individuals with severe disabilities [69], and caregivers [70,71], among others. To date, however, the majority of treatment programs in chronic pain fail to incorporate problem solving [72][73][74][75] and existent models of pain behaviour, such as the Fear Avoidance Model of pain or the Psychological Flexibility Model of pain [30,31], tend to ignore problem solving. The present study suggests that, compared to other psychological variables, a negative problem orientation, together with neuroticism, might be important target outcomes in psychological interventions for chronic pain patients. ...
Abstract Background Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. Methods Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. Results The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p
... This technique has been shown to effectively enhance descending modulation of pain, reduce pain catastrophizing, and increase a patient's self-efficacy to engage in meaningful life activities despite living with ongoing pain. [62][63][64][65] Specifically, this technique teaches patients to engage in cognitive restructuring of maladaptive thoughts and to use relaxation techniques and positive distraction as adaptive skills to interrupt pain catastrophizing. Repeated application of these techniques to interrupt negative cognitive patterns can help patients volitionally calm the nervous system and reinforce one's belief in their ability to self-soothe and self-manage pain. ...
Background:
Palliative care (PC) teams increasingly care for patients with cancer into survivorship. Cancer survivorship transcends distinctions between acute, chronic, malignant, and nonmalignant pain. Partnering with oncologists, PC teams manage pain that persists after disease-directed treatment, evaluate changing symptoms as possible signs of cancer recurrence, taper opioids and mitigate risk of opioid misuse, and manage comorbid opioid use disorder (OUD). While interdisciplinary guidelines exist for pain management in survivorship, there is a need to develop a conceptual model that fully translates the biopsychosocial framework of PC into survivorship pain management.
Objective:
This review frames a model for pain management in cancer survivorship that balances analgesia with the imperative to minimize risk of OUD, recognizes signs of disease recurrence, and provides whole-person care.
Methods:
Comprehensive narrative review of the literature.
Results:
Little guidance exists for co-management of pain, psychological distress, and opioid misuse in survivorship. We identified themes for whole-person pain management in survivorship: use of opioids and co-analgesic medications to prevent recurrent pain from residual tissue damage following cancer treatment, opioid tapering to the lowest effective dose, utilization of nonpharmacologic psychological interventions shown to reduce pain, screening for and management of OUD in partnership with addiction medicine specialists, maintaining vigilance for disease recurrence, and engaging in shared medical decision making.
Conclusions:
The management of pain in cancer survivorship is complex and requires interdisciplinary care that balances analgesia with the imperative to reduce long-term inappropriate opioid use and manage OUD, while maintaining therapeutic presence with patients in the spirit of PC.
... In this case, students are mostly exposure to the continuous stressful environment due to their busy schedule. This could be related to majority of them suffering from illnesses such as cold and headache [33]. ...
... The CBT treatment manual used in this study is standardized and supported by empirical studies (15,19). Ten weekly 90-minute group sessions provided simplified cognitive behavioral techniques, including motivational reinforcement, pain education, and pain management skills training (such as cognitive restructuring, activity pacing, and relaxation). ...
... As shown in previous studies, behavioral approaches were successful in treating pain catastrophizing and other aspects (eg, pain coping, internal control beliefs) and were effective on both reduction of headaches frequency and prevention of chronification. [52][53][54] Although our data do not enable to get to any definitive conclusion on the direction of any relationships, it could be hypothesized that these negative psychological features, and in particular presence of depressive traits and learned helplessness, are the result of years of lived experience of having CM. ...
Background
It is common clinical experience that, after structured withdrawal, some patients with chronic migraine and medication overuse headache (CM with MOH) are more prone than others to relapse and to be in need of further structured treatments. Our aim was to explore similarities and differences between frequent relapsers (FRs) and non‐frequent relapsers (NFRs) by considering their point of view, perceptions, and perspective of their subjective experience with relapse into CM with MOH.
Methods
Patients were consecutively recruited on occasion of a structured withdrawal treatment and were interviewed individually about their headache experience and their perspectives on relapse into CM with MOH. We considered FR those patients requiring 2 or more structured withdrawals for MOH within 3 years. A narrative approach with no preconceived coding schemes was employed. To facilitate coding, categorization and organization of data the software QRS NVivo 11.0 was used: themes were defined as common to FR and NFR, or peculiar (by frequency or content) to one of the 2 groups.
Results
Sixteen patients (13 women; mean age of 53) were interviewed: 7 were classified as FRs. A total of 22 themes emerged from 552 single quotations (the 10 most relevant covered 82% of the entire body of quotations). Four themes were commonly reported by both FR and NFR patients, and 6 were peculiar to one group only. Common aspects included issues connected to the dilemma between disclosing, concealing and the feelings of isolation around MOH, the idea of being addicted to medication, presence of anxiety, and the attempt to use non‐pharmacological therapies as an alternative to medication. Peculiar aspects included causal attribution (FRs attributed headache to uncontrollable factors); future expectations at the time point of withdrawal (FRs were generally resigned); high‐performance functioning (FRs believed they are “forced” to reach high levels of performance as a consequence of others’ inability); coping strategies (FRs tended to “passively accept” problems and showed avoidance‐related behaviors). Moreover, FRs were less frequently aware of their problems and described more frequently depressive symptoms.
Conclusions
Our results highlight that some differences between FR and NFR patients with CM and MOH exist. Frequent relapsers among patients with CM and MOH reported some important peculiarities of the lived experience of having chronic migraine; clinicians should recognize these psychosocial aspects such as social relationships, future expectations, the experience of illness, medication management, and how the withdrawal experience is regarded, as they may be associated with frequent relapse into MOH.
Objective:
Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who may be at higher pain risk. While biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy.
Methods:
In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information, and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy.
Results:
Women had a mean age of 34 years, 73% identified as White, 11% as African American, 10% as Hispanic/Latino, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latino and greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (vs. repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing.
Conclusions:
Independent of demographic or clinical factors, psychological factors including depression, sleep disturbance, and pain catastrophizing conferred greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy may benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.
Objective:
The avoidance-endurance model (AEM) proposes multiple pathways from acute to chronic pain, with distinct cognitive and behavioral components in each pathway. The AEM may also be applicable to persistent symptoms after concussion. In this study, we tested the AEM as an explanatory framework for concussion outcomes, by using mediation analyses through the proposed psychological mechanisms. Based on the AEM, we hypothesized that postconcussion symptoms would significantly predict avoidance behavior through catastrophizing, and endurance behavior through thought suppression and self-distraction.
Participants and methods:
We recruited 84 adults seeking treatment at 2 outpatient concussion clinics (M = 41.8 years old, 63% female) who completed measures of postconcussion symptoms, catastrophizing, thought suppression, "self-distraction" (Five Factor Mindfulness Questionnaire "Act with Awareness" Scale reverse-scored), avoidance behavior, and endurance behavior at an average of 17.8 weeks postconcussion. We conducted 3 mediation analyses to assess each of the AEM pathways.
Results:
We found a significant indirect effect of postconcussion symptoms on avoidance behavior through catastrophizing (ab = .113 (.036), 95% CI [.053, .195]). The indirect effects of postconcussion symptoms on endurance behavior through thought suppression (ab = .011 (.012), 90% CI [.002, .035]) and "self-distraction" (ab = .003 (.009), 90% CI [.008, .022]) were not statistically significant.
Conclusions:
Results supported the catastrophizing-avoidance pathway in concussion, but not the thought-suppression-endurance or self-distraction-endurance pathways. Therefore, catastrophic thinking about concussion symptoms may be an appropriate treatment target for individuals who exhibit fear-avoidance behavior. Further research is needed to establish whether thought suppression and self-distraction are relevant for interventions aimed at reducing excessive endurance behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Catastrophizing is a cognitive process that can be defined as predicting the worst possible outcome. It has been shown to be related to psychiatric diagnoses such as depression and anxiety, yet there are no self-report questionnaires specifically measuring it outside the context of pain research. Here, we therefore develop a novel, comprehensive self-report measure of general catastrophizing. We performed five online studies (total n = 734), in which we created and refined a Catastrophizing Questionnaire, and used a factor analytic approach to understand its underlying structure. We also assessed convergent and discriminant validity, and analysed test–retest reliability. Furthermore, we tested the ability of Catastrophizing Questionnaire scores to predict relevant clinical variables over and above other questionnaires. Finally, we also developed a four-item short version of this questionnaire. We found that our questionnaire is best fit by a single underlying factor, and shows convergent and discriminant validity. Exploratory factor analyses indicated that catastrophizing is independent from other related constructs, including anxiety and worry. Moreover, we demonstrate incremental validity for this questionnaire in predicting diagnostic and medication status. Finally, we demonstrate that our Catastrophizing Questionnaire has good test–retest reliability (intraclass correlation coefficient = 0.77, p < 0.001). Critically, we can now, for the first time, obtain detailed self-report data on catastrophizing.
Psychosocial treatments for chronic pain produce favorable outcomes. However, we still do not know precisely by what mechanisms or techniques these outcomes are wrought. In secondary analyses of a 10-week group intervention study comparing the effects of literacy-adapted cognitive behavioral therapy (CBT) with literacy-adapted pain education (EDU) among patients with chronic pain, low-socioeconomic status, and low literacy, the Learning About My Pain trial, we examined whether pain catastrophizing was a mechanism specific to CBT. Participants (N = 168) completed mechanism and outcome measures weekly for the 10 weeks of group treatment. Analyses revealed that (1) pain catastrophizing was reduced similary across CBT and EDU; (2) lagged analyses indicated that previous week reductions in pain catastrophizing predicted next week reductions in pain intensity and pain interference; (3) cross-lagged analyses indicated that previous week reductions in pain intensity and interference predicted next week reductions in pain catastrophizing; and (4) the relationships between pain catastrophizing and pain intensity and interference were moderated by session progression such that these links were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. Results suggest the existence of reciprocal influences whereby cognitive changes may produce outcome improvements and vice versa. At the same time, results from analyses of changes in slopes between pain catastrophizing and outcomes indicated that CBT and EDU were successful in decoupling pain catastrophizing and subsequent pain intensity and interference as treatment progressed. Results provide further insights into how psychosocial treatments for chronic pain may work.
Background
Pain catastrophizing is a maladaptive cognitive response characterized by an exaggerated negative interpretation of pain experiences. It has been associated with greater disability and poorer outcomes in chronic pain, to include several specific orofacial pain conditions. The goal of this study was to examine pain catastrophizing at a military orofacial pain specialty clinic.
Methods
This retrospective chart review (RCR) examined information collected at initial examination from 699 new patients seen between September 2016 and August 2019 at the Orofacial Pain Center at the Naval Postgraduate Dental School (Bethesda, MD). Pain catastrophizing, pain characteristics, psychosocial factors, and sleep were assessed using standardized scales. Linear regression was used to evaluate associations of patient characteristics and pain intensity with pain catastrophizing. Mediation analyses were done to characterize the extent to which the relationship between pain intensity and pain catastrophizing may be explained by anxiety, depression, and insomnia.
Results
Higher pain intensity, depression, anxiety, insomnia, and younger age were each associated with higher pain catastrophizing (all p<0.05). A primary diagnosis of neuropathic pain was the strongest independent predictor of higher pain catastrophizing. The relationship between pain intensity and pain catastrophizing was partially mediated by anxiety, depression, and insomnia.
Conclusions
In this RCR of a population of orofacial pain patients, those diagnosed with neuropathic pain were most likely to display high levels of pain catastrophizing, a characteristic which is associated with poor long‐term pain outcomes. This is the first study to show that, independent of other patient characteristics, those suffering from neuropathic pains displayed the highest levels of pain catastrophizing. This highlights the importance of also addressing psychosocial factors in the treatment of neuropathic pain conditions, which are commonly treated using a predominantly biomedical approach. Additionally, anxiety, depression, and insomnia each partially explain the relationship between pain intensity and pain catastrophizing.
Catastrophizing is a cognitive process that can be defined as predicting the worst possible outcome. It has been shown to be related to psychiatric diagnoses such as depression and anxiety, yet there are no self-report questionnaires specifically measuring it outside the context of pain research. Here we therefore, develop a novel, comprehensive self-report measure of general catastrophizing. We performed five online studies (total n = 734), in which we created and refined a Catastrophizing Questionnaire, and used a factor analytic approach to understand its underlying structure. We also assessed convergent and discriminant validity, and analysed test–retest reliability. Furthermore, we tested the ability of Catastrophizing Questionnaire scores to predict relevant clinical variables over and above other questionnaires. Finally, we also developed a four-item short version of this questionnaire. We found that our questionnaire is best fit by a single underlying factor, and shows convergent and discriminant validity. Exploratory factor analyses indicated that catastrophizing is independent from other related constructs, including anxiety and worry. Moreover, we demonstrate incremental validity for this questionnaire in predicting diagnostic and medication status. Finally, we demonstrate that our Catastrophizing Questionnaire has good test–retest reliability (intraclass correlation coefficient = 0.77, p < 0.001). Critically, we can now, for the first time, obtain detailed self-report data on catastrophizing.
Background:
Interdisciplinary cognitive behavioral therapy (CBT) for chronic pain is effective at improving function, mood, and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent, and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain. Consequently, pain catastrophizing is commonly targeted in CBT for chronic pain.
Objectives:
To examine change trajectories in pain catastrophizing during treatment and assess the relevance of these trajectories to outcomes at post-treatment.
Methods:
Participants included individuals with chronic pain (N = 463) who completed a three-week program of interdisciplinary CBT. Pain catastrophizing was assessed weekly over the three weeks of treatment and latent growth curve modeling was used to identify trajectories of change.
Results:
Findings indicated the presence of two classes of linear change, one with a significant negative slope in pain catastrophizing (i.e., improved class) and the other with a non-significant slope (i.e., unchanged class). Next, latent growth mixture modeling examined treatment outcome in relation to class membership. These results indicated that individuals in the "improved" PCS class had significantly greater improvement in pain interference and mood, as well as physical and mental quality of life compared to the "unchanged" class.
Conclusions:
Implications for our findings, in relation to the CBT model, are discussed.
Objective:
Pain catastrophizing and cutaneous allodynia represent two risk factors for greater headache-related disability. Yet, there is limited knowledge of the extent to which these risk factors are modifiable and whether nonpharmacological treatment-related changes are associated with migraine improvements. Using data from the Women's Health and Migraine (WHAM) study, a randomized controlled trial that compared effects of behavioral weight loss (BWL) and migraine education (ME) in women with migraine and overweight/obesity, we tested whether: (a) BWL versus ME produced greater changes in pain catastrophizing and allodynia from baseline across posttreatment and follow-up time points, and (b) whether these improvements were associated with improvements in headache disability.
Method:
Women (N = 110) were randomly assigned to 16 weeks of either BWL or ME and assessed at baseline, posttreatment, and follow up (32 weeks). Multilevel mixed effects modeling tested: (a) for between-groups differences in pain catastrophizing and allodynia changes over time, and (b) associations of changes in pain catastrophizing and allodynia with changes in headache disability, adjusting for migraine severity and weight loss.
Results:
Both BWL and ME had significant reductions in pain catastrophizing and allodynia from baseline to posttreatment and follow up, and the improvements were comparable across conditions. Reductions in pain catastrophizing and cutaneous allodynia were associated with significant reductions in headache disability, even when controlling for intervention-related improvements in migraine and weight loss.
Conclusion:
Pain catastrophizing and allodynia are not only reduced after nonpharmacologic treatments for migraine, but greater improvements are associated with greater reductions in headache-related disability, independent of migraine severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Chronic pain is a significant health problem worldwide with limited pharmacological treatment options. This study evaluated the relative efficacy of four treatment sessions each of four non-pharmacological treatments: (1) hypnotic cognitive therapy (using hypnosis to alter the meaning of pain); (2) standard cognitive therapy; (3) hypnosis focused on pain reduction, and (4) pain education. One hundred seventy-three individuals with chronic pain were randomly assigned to receive four sessions of one of the four treatments. Primary (pain intensity) and secondary outcome measures were administered by assessors unaware of treatment allocation at pre-treatment, post-treatment, and 3-, 6- and 12-month follow-up. Treatment effects were evaluated using ANOVA, a generalized estimating equation approach, or a Fisher Exact Test, depending on the outcome domain examined. All four treatments were associated with medium to large effect size improvements in pain intensity that maintained up to 12 months post-treatment. Pre- to post-treatment improvements were observed across the four treatment conditions on the secondary outcomes of pain interference and depressive symptoms, with some return towards pre-treatment levels at 12-months follow-up. No significant between group differences emerged in omnibus analyses, and few statistically significant between-group differences emerged in the planned pairwise analyses, although the two significant effects that did emerge favored hypnotic cognitive therapy. Future research is needed to determine if the significant differences that emerged are reliable.
Multiple sclerosis is a chronic, demyelinating disease of the central nervous system mainly affecting young adults. In addition to physical problems, the patients suffer from many psychological problems affecting their psychological well-being. The aim of the present study was to determine the effectiveness of group-based cognitive hypnotherapy on the psychological well-being of patients suffering from multiple sclerosis. This study was designed as a clinical trial with a pretest-posttest control group. From 60 patients diagnosed with multiple sclerosis referred to Beheshti hospital in Yasuj, Iran, 45 patients who met the inclusion criteria were selected by the convenience sampling method. The patients were randomly assigned to intervention (23 individuals) and control (22 individuals) groups through stratified random allocation. After completing the Ryff Scales of Psychological Well-Being, the intervention group attended eight sessions of group-based cognitive hypnotherapy on a weekly basis. The control group did not attend any intervention sessions. At the end of the eight intervention sessions, both groups completed the Ryff’s Scale of Psychological Well-being again. The collected data were analyzed using the SPSS software (Version 23). Analysis of Covariance (ANCOVA) and two-way Analysis of variance (ANOVA) tests were used in order to compare the groups. The results indicated that cognitive hypnotherapy had a significant effect on the total score of psychological well-being (F (45, 1) = 6.07, p = .018, η2 = 0.12) and the dimension of environmental mastery (p < .05). Therefore, it is recommended to use hypnotherapy to promote the psychological well-being of patients suffering from multiple sclerosis.
Despite the shown effectiveness of Cognitive-Behavioural Therapies (CBT) for chronic pain, it is not clear which CBT approach is more effective and which components or combinations of CBT account
for a better treatment outcome. In this regard, this study aimed to systematically review the studies investigating the effectiveness of all forms of CBT for the treatment of individuals with chronic pain.
For this purpose, randomised controlled clinical trials on adults with chronic pain published between the
years of 2006 and 2016 have been searched in the Google Scholar, Web of Science and EBSCO databases
by using the keywords “chronic pain”, “pain disorders”, “cognitive behavioural therapy” or “treatment”. Following database search, 24 trials were identified based on the eligibility criteria. Primary outcomes
were demonstrated to be pain intensity, disability, self-efficacy, and pain control, whereas secondary outcomes were related to emotional difficulties. In terms of comparative effectiveness, findings revealed
that all forms of CBT are significantly more effective than physical treatments, particularly for emotional problems. However, no statistically significant differences were found for the comparison of traditional CBT and mindfulness and acceptance-based treatments. Findings further underlined that some forms of CBT appeared to produce greater improvements in some of the outcome measures. Findings of this review emphasise that what is in fact responsible for the positive outcome while delivering CBT for chronic pain is still not clear. Thus, future research should focus on identifying specific components and underlying mechanisms of CBT in order to maximize treatment outcome.
Migraine is a common and disabling neurologic disorder that often occurs alongside anxiety and mood disorders. Information is provided on the biological basis of the disorder, behavioral factors that influence migraine, and common psychological comorbidities. Psychological treatments based on cognitive behavioral techniques have demonstrated efficacy to treat migraine. Migraine treatment can be incorporated in private practice and integrated care settings.
Concussion and Traumatic Encephalopathy - edited by Jeff Victoroff February 2019
Background:
Studies have reported that medically unexplained symptoms (MUS) tend to be associated with increased healthcare use, which is demanding of resources and potentially harmful to patients. This association is often used to justify the funding and study of psychological interventions for MUS, yet no systematic review has specifically examined the efficacy of psychological interventions in reducing healthcare use.
Aim:
To conduct a systematic review and meta-analysis to evaluate the effectiveness of cognitive behavioural therapies (CBT) for MUS in reducing healthcare use.
Design and setting:
Systematic review and meta-analysis.
Method:
The search from a previous systematic review was updated and expanded. Twenty-two randomised controlled trials reported healthcare use, of which 18 provided data for meta-analysis. Outcomes were healthcare contacts, healthcare costs, medication, and medical investigations.
Results:
Small reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs.
Conclusion:
Cognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach.
cognitive behavioral therapy in migraine patients
Cognitive behavioral therapy (CBT) for pain management is a therapy that aims to modify thoughts and behavior to be more realistic and balanced. There are limited number of studies to assess the efficacy of CBT for patients with pharmacotherapy-resistant chronic migraine in our population. We aimed to invstigate the effects of CBT for patients with refractory chronic migraine on pain attack frequency, disability, severity, anxiety and depression. Fourteen patients with refractory chronic migraine who were referred from the headache clinic to the psychiatry department and regularly attended CBT sessions at least once every 2 weeks for at least 6 months, were included in the study. After 2 sessions of psychiatric evaluation, the subjects had 12 40-min CBT sessions and were given relaxation exercises. The Hamilton depression and anxiety inventories, visual analogue scale for assessing the severity of pain, and the Migraine disability assessment (MIDAS) test were used before and after CBT. The mean Hamilton depression scores before and after CBT were 29.07 ± 7.74 and 14.21 ± 7.7, respectively (p < 0.0001). The mean Hamilton anxiety scores before and after CBT were 26.8 ± 11.7 and 11.7 ± 2.6, respectively (p < 0.0001). The mean VAS scores before and after CBT were 8.07 ± 0.91 and 3.71 ± 1.32, respectively (p < 0.0001). The mean MIDAS scores before and after CBT were 55.5 ± 20.4 and 20.12 ± 16.6, respectively (p < 0.0001). Our results showed that CBT had made a statistically significant difference on pain severity, number of migraine attacks and disability in patients with refractory chronic migraine. CBT should be considered in this patient group.
Two studies were conducted to further psychometric research on the recently developed Beck Anxiety Inventory (BAI). In Study 1 the test-retest reliability and internal consistency of the scale were examined with a sample of 40 outpatients having anxiety disorders. The BAI proved highly internally consistent (cronbach's alpha = .94) and acceptably reliable over an average time lapse of 11 days (r = .67). Study 2 was conducted to assess the convergent and discriminant validity of the BAI vis á vis anxiety and depression and in comparison to the widely used trait Anxiety measure from the State-Trait Anxiety Inventory. Seventy-one outpatients with anxiety disorders completed the revised State-Trait Anxiety Inventory, the Beck Depression Inventory, and daily diary ratings of anxiety and depression in addition to the BAI. The BAI fared better on tests of convergent and discriminant validity than did Trait Anxiety. The correlation between the BAI and Diary Anxiety was significantly higher than that between BAI and Diary Depression, and, compared to Trait Anxiety, the BAI was significantly less confounded with depression as measured by the BDI. Scores for STAI-Y Trait Anxiety were highly confounded with measures of depression, but results for the STAI-Y State scale were more positive.
In Study 1, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n = 15) or noncatastrophizers (n = 15) on the basis of their PCS scores and participated in an cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity.
In Study I, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (
n = 15) or noncatastrophizers (
n = 15) on the basis of their PCS scores and participated in a cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A computer and a hand search of the literature recovered 33 papers from which 25 trials suitable for meta-analysis were identified. We compared the effectiveness of cognitive-behavioural treatments with the waiting list control and alternative treatment control conditions. There was a great diversity of measurements which we grouped into domains representing major facets of pain. Effect sizes, corrected for measurement unreliability, were estimated for each domain. When compared with the waiting list control conditions cognitive-behavioural treatments were associated with significant effect sizes on all domains of measurement (median effect size across domains = 0.5). Comparison with alternative active treatments revealed that cognitive-behavioural treatments produced significantly greater changes for the domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced behavioural expression of pain. Differences on the following domains were not significant; mood/affect (depression and other, non-depression, measures), cognitive coping and appraisal (negative, e.g. catastrophization), and social role functioning. We conclude that active psychological treatments based on the principle of cognitive behavioural therapy are effective. We discuss the results with reference to the complexity and quality of the trials.
The behavioral clinical trials guidelines presented in this supplement1 were developed to enhance the quality and consistency of research evaluating behav- ioral treatments for primary headache disorders. De- veloped under the auspices of the American Headache Society (AHS), these guidelines are complementary to and modeled after guidelines published by the International Headache Society to address research methodology apropos to drug trials for migraine,2 tension-type headache,3 and cluster headache.4 Ex- plicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials neces- sarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmaco- logic research. the behavioral trial guidelines. Emerging from discus- sions and debates that took place during the guideline development, the thesis of each article in the series was judged to be a key methodological issue meriting further articulation and development expressly for headache investigators.5-21 The series is arranged in two sections, with the first examining headache research issues of general relevance7-12 and the sub-
One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work.
Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4-100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada.
In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35-0.95) and pain severity (OR = 0.64, 95% CI = 0.43-0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07-0.46) were significant predictors of return to work.
The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes.
Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.
Objective. To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees. Methods. Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions. Results. Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies. Conclusion. These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.
Pain beliefs and coping are believed to be important determinants of adjustment to chronic pain. The majority of the studies in this area have focused on the potential benefits of adaptive pain coping strategies and beliefs to improve adjustment to pain. In this Focus article, we propose a model whereby maladaptive pain beliefs and coping strategies are considered primary determinants of chronic pain adjustment, and influence the likelihood of engaging in more adaptive coping through influencing mediating factors such as perceived self-efficacy to manage pain. Well review data to support this model; (2) discuss evidence for the influence of maladaptive and adaptive coping and beliefs on chronic pain adjustment within the context of methodological limitations of studies in this area; (3) discuss the difficulties in assessing adaptive pain coping and beliefs; and (4) examine the implications of our proposed model for cognitive/behavioral interventions for chronic pain. We conclude that future studies on chronic pain adjustment should place more emphasis on the examination of maladaptive pain beliefs and coping strategies, examine causal relationships between adaptive and maladaptive strategies, and employ more multivariate analyses when examining the relationship between pain beliefs, coping, and adaptation to chronic pain.
A variety of experimental designs have been developed to estimate the effect of an intervention. This article compared analyses in 2 standard randomized designs; the posttest-only and pretest-posttest designs, with an analysis in the newly suggested intensive design in terms of the statistical power and precision of estimated intervention effect afforded by each design. These comparisons are especially interesting because the suggested analysis of data from the intensive design is equivalent to a possible use of hierarchical linear modeling when there are no missing data. Results show that an analysis of variance (ANOVA) of slopes from the intensive design is almost always more powerful than an ANOVA in the posttest-only design, and can also be more powerful than an analysis of covariance in the pretest-posttest design, but typically only when the number of measurement waves is 5 or more.
A variety of experimental designs have been developed to estimate the effect of an intervention. This article compared analyses in 2 standard randomized designs, the posttest-only and pretest-posttest designs, with an analysis in the newly suggested intensive design in terms of the statistical power and precision of estimated intervention effect afforded by each design. These comparisons are especially interesting because the suggested analysis of data from the intensive design is equivalent to a possible use of hierarchical linear modeling when there are no missing data. Results show that an analysis of variance (ANOVA) of slopes from the intensive design is almost always more powerful than an ANOVA in the posttest-only design, and can also be more powerful than an analysis of covariance in the pretest-posttest design, but typically only when the number of measurement waves is 5 or more. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Recurrent tension (N = 43) and migraine (N = 42) headache sufferers as well as headache-free controls (N = 59) completed the Life Events Inventory, the Cognitive Appraisal Inventory, and the Coping Strategies Inventory. An analysis of variance (ANOVA) revealed that both migraine and tension headache Ss appraise and cope with stressful events differently than headache-free controls. The 2 headache groups appeared to make virtually identical appraisals and use similar coping strategies in dealing with stress. Finally, discriminant analyses indicated that appraisal and coping variables could be used to differentiate tension and migraine sufferers from control Ss. Results suggest that 7 of 10 tension headache sufferers and 8 of 10 migraine sufferers can be correctly identified solely on the basis of how they appraise and cope with stress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
Pain beliefs and coping are believed to be important determinants of adjustment to chronic pain. The majority of the studies in this area have focused on the potential benefits of adaptive pain coping strategies and beliefs to improve adjustment to pain. In this Focus article, we propose a model whereby maladaptive pain beliefs and coping strategies are considered primary determinants of chronic pain adjustment, and influence the likelihood of engaging in more adaptive coping through influencing mediating factors such as perceived self-efficacy to manage pain. We (1) review data to support this model; (2) discuss evidence for the influence of maladaptive and adaptive coping and beliefs on chronic pain adjustment within the context of methodological limitations of studies in this area; (3) discuss the difficulties in assessing adaptive pain coping and beliefs; and (4) examine the implications of our proposed model for cognitive/behavioral interventions for chronic pain. We conclude that future studies on chronic pain adjustment should place more emphasis on the examination of maladaptive pain beliefs and coping strategies, examine causal relationships between adaptive and maladaptive strategies, and employ more multivariate analyses when examining the relationship between pain beliefs, coping, and adaptation to chronic pain.
Conventional models of persistent pain have tended to be dichotomous in nature, with pain viewed as either physically or psychologically based. Inadequacies inherent in both of these views have resulted in alterative conceptualizations that focus on the integration of biomedical with cognitive, affective, and behavioral factors. During the past decade there has been a proliferation of research designed to examine the relative contributions of individuals' attitudes, beliefs, appraisals, self-perceptions, and coping strategies to the perception, experience, and response to noxious sensations as well as treatment, and how these are modified as a result of treatment. In this paper a cognitive—behavioral conceptualization of persistent pain is described and contrasted with sensory, psychogenic, motivational, and operant conditioning models. A number of cognitive assessment procedures and recent research on the role of cognitive schemata, cognitive processes, and ongoing cognition in chronic pain are briefly summarized. The central importance of negative cognition — catastrophizing — is emphasized. Once pandora's cognitive box has been opened, a range of important issues must be addressed or one may be consumed by unbridled enthusiasm for the development of instruments and correlational research. Several caveats regarding current research on cognitive mediators are raised, namely, confounds among the cognitive measures that have proliferated and between cognitive measures and measures of mood states, generalizability of results based on pain clinic samples, and adherence to patient uniformity myths.
Thirty-six community residents with mixed headache symptomatology were assigned either to a group receiving cognitive-behavioral treatment or to a waiting list control. Treatment focused explicitly upon training subjects to manage headache attacks more effectively. During a baseline assessment and following completion of treatment, all participants self-monitored cognitive activity during headache and kept a written record of headache symptoms. Cognitions were obtained by means of a thought-sampling procedure in which subjects provided a series of cognitive reports during each headache episode. Headache cognitions were scored on five cognitive measures developed in a preliminary study. In comparison with controls, treated subjects appraised headache attacks in a more positive manner and reported more frequent occurrence of coping thoughts of a problem-solving nature. Changes in cognitive appraisal were also correlated with reductions in headache intensity following treatment. In addition, prior to treatment, reported levels of pain intensity appeared to be related to cognitive activity during headache. The findings provide support for a multidimensional model of pain and suggest that treatment effectiveness may be mediated by changes in particular cognitive reactions to headache.
Setting goals for coping that are based on time enhances subjects' ability to withstand painful stimuli in laboratory analog studies. This study sought to determine whether explicit time goals for using coping strategies would enhance treatment outcome in a clinical population. Subjects were 33 patients with chronic headache assigned to one of three 6-week groups: a goal group, given specific time goals for using coping strategies; an open group, given instructions to use strategies for as long as possible; and a waiting-list control group. Both treatment groups showed greater use of pain coping skills at posttreatment than the control group. Subjects with time goals reported lower headache activity and reported reductions in nonnarcotic medication use, whereas the control and open groups did not. The study suggests that goal specification can enhance the general efficacy of cognitive-behavioral therapy for treatment of chronic headache pain.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
Assigned 39 community residents, mean age 35.2 yrs, with chronic tension headache to 1 of 2 self-control treatment groups, a headache discussion group, or a symptom-monitoring control group. Ss in the 2 self-control treatment groups and in the headache discussion group were provided similar rationales for treatment and were taught to monitor their cognitive responses to stress-eliciting situations. Ss in the 2 self-control treatment groups were also taught either cognitive or both cognitive and relaxation coping skills for controlling tension headache. Ss in the headache discussion group were not provided with specific skills for controlling their headaches but were led in a discussion of the historical roots of their symptoms. Both the self-control treatments and the headache discussion procedure produced substantial reductions in headache that were maintained at a 6-wk follow-up. The symptom-monitoring control group showed no change in headache symptoms. These findings provide additional evidence of the effectiveness of cognitively oriented therapeutic procedures for the treatment of tension headache but raise questions concerning the active ingredients of these treatments. (41 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
96 undergraduates were stratified in terms of hypnotic susceptibility (high, medium, and low) on the Harvard Group Scale of Hypnotic Susceptibility, Form A. Ss next had 1 arm immersed in ice water for a 60-sec pretest and, afterward, were assigned to 1 of 4 treatments: (a) hypnosis plus analgesia suggestion, (b) hypnosis alone, (c) suggestion alone, or (d) no hypnosis––no suggestion. Ss were retested in ice water and then interviewed about their experiences during the retest. High susceptibles reported the use of more cognitive strategies during the retest and showed greater pretest-to retest pain magnitude reductions than did low susceptibles. Similar effects occurred for Ss given, as opposed to not given, a suggestion. The hypnosis variable, however, failed to affect either strategy use or pain magnitude. Strategy use facilitated pain reduction only for Ss who did not worry about and did not exaggerate the unpleasantness of the situation (i.e., noncatastrophizers). The few Ss who showed dramatic pretest-to-retest reductions in pain magnitude (50% reduction or more) were all high-susceptible noncatastrophizers who used one or more cognitive strategies. (37 ref)
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.
In a population-based telephone interview survey of 9,380 Washington County, Maryland, residents 12-29 years of age who reported a headache in the prior year, only 26.7% of women and 13.6% of men had ever sought a physician's advice for a headache problem. Women (13.9%) were more than twice as likely as men (5.6%) to have consulted a doctor for this condition within the previous 12 months. The likelihood of seeking medical care for headache increased with age among women but not men. Married women were more likely to have consulted with a physician for a headache problem than single or divorced women. Men and women consulting a doctor for this disorder within the previous 12 months described recent headaches (within the prior week) that were more severe, of longer duration (women only), and more likely to have migraine characteristics than recent headaches of persons not seeking medical attention. Compared with persons never consulting a physician for a headache problem, men and women who sought medical care had elevated attack rates of certain, probable, and possible migraine and mixed migraine-tension type headaches within the preceding week. Differences in attack rates for migraine and mixed migraine-tension headaches between those who recently and those who more than 12 months ago sought a physician's advice were more striking for men than for women.
Soft data are defined as measures having substantial intrasubject variability due to errors of measurement or to the inconsistency of subjects' responses. Such data are often important measures of response in randomized clinical trials. In this context, we show that using an intensive design and the slope of response on time as the outcome measure (a) maximizes sample retention and (b) decreases within-group variability, thus (c) maximizing the power of test procedures without requiring increased sample sizes.
SYNOPSIS
This study investigated change in cognitions of migraine patients as they progressed through biofeedback training. Specific cognitions investigated were beliefs about their ability to control physiological processes and their health in general, and coping strategies used.
Subjects were male and female patients presenting with chronic migraine headache at Sunnybrook Medical Centre. They completed the Health Locus of Control, PSC Belief Survey and Cognitive Coping Questionnaire at three different intervals - pre-, mid- and post-treatment. The results showed that patients became more internal about their beliefs to control their general health, held higher beliefs of ability to control their physiological processes, and were ignoring their pain sensations more than when they started treatment. There was a trend for patients to increase the use of coping self-statements and to decrease catastrophizing. Interestingly, the significant change in cognitions took place between pre- and mid-treatment (i.e. before biofeedback training occurred). There were some significant correlations between the cognitive and physiological measures, and headache outcome.
The purpose of this study was to investigate how headache sufferers and headache-free controls differ in their responses to acute pain. Thirty-three women completed the study (15 headache sufferers and 18 controls). The cold pressor was used to induce pain, and a partially inflated blood pressure cuff was used as a nonpainful comparison task. Headache sufferers reported more discomfort during both tasks; however, the 2 groups did not differ in the number of facial expressions of pain displayed during the tasks. Headache sufferers reported a tendency to catastrophize during both tasks; positive coping did not differ between the 2 groups. These results offer evidence that recurrent tension headache sufferers are more sensitive to both painful and nonpainful stimuli and that they cope differently from controls with these physical stressors.
The amended (revised) Beck Depression Inventory (BDI-IA; Beck & Steer, 1993b) and the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) were self-administered to 140 psychiatric outpatients with various psychiatric disorders. The coefficient alphas of the BDI-IA and the BDI-II were, respectively, .89 and .91. The mean rating for Sadness on the BDI-IA was higher than it was on the BDI-II, but the mean ratings for Past Failure, Self-Dislike, Change in Sleeping Pattern, and Change in Appetite were higher on the BDI-II than they were on the BDI-IA. The mean BDI-II total score was approximately 2 points higher than it was for the BDI-IA, and the outpatients also endorsed approximately one more symptom on the BDI-II than they did on the BDI-IA. The correlations of BDI-IA and BDI-II total scores with sex, ethnicity, age, the diagnosis of a mood disorder, and the Beck Anxiety Inventory (Beck & Steer, 1993a) were within 1 point of each other for the same variables.
To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees.
Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions.
Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies.
These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.
The aim of the present study was to ascertain the effects of two behavioral medicine approaches to the treatment of migraine. We also evaluated the specific effect of the sequence of the two treatments. Thirty-eight patients, suffering from migraine without aura, either obtained treatment in the following sequence: blood-volume-pulse biofeedback followed by cognitive behavioral therapy (Group I) or were given the treatment in reverse order (Group II). The effects of treatment in Group I were significantly better than those in Group II. We conclude that the application of biofeedback helps the patient to recognize the influence of thoughts and emotions on bodily reactions and therefore prepares the way for successful cognitive treatment.
The present study examined the role of catastrophizing in predicting levels of pain and disability in a sample of individuals who had sustained soft-tissue injuries to the neck, shoulders or back following work or motor vehicle accidents. Participants were 86 (27 men, 59 women) consecutive referrals to the Atlantic Pain Clinic, a multidisciplinary treatment centre for the management of persistent pain disorders. Findings revealed that catastrophizing, measured by the Pain Catastrophizing Scale (PCS; Sullivan, M.J.L. et al., Psychol. Assess., 7 (1995) 524-532) was significantly correlated with patients' reported pain intensity, perceived disability and employment status. The results of a regression analysis further showed that catastrophizing contributed to the prediction of disability over and above the variance accounted for by pain intensity. In addition, catastrophizing was associated with disability independent of the levels of depression and anxiety. The rumination subscale of the PCS was the strongest predictor of pain and disability. Theoretical and clinical implications of the findings are discussed.
Catastrophizers and non-catastrophizers were asked to disclose about their dental worries prior to undergoing dental hygiene treatment. It was hypothesized that the effects of emotional disclosure would vary as a function of the level of catastrophizing; where catastrophizers would be more likely than non-catastrophizers to show reductions in pain and emotional distress. The study also examined whether emotional disclosure influenced subsequent levels of catastrophizing and dental anxiety. Eighty undergraduate students were randomly assigned to a disclosure condition or a control condition prior to undergoing a scaling and root planing procedure. In the control condition, catastrophizers reported significantly more pain and emotional distress than non-catastrophizers. In the disclosure condition, catastrophizers and non-catastrophizers did not differ significantly in their pain and emotional distress. The interaction between condition and level of catastrophizing remained significant even when controlling for emotional distress and the emotional content of the thought records. While catastrophizers benefited from disclosure in regard to their immediate physical and emotional experience, their levels of catastrophizing and dental anxiety remained essentially unchanged. Theoretical and clinical implications of the findings are discussed.