Multidimensional Pain Inventory Research Articles

Experiential Avoidance as a Factor in Generalized Psychological Vulnerability: In the Relationship Between Chronic Pain and Pain Anxiety With Pain Disability

BackgroundPain is a major socio-psychological problem worldwide. Chronic pain has a negative effect on areas of psychological functioning such as depression, anxiety, and perceived stress. AimThe present study investigated the mediating role of experiential avoidance in the relationship between chronic pain and pain anxiety with pain disability. MethodsParticipants were treatment-seeking patients (N = 361) at an outpatient pain clinic in Shiraz (Fars, Iran). The Multidimensional Pain Inventory (MPI), Pain Anxiety Symptom Scale (PASS-20), Pain Disability Questionnaire (PDQ), and Acceptance and Action Questionnaire-II (AAQ-II) were used to measure multidimensional pain, anxiety, pain disability, experiential avoidance, and pain severity. ResultsThe results of the correlation revealed that a significant relationship exists between multidimensional pain and pain anxiety, pain disability, and experiential avoidance. Experiential avoidance mediated the associations from multidimensional pain and pain disability significantly. Also, experiential avoidance moderated associations between pain anxiety and pain disability significantly. In general, Structural Equation Modeling (SEM) showed that experiential avoidance mediated the relationship between multidimensional pain and pain anxiety with pain disability. ConclusionIn general, the results revealed that experiential avoidance can mediate the relationship among pain, pain anxiety, and pain disability as a maladaptive regulation strategy. The results obtained from this study seem to introduce experiential avoidance as a vulnerability factor effectively.

Adaptation and validation of the west haven-yale multidimensional pain inventory for Pakistani population.

To evaluate the adapted version of West Haven-Yale Multidimensional Pain Inventory for patients with chronic pain. The multiphase study was conducted from January to December 2021. The factorial structure of the Urdu version of West Haven-Yale Multidimensional Pain Inventory was evaluated on a sample of adult patients aged 18- 45 years with non-specific chronic pain, taken from public and private hospitals and clinics of Lahore, Pakistan. The Urdu version was then subjected to factor analysis, while Cronbach's alpha, composite reliability, convergent and discriminant validity of the scale were also calculated. Data was analysed using SPSS 24. Of the 306 subjects, 204(66.7%) were females and 102(33.3%) were men. The overall mean age was 30.94+/-8.44 years. There were 166(54.2%) subjects who were married, and 137(44.8%) reported experiencing pain daily. The confirmatory factor analysis showed a 45-item structure for 12 sub-scales as the best fit. The statistics for the final model were observed as minimum discrepancy function by degrees of freedom divided was 1.69, root mean square error of approximation was 0.05, and standardised root mean square residual was 0.06. Comparative fit index value was 0.91 and Tucker-Lewis coefficient was 0.90. Cronbach's alpha reliability ranged between 0.68 and 0.89 for the subscales, while for the total scale, it was 0.72. The Urdu version of West Haven-Yale Multidimensional Pain Inventory was found to be a reliable and valid tool for chronic pain assessment for patients in Pakistan.

Orthopaedic Hand Patient Support Systems Have Valuable Insight to Patient Function and Pain

Patient-reported outcome measures (PROs) are increasingly used in clinical assessment. Research on how patient support systems contribute to physician understanding of patient condition is limited. Thus, insights from significant others may provide value, especially when concerns exist regarding patient response validity. Patients recruited from the pre-operative environment undergoing orthopaedic hand procedures responded to PROMIS-Pain Interference (PI), PROMIS-Upper Extremity (UE), PROMIS-Depression (D), and QuickDASH. They then selected a significant other (SO) to do the same. Patients and SOs were also asked to complete the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) as a measure of support-related responses. Patient and SO responses were compared, and support-related responses were added in subsequent analyses to examine their effect on SO PRO assessment.

Transaksiyonel Stres ve Başetme Modeline Göre Kronik Ağrı Yaşantısı: Farklı Ağrı Ölçümleri ve Sağlık Sonuçları Arasındaki İlişkiler

According to Lazarus and Folkman's Transactional Stress and Coping Model, chronic pain is defined as a source of stress. The model emphasizes the interaction between the person and the environment and focuses on primary (pain severity and/or frequency) and secondary appraisals (pain and/or discomfort from pain) when examining the effects of a stressor on a person's life. In this study, chronic pain was defined as a type of stress and pain stress was measured in three different ways: unidimensional pain stress (primary appraisal only), multidimensional pain stress (sum of both primary and secondary appraisals), and transactional pain stress (product of both primary and secondary appraisals). The aim of the study was to examine the relationships between the three different pain stress measures and the outcome variables of pain-related disability, negative mood and daily activity level. The study was conducted with 167 individuals with different types of chronic pain. Sociodemographic Characteristics and Pain Information Form, Visual Analog Scale, West Haven Yale Multidimensional Pain Inventory and Life Changes Questionnaire were used as data collection tools. The results of the study showed that there were significant relationships between unidimensional pain stress and disability and negative mood (r(1,167) = 0.33; 0.36, respectively); multidimensional pain stress and disability and negative mood (r(1,167) = 0.51; 0.38, respectively); transactional pain stress and disability, negative mood (r(1,167) = 0.43; 0.37, respectively) and daily activity (r(1,167) = -0.24). The results indicate the significance of new measures in the assessment of pain experience.

Psychological Treatment Targeting Acceptance and Compassion in Chronic Pain Patients: A Randomized Controlled, Internet Delivered, Treatment Trial.

Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. Missing data at post-intervention was 22.5%. Intention to treat (ITT) analyses were conducted using linear mixed-models. Results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favour for the treatment group. Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.

The Roles of Depression, Life Control and Affective Distress on Treatment Attendance and Perceived Disability in Chronic Back Pain Sufferers throughout the Duration of the Condition.

The aims of this study were to examine psychological factors that predict treatment seeking and disability over the total duration of experiencing back pain. A sample of 201 adults experiencing chronic back pain was recruited through health professionals and completed the Depression, Anxiety and Stress Scale (DASS), the Oswestry Back Pain Disability Questionnaire (ODQ), the McGill Pain Questionnaire (MPQ) and the life control and affective distress variables of the West Haven-Yale Multidimensional Pain Inventory (WHYMP), and participants disclosed the number of treatment sessions attended over the course of the illness. Depression, life control and affective distress were tested as indirect predictors of disability severity that were mediated by treatment attendance. Each unit increase in life control predicted attending nearly 30 more treatment sessions, each unit increase in affective distress predicted attending 16 fewer treatments and each unit increase in depression predicted 4 fewer treatments, together explaining 44% of variance in treatment seeking. The effects of life control and affective distress on disability were explained by treatment attendance, whereas depression retained a direct effect on disability. Treatment attendance had an effect on disability. The findings show that participants with lower life control and higher affective distress and depression had higher levels of pain and disability, in part due to due to their treatment-seeking behaviour.

The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions.

The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect. Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus. Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target. Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.

Coping strategies, illness perceptions, and relationship dynamics contribute to female sexual function and sexual distress in Sjögren's syndrome.

Sexual dysfunction and sexual distress are common complaints for women with the autoimmune rheumatic disease Sjögren's syndrome (SS); however, the role of psychosocial and interpersonal factors has not previously been explored in SS. This study investigated whether psychosocial variables, such as coping strategies, illness perceptions, and relationship dynamics, contributed to sexual function and sexual distress for women with SS. Participants with SS completed an online cross-sectional survey that included prevalidated questionnaires assessing sexual function, sexual distress, disease-related symptom experiences, cognitive coping strategies, illness perceptions, relationship satisfaction, and partners' behavioral responses. Multiple linear regression was used to identify factors significantly associated with sexual function (total Female Sexual Function Index [FSFI] score) and sexual distress (total Female Sexual Distress Scale score) for women with SS. Study outcome measures were the FSFI, Female Sexual Distress Scale, EULAR Sjӧgren's Syndrome Patient Reported Index, numeric rating scale for vaginal dryness (0-10), Profile of Fatigue and Discomfort, Cognitive Emotion Regulation Questionnaire (CERQ), Brief Illness Perceptions Questionnaire (B-IPQ), West Haven-Yale Multidimensional Pain Inventory (WHYMPI), and Maudsley Marital Questionnaire. A total of 98 cisgender women with SS participated in the study (meanage = 48.13 years, SD = 13.26). Vaginal dryness was reported by 92.9% of participants, and clinical levels of sexual dysfunction (total FSFI score <26.55) were observed in 85.2% (n = 69/81) of cases. More vaginal dryness, lower CERQ positive reappraisal, and higher CERQ catastrophizing were significantly associated with poorer self-rated sexual function (R2 = 0.420, F3,72 = 17.394, P < .001). Higher CERQ rumination, lower CERQ perspective, lower WHYMPI distracting responses, and higher B-IPQ identity were significantly associated with higher sexual distress (R2 = 0.631, F5,83 = 28.376, P < .001). This study suggests that interpersonal and psychosocial factors are important contributors to sexual function and distress in women with SS and that the development of psychosocial interventions for this population is warranted. This study is one of the first to explore the impacts of coping strategies, illness perceptions, and relationship dynamics on sexual function and sexual distress for women with SS. Limitations of our study include its cross-sectional nature and narrow sample demographic, which limit the generalizability of our results to other population groups. Women with SS who utilized adaptive coping strategies had better sexual function and lower levels of sexual distress than women who utilized maladaptive coping strategies.

Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial

To evaluate the efficacy and safety of acupuncture in the treatment of endometriosis-associated pain. A multicenter, randomized, single-blind, placebo-controlled trial. Four tertiary hospitals in Jiangxi and Hainan Provinces. Women with endometriosis-associated pain aged between 20 and 40 years. Subjects were assigned randomly to receive either acupuncture or sham acupuncture treatment for 12 weeks, starting one week before each expected menstruation and administered as a 30-minute session once per day, 3 times a week. During the menstruation period, acupuncture was administered daily when pelvic pain associated with endometriosis occurred. After acupuncture or sham acupuncture treatment, the subjects were followed for another 12 weeks. Changes in maximum pain as assessed with the visual analog scale (VAS) for various pelvic pain, duration of dysmenorrhea, and scores on the Multidimensional Pain Inventory, Beck Depression Inventory, Profile of Mood States, and Endometriosis Health Profile from baseline to week 12 and week24. A total of 106 women were assigned randomly to the acupuncture and sham groups. In the acupuncture group, the reduction in the dysmenorrhea VAS score was significantly greater after treatment, but not at the end of the trial, compared to the sham group. The duration of pain was significantly shorter in the acupuncture group. All test scores were improved to a significantly greater extent in the acupuncture group than in the sham group at week 12 but not at week 24. Changes in nonmenstrual pelvic pain and dyspareunia VAS scores were not different between the groups. No severe adverse events or differences in adverse events were recorded. Acupuncture is an effective and safe method of relieving dysmenorrhea, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain, although its efficacy fades after treatment is discontinued. NCT03125304.

The Effectiveness of Acceptance and Commitment Therapy and on Pain Intensity, Childhood Trauma, Perfectionism and Psychological Flexibility in Patients with Chronic Pain

Objective: Chronic pain often leads to distress, morale weakness, and functional impairment, becoming a primary source of suffering and economic burden. This research aimed to determine the effectiveness of Acceptance and Commitment Therapy (ACT) on pain intensity, childhood trauma, perfectionism, and psychological flexibility in patients with chronic pain. Materials and Methods: This applied, quasi-experimental pre-test, post-test, and follow-up study with a control group included 198 patients with chronic pain from Tehran's pain clinics. Fifty patients were selected through purposive sampling based on inclusion and exclusion criteria and randomly divided into two groups: ACT (25 participants) and control (25 participants). Data were collected using the West Haven-Yale Multidimensional Pain Inventory (Kerns et al., 1985), Childhood Trauma Questionnaire (Bernstein et al., 2003), Frost Multidimensional Perfectionism Scale (Frost et al., 1990), and Acceptance and Action Questionnaire-II (Bond et al., 2011). The ACT for chronic pain was conducted in seven 60-minute group sessions over two months, based on a treatment package (McCracken, 2015). Data analysis utilized repeated measures ANOVA and SPSS software version 22. Findings: Results showed that ACT significantly affected pain intensity (F = 57.99, p &lt; 0.001), childhood trauma (F = 144.38, p &lt; 0.001), perfectionism (F = 68.87, p &lt; 0.001), and psychological flexibility (F = 5.87, p &lt; 0.001) in patients with chronic pain. Conclusion: ACT is effective in reducing pain severity, childhood trauma, perfectionism, and enhancing psychological flexibility in patients with chronic pain and can be used to alleviate psychological problems in these individuals.

The PerPAIN trial: a pilot randomized controlled trial of personalized treatment allocation for chronic musculoskeletal pain-a protocol.

The therapy of chronic musculoskeletal pain (CMSP) is complex and the treatment results are often insufficient despite numerous therapeutic options. While individual patients respond very well to specific interventions, other patients show no improvement. Personalized treatment assignment offers a promising approach to improve response rates; however, there are no validated cross-disease allocation algorithms available for the treatment of chronic pain in validated personalized pain interventions. This trial aims to test the feasibility and safety of a personalized pain psychotherapy allocation with three different treatment modules and estimate initial signals of efficacy and utility of such an approach compared to non-personalized allocation. This is a randomized, controlled assessor-blinded pilot trial with a multifactorial parallel arm design. CMSP patients (n = 105) will be randomly assigned 1:1 to personalized or non-personalized treatment based on a cluster assignment of the West Haven-Yale Multidimensional Pain Inventory (MPI). In the personalized assignment condition, patients with high levels of distress receive an emotional distress-tailored intervention, patients with pain-related interference receive an exposure/extinction-tailored treatment intervention and patients who adapt relatively well to the pain receive a low-level smartphone-based activity diary intervention. In the control arm, patients receive one of the two non-matching interventions. Effect sizes will be calculated for change in core pain outcome domains (pain intensity, physical and emotional functioning, stress experience, participant ratings of improvement and satisfaction) after intervention and at follow-up. Feasibility and safety outcomes will assess rates of recruitment, retention, adherence and adverse events. Additional data on neurobiological and psychological characteristics of the patients are collected to improve treatment allocation in future studies. Although the call for personalized treatment approaches is widely discussed, randomized controlled trials are lacking. As the personalization of treatment approaches is challenging, both allocation and intervention need to be dynamically coordinated. This study will test the feasibility and safety of a novel study design in order to provide a methodological framework for future multicentre RCTs for personalized pain psychotherapy. German Clinical Trials Register, DRKS00022792 ( https://www.drks.de ). Prospectively registered on 04/06/2021.

Primary mitochondrial myopathy: 12-month follow-up results of an Italian cohort

ObjectivesTo assess natural history and 12-month change of a series of scales and functional outcome measures in a cohort of 117 patients with primary mitochondrial myopathy (PMM).MethodsTwelve months follow-up data of 117 patients with PMM were collected. We analysed the 6-min walk test (6MWT), timed up-and-go test (× 3) (3TUG), five-times sit-to-stand test (5XSST), timed water swallow test (TWST), and test of masticating and swallowing solids (TOMASS) as functional outcome measures; the Fatigue Severity Scale and West Haven-Yale Multidimensional pain inventory as patient-reported outcome measures. PMM patients were divided into three phenotypic categories: mitochondrial myopathy (MiMy) without extraocular muscles involvement, pure chronic progressive external ophthalmoplegia (PEO) and PEO&MiMy. As 6MWT is recognized to have significant test–retest variability, we calculated MCID (minimal clinically important difference) as one third of baseline 6 min walking distance (6MWD) standard deviation.ResultsAt 12-month follow-up, 3TUG, 5XSST and FSS were stable, while TWST and the perceived pain severity (WHYMPI) worsened. 6MWD significantly increased in the entire cohort, especially in the higher percentiles and in PEO patients, while was substantially stable in the lower percentile (< 408 m) and MiMy patients. This increase in 6MWD was considered not significant, as inferior to MCID (33.3 m). NMDAS total score showed a slight but significant decline at 12 months (0.9 point). The perceived pain severity significantly worsened. Patients with PEO performed better in functional measures than patients with PEO&MiMy or MiMy, and had lower values of NMDAS.ConclusionsPMM patients showed a slow global decline valued by NMDAS at 12 months; 6MWT was a more reliable measurement below 408 m, substantially stable at 12 months. PEO patients had better motor performance and lower NMDAS than PEO&MiMy and MiMy also at 12 months of follow-up.

Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain.

Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation. The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modelling to adjust for confounders. Sex- and age-matched cohorts (n=71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), self-rated function by 0.403 and 0.308, and the 6MWD by 0.270 and - 0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162. Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain. Our study showed surprisingly high associations between state and change in catastrophizing to pain relief and functional improvement in chronic pain patients. This is supported by clinical experience and research data, even if the construct and measurement of catastrophizing is under debate. Our findings and those of literature point to more pessimistic self-rating of pain and catastrophizing in fibromyalgia when compared to other conditions. This might obscure positive effects on pain and function achieved by adaptive coping in fibromyalgia.

Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials.

Although botulinum toxin (BoNT) has been suggested as a treatment to counter neuropathic pain, no previous systematic reviews investigated the multidimensional effects of BoNT on pain relief and Health-Related Quality of Life (HR-QoL). The aim of this systematic review is to summarize the current evidence on the effectiveness of BoNT treatment for neuropathic pain, and to characterize its multidimensional effectiveness in order to guide physicians in clinical practice. Five databases were systematically searched up to 4 April 2022, to identify randomized controlled trials satisfying the following criteria: adults suffering from neuropathic pain, BoNT administration, any comparator, multidimensional assessment of pain as primary outcome, HR-QoL, physical function, anxiety and depression, and sleep quality as secondary outcomes. Twelve studies were included. The multidimensional pain scales used were short-form McGill Pain Questionnaire, Neuropathic pain scale, Neuropathic Pain Symptom Inventory, International SCI Pain Basic Data Set, West Haven-Yale Multidimensional Pain Inventory, Brief Pain Inventory, and Douleur Neuropathique 4. These scales highlighted the positive effects of BoNT administration. According to the Jadad scale, all the RCTs included were high-quality studies. BoNT administration might be effectively introduced in the comprehensive management of neuropathic pain. Further research should focus on optimal and cost-effective therapeutic protocols.

Development and evaluation of the MAINTAIN instrument, selecting patients suitable for secondary or tertiary preventive manual care: the Nordic maintenance care program

BackgroundChiropractic maintenance care (MC) has been found to be effective for patients classified as dysfunctional by the West Haven-Yale Multidimensional Pain Inventory (MPI). Although displaying good psychometric properties, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. The aim was to develop a brief clinical instrument with the intent of identifying dysfunctional patients with acceptable diagnostic accuracy.MethodsData from 249 patients with a complete MPI dataset from a randomized clinical trial that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. A brief screening instrument was developed to identify dysfunctional patients, with a summary measure. Different cut-offs were considered with regards to diagnostic accuracy using the original instrument’s classification of dysfunctional patients as a reference. Very good diagnostic accuracy was defined as an area under the curve (AUC) metric between 0.8 and 0.9. The instrument was then externally validated in 3 other existing datasets to assess model transportability across populations and medical settings.ResultsUsing an explorative approach, the MAINTAIN instrument with 10 questions (0–6 Likert responses) capturing 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from − 12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. AUC was estimated to 0.87 (95% CI 0.83, 0.92) and Youden’s index was highest (0.70) at a score of 20. The diagnostic accuracy was similar and high across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.ConclusionThe MAINTAIN instrument has very good diagnostic accuracy with regards to identifying dysfunctional patients and may be used as a decision aid in clinical practice. By using 2 thresholds, patients can be categorized into “low probability (− 12 to 17)”, “moderate probability (18 to 21)”, and “high probability (22 to 48)” of having a good outcome from maintenance care for low back pain.Trial registrationClinical trials.gov; NCT01539863; registered February 28, 2012; https://clinicaltrials.gov/ct2/show/NCT01539863.

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.

Body Schema Self-Awareness and Related Dream Content Modifications in Amputees Due to Cancer.

Purpose: the evaluation of body image perception, pain coping strategies, and dream content, together with phantom limb and telescoping phenomena in patients with sarcoma who underwent surgery for limb amputation. Material and Methods: consecutive outpatients were evaluated at T0 (within 3 weeks after surgery) and T1 (4–6 months after surgery) as follows: demographic and clinical data collection; the Groningen Questionnaire Problems after Arm Amputation; the West Haven-Yale Multidimensional Pain Inventory; the Body Image Concern Inventory, a clinical trial to identify telescoping; and a weekly diary of dreams. Dream contents were coded according to the Hall and Van de Castle coding system. Results: Twenty patients completed the study (15 males and 5 females, mean age: 53.9 ± 24.6, education: 7.8 ± 3.4). All subjects experienced phantom limb and 35% of them experienced telescoping soon after surgery, and 25% still after 4–6 months. Both at T0 and T1, that half of the subjects reported dreams about still having their missing limbs. At T1 the patients’ perceptions of being able to deal with problems were lower, and pain and its interference in everyday life were higher yet associated with significant engagement in everyday activities and an overall good mood. The dream content analysis highlighted that males were less worried about health problems soon after amputation, and women showed more initial difficulties that seemed to be resolved after 4–6 months after surgery. Conclusions: The dream content analysis may improve clinicians’ ability to support their patients during their therapeutic course.

Outcomes of a Comprehensive Pain Rehabilitation Program for Patients With Fibromyalgia.

ObjectiveTo analyze opioid intake interference with psychological, well-being, and functional outcomes and medication tapering in patients with fibromyalgia admitted to the Mayo Clinic Pain Rehabilitation Program (MCPRP) in Florida.Patients and MethodsA retrospective study on MCPRP outcomes was conducted. We reviewed the health records of 150 patients with fibromyalgia who participated in the program from May 1, 2014, to May 1, 2015. All patients were asked to fill out a survey at admission to and dismissal from the program. Surveys contained questions from the numeric pain score, Multidimensional Pain Inventory (perceived life control and interference of pain subscales), Center for Epidemiological Studies–Depression Scale, Pain Catastrophizing Scale, 36-Item Short-Form Health Status Survey (general health perceptions subscale), and Pain Self-Efficacy Questionnaire. A medical record review identified categories and number of medications at program admission and dismissal. Patients were divided in 2 groups: those whose concomitant medication did not include opioids at admission (no opioids group) and those whose concomitant medication included opioids at admission (opioids group).ResultsBy dismissal from the MCPRP, patients with fibromyalgia in the no opioids group had a significant (P<.05) improvement in all the self-reported scores. Medication, including opioids, were effectively tapered at a substantially higher percentage in the opioids group.ConclusionBenefit of the comprehensive pain rehabilitation program in patients with fibromyalgia was indicated by clinical improvements in pain severity, physical and emotional health, and functional capacity while successfully tapering medication. Opioid intake at admission may modify the program outcomes.

The Link between Chronic Pain and Depression in Low Income Country, Pakistan.

To examine the relationship of subjective and physiological variables of pain in relation to depression among patients with chronic pain. The cross-sectional study was conducted at the Centre for Clinical Psychology in Lahore, Pakistan, from January to June 2016, and comprised patients with organic, identifiable chronic pain presenting at various government, semi-government and private hospitals. Data was collected using a personal history questionnaire, West Haven-Yale Multidimensional Pain Inventory and the depression subscale of the Symptom Checklist Revised. Data was analysed using SPSS 20. There were 186 subjects with a mean age of 46.92±13.92 years. All variables related to chronic pain had significant relationship with depressive symptoms (p<0.05). The relationship between chronic pain and depressive symptoms was found to be significant, and females were at a higher risk than males.

DEEP Study: Utility of the multidimensional pain inventory in persistent oro-facial pain.

Persistent oro-facial pain (POFP) is disabling, and patients' treatment outcomes are difficult to predict; psychosocial factors play a role. The West Haven-Yale Multidimensional Pain Inventory (MPI) is a self-report measure, which to our knowledge, has not been studied across primary and secondary care in heterogeneous POFP. Assess the MPI's ability to predict clinical outcome in POFP patients across primary and secondary care settings receiving usual care. About 146 patients receiving usual care for POFP were recruited from primary and secondary care medical and dental practices in north-east England. Participants completed the MPI (v3) and Graded Chronic Pain Scale (GCPS) at recruitment, and after 6, 12, 18 and 24months. The Patient Health Questionnaire-4 (PHQ-4) was completed at recruitment, 12, and 24months. 'Good' and 'poor' outcome status was assigned to participants based on their mode dichotomised GCPS score across timepoints. Logistic regression was used with overall GCPS outcome (good/poor) as the dependent variable and MPI subscale scores, demographic variables, and PHQ-4 scores as predictors. 110 participants had a 'good', and 36 had a 'poor' outcome. In the 'poor' outcome group, age, mean income, and life control scores were lower; deprivation, months in pain, PHQ-4, pain severity, interference, and affective distress scores were higher. In the 'good' group, MPI scores improved over time. Interference was the only consistent predictor of 'poor' outcome in the logistic regression model (OR: 1.14-1.98, p<0.05). The MPI interference subscale may help to identify patients with POFP who are likely to have consistent pain-related disability over time; it may therefore be useful clinically to identify patients likely to need early intervention.