Chronic Pain Acceptance Questionnaire Research Articles

Investigating the Relationship between Empowerment and Chronic Pain Acceptance and the Resulting Limitations in the Elderly with Diabetes Living Southwest of Iran

Background AimConsidering the importance of pain acceptance in adjusting to chronic pain among diabetic patients, this study was conducted to determine the relationship between the empowerment scale and the level of chronic pain acceptance among the elderly with diabetes and the resulting limitations. MethodThis is a descriptive-analytical study on 250 older patients (65 years and older) with diabetes. The samples were selected through random convenience sampling, performed during 2019 to 2020 in the health centers of Ahvaz, Iran. The data were collected using the demographic information checklist and standard questionnaires including chronic pain acceptance questionnaire (CPAQ), the scale of chronic pain-related limitations, and the diabetes empowerment scale-short form (DES-SF). The data were analyzed using SPSS V24. ResultsThe majority of the samples were male (56%) and the mean age of the participants was 70.96 ± 8.95 years. The results showed that the mean and standard deviation were reported to be 20.04 ± 4.63 for pain acceptance, 46.16 ± 10.85 for chronic pain-related limitations, and 27.24 ± 9.65 for the empowerment scale. According to regression coefficients, the mean score of empowerments of patients with diabetes has no significant relationship with pain acceptance (p = .199, b = -0.327) and pain-related limitations (p = .925, b = 0.004). ConclusionsBased on the results of this study, the level of empowerment, pain acceptance, and pain-related limitations in the older patients with diabetes was moderate and there was no significant relationship between them. Identifying vulnerable groups in the field of chronic pain and preventive, educational and therapeutic interventions will help increase patients’ self-care capacity and reduce the limitations and the disability caused by pain.

Validation of the Japanese version of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8).

This study aimed to examine the reliability and validity of the Japanese version of the Chronic Pain Acceptance Questionnaire (CPAQ-8J). A total of 108 outpatients with chronic pain completed the CPAQ-8 questionnaire, along with the Acceptance and Action Questionnaire-II, Hospital Anxiety and Depression Scale, Pain Disability Assessment Scale, Numerical Rating Scale, and EuroQol 5 dimensions 5-level. Confirmatory factor analyses examined the factor structure. Results indicated that the CPAQ-8J comprised a two-component factor structure. Correlations between the CPAQ-8J and each variable were as expected, except between the "pain willingness" subscale and other scales ; thus, the CPAQ-8J had a certain degree of convergent validity. Internal consistency and test-retest reliability suggest that the CPAQ-8J is reliable. The psychometric properties of the CPAQ-8J meet a certain standard ; meanwhile, some issues must be addressed for its practical application. Further research should consider the influence of cultural characteristics in practical application. J. Med. Invest. 70 : 88-93, February, 2023.

Presenting a model of pain outcomes in patients with chronic low back pain based on mood and anxiety symptoms and emotional schemas: The mediating role of experiential avoidance and self-compassion

Introduction: Various psychological factors, such as mood and anxiety symptoms, can affect pain outcomes. Aim: The present research was conducted to identify these factors aiming at providing a conceptual model of pain outcomes based on emotional schemas and symptoms mediated by experiential avoidance, pain acceptance, and self-compassion of patients with chronic pain. Method: In this descriptive correlational research, the statistical population consisted of men and women (aged 30-50) with chronic low back pain referring to pain clinics in Akhtar, Labafinejad, and Imam Hossein hospitals, Tehran, Iran, in 2019-2020. We selected 400 people using a convenience sampling method considering the inclusion criteria. The tools included the Mood and Anxiety Symptoms Questionnaire (MASQ), Emotional Schemas-Short Form, Acceptance and Action Questionnaire (AAQ), Chronic Pain Acceptance Questionnaire (CPAQ) and the Self-Compassion Scale (SCS). Data were analyzed with SPSS-21 and LISREL-8.8 using Structural Equation Modeling (SEM). Results: The fitted model showed that the direct effect of mood and anxiety symptoms on increasing emotional schemas (p<0.05) was equal to 5, and the direct effect of emotional schemas was significant on increasing experiential avoidance, reducing pain acceptance and self-compassion (p<0.05). Also, the indirect effect of mood and anxiety symptoms through increasing emotional schemas, increasing experiential avoidance, decreasing pain acceptance, and self-compassion on increasing pain outcomes was significant (p<0.05). Conclusion: Experiential avoidance, pain acceptance, and self-compassion could mediate the relationship between emotional symptoms and emotional schemas to pain outcomes. Therefore, developing therapeutic interventions based on emotional schemas to reduce emotional schemas and experiential avoidance and increase pain acceptance and self-compassion could help reduce pain outcomes in patients with chronic pain.

Psychological Profile in Women with Chronic Pelvic Pain.

(1) Background: Chronic Pelvic Pain (CPP) is a prevalent medical condition with a complex treatment due to different variables that influence its clinical course. (2) Methods: Psychological variables such as depression, anxiety, catastrophizing or neuroticism have been described as influencing CPP. This is a cross-sectional study of 63 patients with CPP sent for a psychological evaluation due to participation in group therapy for CPP. The main purpose of this study was to characterize the baseline psychological characteristics of women with CPP. The NEO Five Factor Inventory (NEO-FFI), State and Trait Anxiety Inventory (STAI), Beck Depression Inventory-Fast Screen (BDI-FS), Pain Catastrophizing Scale (PCS) and Chronic Pain Acceptance Questionnaire (CPAQ) were performed. (3) Results: The personality profile of patients (NEO FFI) shows high neuroticism, low extraversion and low conscientiousness. The 25.4% of patients had moderate or severe depression according to BDI-FS results, almost half of the patients had high levels of anxiety trait (>P75, 49.2%) and more than half the patients had high levels of anxiety state (>P75, 59.5%). Punctuations of PCS and CPAQ are similar to patients with fibromyalgia. (4) Conclusions: CPP is associated with high levels of depression, anxiety, neuroticism, catastrophizing and low pain acceptance. It is important to develop interventions that can modify these psychological factors in order to improve the clinical course of CPP.

Catastrophizing, Kinesiophobia, and Acceptance as Mediators of the Relationship Between Perceived Pain Severity, Self-Reported and Performance-Based Physical Function in Women with Fibromyalgia and Obesity.

PurposeIndividuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity.Patients and MethodsIn this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed.ResultsPain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning.ConclusionPain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning.

The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain-A Randomized Controlled Trial.

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.

Pain acceptance and illness intrusiveness in low-back pain: A longitudinal study.

BackgroundIn chronic pain syndromes, acceptance of pain may be a better approach than pain control. So far, little data have been available on how pain and its acceptance affect illness intrusiveness among patients with low-back pain (LBP).ObjectiveThe present longitudinal study evaluates the impact of pain acceptance on illness intrusiveness in patients with LBP.MethodsStudy participants were asked to complete the following questionnaires during their visit (T1) at one of four diverse rheumatologic outpatient clinics, and then 2–3 months later (T2) via phone or online: Chronic Pain Acceptance Questionnaire (CPAQ), Illness Intrusiveness Rating Scale (IIRS), Roland-Morris Disability Questionnaire (RMDQ), Patient Health Questionnaire Depression subscale (PHQ9), and socioeconomic data.ResultsOne hundred and twenty-seven individuals completed the questionnaires at baseline (31 having acute, 15 subacute and 81 chronic low back pain) and 97 at follow-up. Illness intrusiveness was negatively correlated with chronic pain acceptance both at T1 (r = −0.39) and T2 (r = –0.44). Illness intrusiveness scores have not changed significantly from T1 (M = 28.59 SD = 13.08) to T2 (M = 28.24, SD = 15.76). In a multiple regression model—including pain intensity, functional status, pain acceptance, depression severity, age, sex and educational level—the independent predictors of follow-up illness intrusiveness scores were lower pain acceptance and higher depression scores.ConclusionsIn our study, patients with acute, subacute and chronic low back pain reported similar levels of illness intrusiveness. In addition, illness intrusiveness scores have not changed significantly during the 2-month follow-up period and pain acceptance proved to be a significant independent predictor of illness intrusiveness among patients with chronic low-back pain.

Validation of the Turkish Chronic Pain Acceptance Questionnaire-8.

The aim of this study was to test the validity of the Turkish version of the Chronic Pain Acceptance Questionnaire (CPAQ)-8. This methodological and cross-sectional study was conducted with 80 female patients (mean age: 49.5±10 years; range, 28 to 75 years) diagnosed with fibromyalgia syndrome between January 2020 and December 2021. Participants completed the Turkish version of the CPAQ-8, as well as the Fibromyalgia Impact Questionnaire, Brief Pain Inventory, Hospital Anxiety and Depression Scale, and Tampa Kinesiophobia Scale. Internal consistency, confirmatory factor analysis, and construct validity were examined in the statistical analysis of the data obtained. The two-factor model created by exploratory factor analysis provided a better fit than the global factor model. Cronbach's alphas of both subscales of the CPAQ-8 were found to be 0.76 and 0.80; therefore, they provided internal consistency. The CPAQ-8 was found to be significantly correlated with all other scales compared. The Turkish version of the CPAQ-8 is an assessment tool with sufficient validity in assessing pain acceptance levels in fibromyalgia patients experiencing chronic pain. Future studies are needed to evaluate the validity and reliability of the questionnaire in different chronic pain models.

The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients.

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.

Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial.

BackgroundCombination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions.ObjectiveThe aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting.MethodsA randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment.ResultsPositive effects were found in the intervention group (T2–T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (−0.72 vs 0.1; P=.002), rumination (−1.59 vs −0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs −0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs −0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; −0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (−0.65 vs 0.01; P=.07), rumination (1.23 vs −0.59; P=.04), and magnification (0.1 vs 0.86; P=.02).ConclusionsThe results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments.Trial RegistrationClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154

Preferred Self-Administered Questionnaires to Assess Resilience, Optimism, Pain Acceptance, and Social Support in People with Pain: A Modified Delphi Study.

The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A three-round modified Delphi study. Forty international experts. In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don't know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0-10 Likert scale. Consensus was reached if ≥75% of experts rated the questionnaire ≥7. From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires. We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.

The Role of Pain Acceptance, Pain Catastrophizing, and Coping Strategies: A Validation of the Common Sense Model in Females Living with Fibromyalgia

This study aimed to examine the extent to which illness beliefs, coping styles, pain acceptance, pain catastrophizing, and psychological distress mediate the relationship between fibromyalgia symptoms and quality of life (QoL) in a female cohort diagnosed with Fibromyalgia (n = 151). Measures used included the Revised Fibromyalgia Impact Questionnaire, Carver Brief COPE scale, Chronic Pain Acceptance Questionnaire Revised, Pain Catastrophizing Scale, Brief Illness Perceptions Questionnaire, Depression and Anxiety Stress Scales, and European Health Interview Survey Quality of Life 8-item Index. Using structural equation modelling, the final model indicated that fibromyalgia symptom severity had a significant direct influence on illness perceptions and psychological distress. In turn, illness perceptions had a significant direct influence on maladaptive coping, pain catastrophizing, pain acceptance, and QoL. Pain catastrophizing and maladaptive coping influenced psychological distress, and in turn distress impacted QoL. Acceptance of pain was found to be influenced by maladaptive coping and in turn acceptance of pain influenced QoL.

The Mediating Role of Coping Strategies and Emotion Regulation in the Relationship Between Pain Acceptance and Pain-Related Anxiety.

Pain is an unpleasant sensory and emotional experience that exists all over the world and has a negative effect on people's ability to engage in valuable life activities. The present study was conducted aiming to investigate the mediating role of coping strategies and emotion regulation in the relationship between pain acceptance and pain anxiety. The research design was descriptive, and the sample consisted of 428 students selected via purposive sampling. Pain Anxiety Symptoms Scale (PASS-20), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), Ways of Coping Questionnaire (WCQ), The Multidimensional Pain Inventory (MPI), and Emotion Regulation Questionnaire (ERQ) were used as research tools. The results obtained from the correlation revealed that there is a significant relationship between pain acceptance and pain anxiety, coping strategies, and emotion regulation. Structural Equation Modeling (SEM) showed that coping strategies and emotion regulation are able to mediate the relationship between pain acceptance and pain anxiety. In general, results revealed that adaptive coping strategies can be effective in coping with pain; emotional components play an important role in this regard. These results demonstrate the importance of attitude and self-regulation in coping with pain, and suggest that people can expand their adaptation to pain by assessing the situation and adopting an effective coping style.

Improved pain acceptance and interference following outpatient interdisciplinary pediatric chronic pain treatment

Objectives Intensive interdisciplinary chronic pain treatment programs have demonstrated that pain acceptance predicts positive treatment outcomes, but limited research has focused on less-intensive programs. This study aimed to examine associations between changes in pain acceptance and pain interference among youth participating in an outpatient interdisciplinary chronic pain treatment program. Design Youth presenting to an evaluation within an interdisciplinary outpatient pediatric chronic pain program completed questionnaires at initial program evaluation (T1) and three months later (T2). Main Outcome Measures Youth (N = 94, Mage = 14.59 years, 74% female) completed the Chronic Pain Acceptance Questionnaire, Adolescent Version (CPAQ-A) and PROMIS Pediatric Pain Interference scale. Results Pain acceptance increased significantly from T1 to T2 (p=.001), driven primarily by activity engagement (p=.001). Pain interference decreased from T1 to T2 (p<.001). Improvements in acceptance were strongly associated with reductions in interference (p<.001). An exploratory cross-lagged structural equation model revealed a number of direct and indirect effects between pain acceptance and pain interference at T1 and T2. Conclusion Pain acceptance and interference improved after three months in an outpatient chronic pain treatment program. Improvements in acceptance were strongly related to reductions in interference. Future research should examine these relationships over longer periods, in larger samples.

Internet-based Treatment for Vulvodynia (EMBLA) – A Randomized Controlled Study

Internet-based ACT (Acceptance and commitment therapy) treatment may improve accessibility and reduce stigma related to seeking health care, but there are a lack of studies investigating internet-based treatment using ACT principles for women with vulvodynia. The aim of this study was to investigate the effects of an internet-based treatment of pain during intercourse for women with provoked vulvodynia compared with no intervention during the waiting period before clinical treatment. A multicenter randomized controlled trial was conducted during 2016 to 2020, in which 99 participants were included. Participants were randomized to either a 6 week guided internet-based treatment using ACT principles or usual care. Data were collected at baseline, 6 weeks after baseline, and approximately 10 months after baseline. Pain-related (pain during intercourse, tampon test, impact of pain on sexual function) and pain behavior-related outcomes (attempts at intercourse, sexual activities besides intercourse, willingness to perform the tampon test, chronic pain acceptance questionnaire) were used as outcomes. Treatment was efficacious in what concerns pain during intercourse and pain acceptance. Less pain during intercourse among women in the intervention group was observed at both post-treatment (primary endpoint, P = .01, Cohen's d = 1.4, 95% CI = 0.33, 2.4), and follow-up (P = .04). Absolut mean difference between groups for pain during intercourse at post-treatment was -2.84, (95 % CI = -4.91, -0.78), and -1.58 at follow-up, (95 % CI = -3.17, 0.02), where the intervention group rated less pain than controls. No differences between groups over time were found for tampon test measures or impact of pain on sexual function. There was a significant difference between groups at all timepoints indicating fewer attempts at intercourse among participants in the intervention group. At post-treatment, women who underwent internet-based treatment reported higher pain acceptance and a rise in activity engagement compared with the control group. There is an indication that internet-based treatment could be incorporated into clinical practice as a complement to clinical treatment. Study strengths included using several forms of recruitment and an intervention built by different professions with long experience of treating patients with vulvodynia. High dropout rate was a limitation of this study. Internet-based treatment may have an impact on pain during intercourse and positive effects on pain acceptance. However, conclusions must be drawn with caution due to the small sample size.

Linguistic indicators of chronic pain acceptance in individuals with spinal cord injury.

Pain acceptance is a robust predictor of adjustment to chronic pain, including pain in those with spinal cord injury (SCI). This preliminary study aimed to identify linguistic patterns indicative of chronic pain acceptance to gain new insights into the underlying cognitive-emotional process of this construct. Individuals with SCI and chronic pain (N = 30) completed the Chronic Pain Acceptance Questionnaire (CPAQ) and a semistructured interview about their pain. Linguistic Inquiry and Word Count software was used to quantify linguistic categories of interest in transcribed interviews. Results of hierarchical linear regressions (controlling for pain intensity, age, and education) showed that personal pronouns explained an additional 26.9% of the variance in CPAQ activity engagement, which was associated with a lower frequency of first-person plural pronouns and a higher frequency of third person pronouns. Conjunction words explained an additional 12.8% and 19.2% of the variance in CPAQ total and pain willingness scores, respectively; frequency of conjunction words was negatively associated with acceptance. Perceptual processes words accounted for an additional 39.9% of the variance in pain willingness, which was associated with a lower frequency of seeing words and a higher frequency of hearing and feeling words. Findings suggest that pain acceptance is associated with unique linguistic patterns that can be identified in natural word use among individuals with SCI and chronic pain. Future research to further investigate linguistic indicators of pain acceptance and other clinically relevant pain constructs is warranted and could advance theoretical models of pain adaptation and clinical approaches to treating pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)\u2014efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up

BackgroundOpioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering.The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering.MethodsThe study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included.When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed.DiscussionA better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society.Trial registrationClinicalTrials.gov NCT03485430. Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.

Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive-behavioural therapy-based programmes.

ObjectiveInterdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes.MethodsWe used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions.ResultsNeither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres.ConclusionsThese findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.

The effectiveness of acceptance and commitment therapy on sociooccupational compatibility and acceptance of symptoms in patients with painful Diabetic Neuropathy: A single-blind randomized clinical trial

Introduction: Neuropathic pain is a common complication of diabetic patients. In these people, the pain reduces the work and social adjustment. Aim: The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy on chronic pain acceptance and the work and social adjustment in patients with painful diabetic neuropathy. Method: This study was a quasi-experimental study in which patients were randomly divided into intervention and control groups. Participants were all patients with a diagnosis of diabetic neuropathy referred to the neurology department of Farabi Hospital in Kermanshah in 2019. Instruments included Chronic Pain Acceptance Questionnaire (CPAQ) and the Work and Social Adjustment Scale (WSAS). The results of three phases of pre-test, post-test and follow-up were evaluated. Data were analyzed by descriptive statistics, the repeated measures ANOVA, and chisquare tests using SPSS version 22. Results: The results demonstrate that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and the work and social adjustment in the intervention group as compared to controls. In the acceptance variable, the test results within the group showed that the effect of time (P=0.003, F=6.48) and the interactive effect of time and group (P=0.001, F=12.49) were significant. Also in the variables of work and social adjustment, the effect of time (P=0.046, F=3.21) and the interactive effect of time and group (P=0.028, F=3.74) were reported (p&gt;0.001). Conclusion: Acceptance and commitment therapy can be used as a psychological intervention along with drug therapy to improve the work and social adjustment and acceptance symptoms in patients with painful diabetic neuropathy (PDN).