Pain Anxiety Symptoms Scale Research Articles

Responsiveness and clinically important differences of the PROMIS short form-depression 8a, anxiety 8a, and PASS-20 in individuals with chronic low back pain.

Depression and anxiety are the most commonly reported mental health conditions. The Patient-Reported Outcomes Measurement Information System Short Form v1.0-Depression 8a (PROMIS-D-8a), Anxiety 8a (PROMIS-Anx8a), and Pain Anxiety Symptoms Scale-20 (PASS-20) measures were designed to assess depression, general anxiety, and pain-related anxiety, respectively. To examine the responsiveness and estimate the clinically important differences (CIDs) of the Thai version of these measures in individuals with chronic low back pain (CLBP). The study sample comprised 144 participants with CLBP. Responsiveness was evaluated by calculating the change scores, effect sizes (ESs), standardized response means (SRMs), area under the curve (AUC), and correlations between the change scores and associated Global Perceived Effect (GPE). We also estimated CIDs by the difference in mean change score between improved and unchanged groups and standard error of measurement (SEM) for each measure. Statistically significant differences in the mean change scores, ESs, and SRMs supported the responsiveness of all measures. The AUCs achieved acceptable discriminatory ability (0.71-0.72) for moderate improvement but not for any improvement (0.65-0.68). The correlations between GPE and change scores on all measures were low (r ranging 0.28-0.33). The estimated CIDs for the PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 were 3.64, 4.20, and 8.80, respectively. The PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 measures were sensitive for detecting clinical changes over time in individuals with CLBP. The CID values can be used as reference points for assessing meaningful improvements in the domains assessed by these scales in clinical and research practice.

Efficacy and Safety of Ultrasound-Guided Acupotomy Versus Celecoxib in Patients with Thoracodorsal Myofascial Pain Syndrome: A Randomized Controlled Trial.

Objective: To evaluate the efficacy and safety of ultrasound-guided acupotomy (UgA) for the treatment of thoracodorsal myofascial pain syndrome (TDMPS) and monitor its mid-term efficacy at 3 months after treatment. Methods: A 3-week, evaluator-blinded randomized clinical trial was conducted among 100 patients with TDMPS (visual analogue scale [VAS] score > 3) in the outpatient clinic of the Department of Orthopaedics of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, with a 3-month follow-up starting after completion of treatment. These patients were randomly assigned to receive UgA (n = 50) or oral celecoxib (n = 50). Recruitment was conducted between January 2021 and July 2022. The primary outcome was the VAS score, and the secondary outcomes included the Oswestry Disability Index (ODI), Pain Anxiety Symptoms Scale (PASS), and TNF-α and IL-1β levels. Outcome data were collected at baseline, week 3 (post-treatment) and week 15 (follow-up). Results: Compared with that in the celecoxib group, the pain in the UgA group was alleviated more strongly, with an adjusted mean group difference of -0.69 (95% CI,-1.07 to -0.31 after multiple imputation) at week 3 and -1.96 (95% CI,-2.33 to -1.59 after multiple imputation) at week 15 (p < 0.001 for overall group × time interaction). Both groups exhibited improvements in the ODI and PASS scores at weeks 3 and 15, but these improvements were significantly greater in the UgA group (p < 0.05). At week 3, the TNF-α and IL-1 levels were significantly lower in both groups, but celecoxib was more effective (p < 0.05). Results from analyses with multilevel multiple imputation for missingness were similar. Conclusion: UgA led to greater and safer alleviation of pain, dysfunction, and pain anxiety in patients treated with TDMPS than did celecoxib and had a durable 3-month efficacy but was inferior to celecoxib in reducing the level of inflammatory factors. These findings may prompt clinicians to recommend UgA as an alternative and supplementary therapy for pain management in patients with TDMPS.

Psychological Characteristics of Patients Undergoing Awake Craniotomy With Dexmedetomidine: A Retrospective Analysis

BACKGROUND AND OBJECTIVES: Only few studies have investigated the psychological profile of patient candidates for awake craniotomy (AC). The aim of this study was to describe the multidisciplinary clinical protocol adopted in our hospital and to retrospectively explore differences in psychological characteristic of 51 patients, analyzing association with the tolerability of the procedure. METHODS: During the preoperative neuropsychological assessment, the Pain Anxiety Symptoms Scale was administered to assess pain-related anxiety. Clinical characteristics and anesthesiological management were retrospectively recollected. The AC procedure was classified as “optimal” or “suboptimal” based on administration of rescue sedative midazolam doses because of psychomotor agitation or emotional distress in excess with respect to our anesthesiological protocol. RESULTS: The awake procedure was considered optimal in 33 cases (64.7% of total sample). General anesthesia was never required in our patients. No significant differences between optimal and suboptimal groups were found. No single variable was significant as a predictor of outcome on the univariate analysis, and no multivariate predictive model was possible. CONCLUSION: Although in our experience the Pain Anxiety Symptoms Scale score was not useful in identifying candidates for AC procedures, our multidisciplinary approach provided good results with respect to the tolerability of AC surgery. However, more studies are required to identify psychological profiles and preoperative possible warning signs to find the best course of surgery for each patient.

Musculoskeletal Morphology and Joint Flexibility-Associated Functional Characteristics across Three Time Points during the Menstrual Cycle in Female Contemporary Dancers.

Findings are inconsistent with regards to whether menstrual cycle phase-associated changes in physical functioning exist. It is possible that such discrepancies are due to varying rigour in experimental approaches. The current study aimed to systematically evaluate any effect of carefully tracked menstrual cycle phase on precisely measured muscle structure and function in a physically active group (contemporary dancers). Eleven women aged (M [SD]) 23.5 [2.94] years, undergoing 10.5 [1.73] hours of contemporary dance practice and 6.12 [2.36] hours of other physical activity per week, were recruited. Sex hormone level (enzyme-linked immunosorbent assays (ELISA), skin temperature and ovulation kits), physical pain assessments (Ice Water Test, Visual Analogue Scale, The Physical Activity Readiness Questionnaire, Self-Estimated Functional Inability Because of Pain Questionnaire, and Pain Anxiety Symptoms Scale), muscle architecture measurement (B-mode ultrasonography), and physical functioning (dynamometry, force-platform and electromyography) on both lower limbs were measured at three time points during one cycle, following three months of menstrual cycle monitoring. There was no difference in musculoskeletal flexibility variables between follicular, ovulatory, or luteal phases. Nonetheless, oestrogen change was associated with variability in 11 musculoskeletal variables, progesterone change was associated with variability in 7, and relaxin change was associated with variability in 15. Negative correlations existed between progesterone and flexibility and between oestrogen and jump variables. Moreover, oestrogen and relaxin were associated with increased musculoskeletal compliance, whilst progesterone was associated with increased muscle stiffness. In short, in absolute sex hormone levels, 'inter-individual' variances appear more impactful than 'intra-individual' variances. Not only are oestrogen and progesterone associated with differing musculoskeletal outcomes, but relaxin is also associated with musculoskeletal compliance changes. These effects are anticipated to impact jump height and flexibility, and hence, they could be expected to affect overall physical performance, including dance.

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.

Cross-Cultural Adaptation and Psychometric Properties of The Thai Versions of The Patient-Reported Outcomes Measurement Information System Short Form – Anxiety 8a and the Pain Anxiety Symptoms Scale-20 in Individuals with Chronic Low Back Pain

Objective: To translate and cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0–Anxiety 8a and the Pain Anxiety Symptoms Scale-20 into Thai versions (T-PROMIS-Anx8a and T-PASS-20, respectively) and evaluate their psychometric properties in individuals with chronic low back pain (CLBP).Material and Methods: The translations and cultural adaptations were performed using the Functional Assessment of Chronic Illness Therapy (FACIT) guidelines. Thai individuals with CLBP completed the T-PROMIS-Anx8a and T-PASS-20. Psychometric evaluation including: internal consistency, test-retest reliability, and dimensionality. Construct validity was evaluated by computing correlations among the scores on the T-PROMIS-Anx8a, T-PASS-20, Thai version of the Hospital Anxiety and Depression Scale–Anxiety (T-HADS-A), and Thai version of the Fear Avoidance Beliefs Questionnaire (T-FABQ).Results: A total of 269 individuals with CLBP were included in the analyses. The T-PROMIS-Anx8a showed unidimensionality and the T-PASS-20 evidenced a 4-factor structure. Both measures demonstrated good to excellent internal consistency (Cronbach’s alphas ranged from 0.85 to 0.95), good test-retest reliability (ICC(2,1) ranged from 0.79 to 0.88), and neither ceiling nor floor effects were observed for any of the scales. Both measures evidenced acceptable convergent and discriminant validity, based on their associations with the T-HADS-A and T-FABQ.Conclusion: The T-PROMIS-Anx8a and T-PASS-20 were culturally adapted and evidenced acceptable psychometric properties for assessing anxiety in Thai individuals with CLBP.

Cross-Cultural Adaptation and Psychometric Properties of The Thai Versions of The Patient-Reported Outcomes Measurement Information System Short Form – Anxiety 8a and the Pain Anxiety Symptoms Scale-20 in Individuals with Chronic Low Back Pain

Objective: To translate and cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0–Anxiety 8a and the Pain Anxiety Symptoms Scale-20 into Thai versions (T-PROMIS-Anx8a and T-PASS-20, respectively) and evaluate their psychometric properties in individuals with chronic low back pain (CLBP).Material and Methods: The translations and cultural adaptations were performed using the Functional Assessment of Chronic Illness Therapy (FACIT) guidelines. Thai individuals with CLBP completed the T-PROMIS-Anx8a and T-PASS-20. Psychometric evaluation including: internal consistency, test-retest reliability, and dimensionality. Construct validity was evaluated by computing correlations among the scores on the T-PROMIS-Anx8a, T-PASS-20, Thai version of the Hospital Anxiety and Depression Scale–Anxiety (T-HADS-A), and Thai version of the Fear Avoidance Beliefs Questionnaire (T-FABQ).Results: A total of 269 individuals with CLBP were included in the analyses. The T-PROMIS-Anx8a showed unidimensionality and the T-PASS-20 evidenced a 4-factor structure. Both measures demonstrated good to excellent internal consistency (Cronbach’s alphas ranged from 0.85 to 0.95), good test-retest reliability (ICC(2,1) ranged from 0.79 to 0.88), and neither ceiling nor floor effects were observed for any of the scales. Both measures evidenced acceptable convergent and discriminant validity, based on their associations with the T-HADS-A and T-FABQ.Conclusion: The T-PROMIS-Anx8a and T-PASS-20 were culturally adapted and evidenced acceptable psychometric properties for assessing anxiety in Thai individuals with CLBP.

The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study

BackgroundMost patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery.MethodsPatients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6–12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses.ResultsA total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = − 0.75) and multivariable (β = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed.ConclusionPain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.

Pain catastrophizing, pain anxiety, and substance use among Black individuals with chronic pain who use opioids.

Substance use is the leading cause of preventable deaths in the U.S. Chronic pain is associated with risky substance use. Black individuals experience substantial disparities in pain and substance use outcomes and treatment. Maladaptive psychological reactions to chronic pain, such as pain catastrophizing and pain anxiety, can increase substance use among White individuals. However, no research to date has tested this among Black individuals. This study is the first to test the relationships between pain catastrophizing, pain anxiety, and substance use among Black individuals with chronic pain who use opioid medications. Black adults with chronic pain who use opioids (N = 401) completed online measures of pain catastrophizing (Brief Pain Catastrophizing Scale); pain anxiety (Pain Anxiety Symptom Scale Short Form-20); risky use of alcohol, tobacco, e-cigarettes, cannabis and opioids (Alcohol, Smoking and Substance Involvement Screening Test); and opioid dependence (Severity of Dependence Scale). We conducted zero-inflated and hierarchical regressions to test associations between pain catastrophizing, pain anxiety and substance use (risky use; general use vs. nonuse) above that of demographics, pain intensity and pain interference. Pain catastrophizing was uniquely associated with risky use of all substances (βs = .03-.09, ps < .001-.02), opioid dependence (β = .13, SE = .05, p = .01), and use (vs. nonuse) of tobacco, alcohol and opioids (βs = .07-.11, ps < .001-.02). Pain anxiety was uniquely associated with tobacco use (vs. nonuse; β = -.02, SE = .01, p = .04) and severity of opioid dependence (β = .21, SE = .01, p < .001). Pain catastrophizing and, to a lesser degree, pain anxiety may be useful intervention targets for this underserved and understudied population. Addressing them may help reduce additional health complications and costs associated with substance use-related risk and dependence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Pain Anxiety Symptom Scale: Initial Development and Evaluation of 4 and 8 Item Short Forms

Elevated levels of anxiety in relation to chronic pain have been consistently associated with greater distress and disability. Thus, accurate measurement of pain-related anxiety is an important requirement in modern pain services. The Pain Anxiety Symptom Scale (PASS) was introduced over 30 years ago, with a shortened 20-item version introduced 10 years later. Both versions of the PASS were derived using Principal Components Analysis, an established method of measure development with roots in classical test theory. Item Response Theory (IRT) is a complementary approach to measure development that can reduce the number of items needed and maximize item utility with minimal loss of statistical and clinical information. The present study used IRT to shorten the 20-item PASS (PASS-20) in a large sample of people with chronic pain (N = 2,669). Two shortened versions were evaluated, 1 composed of the single best-performing item from each of its 4 subscales (PASS-4) and the other with the 2 best-performing items from each subscale (PASS-8). Several supplementary analyses were performed, including comparative item convergence evaluations based on sample characteristics (ie, female or male sex; clinical or online sample), factor invariance testing, and criterion validity evaluation of the 4, 8, and 20-item versions of the PASS in hierarchical regression models predicting pain-related distress and interference. Overall, both shortened PASS versions performed adequately across these supplemental tests, although the PASS-4 had more consistent item convergence between samples, stronger evidence for factor invariance, and accounted for 83% of the variance accounted for by the PASS-20% and 92% of the variance accounted for by the PASS-8 in criterion variables. Consequently, the PASS-4 is recommended for use in situations where a briefer evaluation of pain-related anxiety is appropriate. PerspectiveThe Pain Anxiety Symptom Scale (PASS) is an established measure of pain-related fear. This study derived 4 and 8-item versions of the PASS using IRT. Both versions showed strong psychometric properties, stability of factor structure, and relation to important aspects of pain-related functioning.

Acupuncture on GB34 for immediate analgesia and regulating pain-related anxiety for patients with biliary colic: a protocol of randomized controlled trial

BackgroundBiliary colic (BC) is a frequent hepatobiliary disorder encountered in emergency departments. Acupuncture may be effective as an alternative and complementary medicine for BC. Nonetheless, rigorous trials investigating its efficacy are lacking. Therefore, the aim of this study protocol is to determine whether acupuncture provides immediate relief of pain and associated symptoms in BC patients.MethodEighty-six participants who aged from 18 to 60 years with BC will be recruited in the First People's Hospital of Longquanyi District, Chengdu (West China Longquan Hospital Sichuan University). All participants will be allocated into two treatment groups including acupuncture group and sham acupuncture group using a 1:1 ratio. Each group will only receive a single 30-min needle treatment while waiting for their test results after completing the routine examination for BC. The primary outcome of the study is to assess the change in pain intensity after the 30-min acupuncture treatment. The secondary outcomes of the study include the change in pain intensity at various time points, the degree of gastrointestinal symptoms at different time points, the level of anxiety experienced during pain episodes at different time points, the score of Pain Anxiety Symptoms Scale-20 (PASS-20), the score of Fear of Pain Questionnaire-III (FPQ-III), and the score of Pain Catastrophizing Scale (PCS), among others.DiscussionThe results of this research will provide substantial evidence regarding the efficacy of acupuncture in alleviating symptoms associated with BC.Trial registrationClinicalTrials.gov, ChiCTR2300070661. Registered on 19 April 2023.

Cross-cultural adaptation and psychometric properties of Spanish Child Pain Anxiety Symptoms Scale

IntroductionPain anxiety is a psychological component that can regulate and modulate the experience of pain in children and adolescents. It can also have an impact on the outcomes of surgical procedures, chronic pain management and psychological interventions. The aim of our study was to translate the Child Pain Anxiety Symptoms Scale (CPASS) into Spanish and assess the psychometric properties of the Spanish version. Patients and methodsFirst, the CPASS was translated according to international guidelines. Secondly, to assess the psychometric properties of the translated version, we conducted an analysis in a paediatric sample. A total of 160 children, 49.37% female, with a mean age of 14.5 years (SD, 2.3; range, 8−18 years) completed pain catastrophising, health-related quality of life, pain interference and pain intensity scales. We assessed the following psychometric properties: construct validity (exploratory and confirmatory factor analysis), internal consistency, floor and ceiling effects and convergent validity (correlation of CPASS to the other completed questionnaires completed and with objective aspects of the health history). ResultsIn the exploratory factor analysis, the final 18-item version (having excluded items 18 and 19) of the CPASS was the best fit, with all items included in the hypothetical construct and exhibiting optimal factor loadings. The confirmatory factor analysis showed that the final 18-item, 4-factor model was adequate for the scale structure. We did not detect any floor or ceiling effects in the final version. Lastly, the results confirmed that the Spanish version has good internal consistency (Cronbach α, 0.88) and an adequate convergent validity. ConclusionThe Spanish CPASS exhibits good psychometric proprieties and it can be used to assess pain anxiety in the paediatric population.

(196) Assessing Treatment Outcome of Primary Vaginismus Using Vaginal Dilators Among Women in Saudi Arabia

Abstract Introduction Vaginismus is a pain disorder in which it is difficult to achieve vaginal penetration due to involuntary vaginal muscle spasms. It can occur during intercourse, vaginal examination, or insertion of a menstrual cup or tampon. Risk factors include family history, negative sex views, and cultural influences such as the value placed on the hymen. Moreover, fear of pain, injury, bleeding, and losing control can play a role in the development of vaginismus. Women with vaginismus are primarily treated with gradual desensitization to penetration using vaginal dilators. However, studies that record therapy duration and success are lacking the literature. Objective This study aims to assess the success rate of gradual exposure therapy to penetration using vaginal dilators for the treatment of primary vaginismus. Methods Women diagnosed with primary vaginismus between August 1st, 2019, and December 31st, 2021 at a tertiary care center in Jeddah, Saudi Arabia were included in this study. Those under 18 and those who did not use vaginal dilators were excluded. The primary investigator collected data by contacting participants over the phone to fill out a validated questionnaire, including questions from Female Sexual Function Index (FSFI) and Pain Anxiety Symptom Scale Short Form 20 (PASS-20). We project a total number of 50 participants at the end of the recruitment period by August 31, 2022. Data is collected on paper and entered into STATA 17. Demographic data included age, duration of the marriage, presence of romantic relationship prior to marriage, and education level. Our primary outcome is the degree of treatment success according to pain level and frequency scores during and after intercourse. Results The sample included 16 eligible patients. The mean age was 28.9 years (SD +/− 3.6). Almost all participants had a bachelor's degree or higher. 70% were married for two years or less with about 37% who were married for one year or less. 70% reported having a romantic relationship before marriage. We excluded 4 patients from further analysis who had never used vaginal dilators before. 33% of those who used vaginal dilators did not report any pain during or after intercourse. Only 37.5% of those who reported pain during or after sexual intercourse stated that the pain prevented them from having sexual intercourse. Among women who had sexual intercourse, 63% suffered moderate to a very high level of pain during intercourse and 25% experienced low to moderate pain after intercourse most of the time. Approximately 83% reported treatment success with vaginal dilators, while only 17% reported no success. The largest dilator size used was 6 (27%), and the most used plastic ones (50%). About 58% preferred conducting dilation therapy sessions at home instead of the clinic. Conclusions According to our findings, more than 80% reported success with vaginal dilators for treating primary vaginismus despite still experiencing pain during or after intercourse. Interestingly more than half of the patients preferred doing exercises at home, contradicting previous studies pointing out that one session with the therapist can predict higher success in treating vaginismus. Disclosure No

Adaptación transcultural y propiedades psicométricas de la versión española de la Child Pain Anxiety Symptoms Scale

IntroductionPain anxiety is a psychological component that can regulate and modulate the experience of pain in children and adolescents. It can also have an impact on the outcomes of surgical procedures, chronic pain management and psychological interventions. The aim of our study was to translate the Child Pain Anxiety Symptoms Scale (CPASS) into Spanish and assess the psychometric properties of the Spanish version. Patients and methodsFirst, the CPASS was translated according to international guidelines. Secondly, to assess the psychometric properties of the translated version, we conducted an analysis in a paediatric sample. A total of 160 children, 49.37% female, with a mean age of 14.5 years (SD, 2.3; range, 8–18 years) completed pain catastrophising, health-related quality of life, pain interference and pain intensity scales. We assessed the following psychometric properties: construct validity (exploratory and confirmatory factor analysis), internal consistency, floor and ceiling effects and convergent validity (correlation of CPASS to the other completed questionnaires completed and with objective aspects of the health history). ResultsIn the exploratory factor analysis, the final 18-item version (having excluded items 18 and 19) of the CPASS was the best fit, with all items included in the hypothetical construct and exhibiting optimal factor loadings. The confirmatory factor analysis showed that the final 18-item, 4-factor model was adequate for the scale structure. We did not detect any floor or ceiling effects in the final version. Lastly, the results confirmed that the Spanish version has good internal consistency (Cronbach α, 0.88) and an adequate convergent validity. ConclusionsThe Spanish CPASS exhibits good psychometric proprieties and it can be used to assess pain anxiety in the paediatric population.

Pain-Related Anxiety in Spanish-Speaking Mexican Americans Who Report Chronic Pain: Psychometric Evaluation of a New Spanish Adaptation of the 20-Item Pain Anxiety Symptom Scale (PASS-20)

The 20-item Pain Anxiety Symptom Scale (PASS-20) was adapted for Spanish-speaking Mexican Americans who report chronic pain (SSMACP). The instrument measures pain-related anxiety with fear, physiological, avoidance/escape, and cognitive anxiety as subtypes. In SSMACP, the Spanish PASS-20′s psychometric properties were evaluated while exploring relationships between pain-related anxiety with other variables. Using convenience sampling, 188 SSMACP (women = 108, men = 77; mean age = 37.20 years, standard deviation = 9.87) were recruited across the United States. Confirmatory factor analyses examined the structural validity of the hierarchical factor structure. Hierarchical multiple regression examined incremental validity. Correlational analyses examined convergent validity. Cronbach’s coefficient alphas and McDonald’s omegas examined internal consistency. Pearson’s r, t-tests, and analysis of variance tests examined relationships between demographic variables and PASS-20 scores. Confirmatory factor analyses supported the hierarchical factor structure (root mean square error of approximation = .061, standardized root mean residual = .038, comparative fit index = .940). Total and subscale PASS-20 scores had acceptable convergent validity and internal consistency (range = .75–.93). Hierarchical multiple regression found that total and subscale PASS-20 scores have adequate incremental validity, considering that they contributed uniquely to the prediction of generalized anxiety scores above and beyond other pain-related scores. Demographic variables were significantly related to total and subscale PASS-20 scores. Evidence supports the use of Spanish total and subscale PASS-20 scores in SSMACP. Exploratory evidence also informed on the possible consequences and predictors of their pain-related anxiety. The results also encourage pain research in specific populations from Latin America (eg, Mexican Americans). PerspectiveThe Spanish PASS-20 has adequate psychometric properties in SSMACP. This instrument can help catalyze pain research in SSMACP by informing on their pain-related anxiety and by helping evaluate other pain-related instruments. Evidence also informed on pain-related anxiety in SSMACP.

The impact of physical and psychological pain management training on pain intensity, anxiety and disability in patients undergoing lumbar surgeries

BACKGROUND/CONTEXTLumbar surgery is one of the interventions performed for patients with degenerative conditions. PURPOSEThis study aimed to investigate the effect of pain management education on pain intensity, anxiety, and disability after the lumbar surgery. STUDY DESIGN/SETTINGThis randomized controlled trial was performed on 70 30-65-year-old patients with lumbar canal stenosis and lumbar disc herniation from 2018 to 2019. PATIENT SAMPLESeventy participants were randomly divided into a control and an intervention group by a randomized block design. Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. OUTCOME MEASURESAll participants in the two groups completed the study instruments (numeric rating scale [NRS], Oswestery disability index [ODI], and pain anxiety symptoms scale [PASS]) before, immediately after, and 3 months after the study. METHODSParticipants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. To analyze the treatment effects, repeated-measures multivariate analysis of variance (MANOVA) and effect sizes were used where appropriate and calculated by Partial ɳ2. Clinical outcome (MDC) for pain intensity and PASS was also reported. For participants lost to follow-up, we also used an “intention-to-treat” (ITT) approach. RESULTSThe results of MANOVA indicated that there were significant differences between the two groups on ratings of pain intensity, anxiety, and disability. According to the MDC, the mean differences of pain intensity for the intervention group was also clinically improved. Meanwhile, the mean differences in pain anxiety between three different times in the two groups were not above the MDC (20.14), suggesting that the clinical improvements were not significant. The results were confirmed for all outcome measures; a statistically significant difference was found between the groups in ITT analyses (p<.001). CONCLUSIONSPhysical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability. This strategy may be beneficial for such patients. Variables such as smoking behavior, past history of psychological disorders, and previous surgeries should be considered in future studies.

Differences in pain, disability, and psychological function in low back pain patients with and without anxiety

Objectives: Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Chronic low back pain (LBP) reduces working hours, increases comorbidities, and increases rehabilitation needs. The aim of this study was to evaluate whether there were differences in pain, dysfunction, and psychological factors between two groups. The supplementary demonstrated the relationship between these influencing factors and anxiety. Methods: A cross-sectional study was designed to analyze the differences in pain, disability, and psychological function in non-specific LBP patients with and without anxiety. In total, 60 subjects were divided into two groups based on self-rated anxiety scores: 30 patients with SAS score ≥50 were in the low back pain with anxiety group, and 30 for the LBP without anxiety group with SAS score <50. The pain intensity was assessed using the Visual Analog Scale; psychological function, using the Pain Anxiety Symptoms Scale, the Tampa Scale for Kinesiophobia, and the Fear Avoidance Beliefs Questionnaire; functional disability, using the Oswestry Disability Index and the Roland-Morris Disability Questionnaire; quality of life using 36-Item Short-Form Health Survey questionnaire; and the quality of sleep using Pittsburgh Sleep Quality Index, and the relationships between variables and anxiety scores were estimated using Spearman correlation analysis. Results: A total of 60 participants were enrolled after self-rated anxiety was assessed and the full investigation was finished. The analyses showed significant differences of pain intensity (p = 0.034, disability (ODI, p = 0.007; RMDQ, p = 0.012) and psychological function (TSK, p = 0.000; PASS, p = 0.009; FABQ, p = 0.000; SF-36, p = 0.000; and PSQI, p = 0.000) between the two groups. Spearman correlation analysis showed that the anxiety score had significant positive correlations with functional disability (ODI, p = 0.004 and 95% CI = 0.112-0.573; RMDQ, p = 0.003, 95% CI = 0.135-0.586) and psychological function (TSK, p = 0.001, 95% CI = 0.174-0.612), excellent positive correlation with quality of sleep (PASS, p = 0.025, 95% CI = 0.031-0.512), and strongly negative correlations with the quality of life (SF-36, p = 0.000, 95% CI = 0.761-0.433). Conclusion: We recognized that anxiety in low back pain patients was mainly due to interaction with the intensity of pain, disability level, and a mass of psychological function. The future research direction could be to alleviate the anxiety on the comprehensive efficacy of patients with low back pain.

A longitudinal case-control analysis of pain symptoms, fear of childbirth, and psychological well-being during pregnancy and postpartum among individuals with vulvodynia

ObjectiveLittle research has examined changes in chronic vulvar pain (vulvodynia) symptoms with pregnancy and childbirth, nor fear as it relates to pregnancy/delivery amongst individuals with vulvodynia. The purpose of this study was to examine change in pain symptoms from pregnancy to postpartum amongst women with vulvodynia, as well as pain anxiety, fear of childbirth, and anxiety and depressive symptoms. DesignProspective Case-Control Study. SettingOnline survey. ParticipantsFifty-Seven pregnant individuals with a diagnosis of vulvodynia, and 41 pregnant control participants who reported being free of vulvar pain. Participants were recruited from the community and from hospital-based clinics for this study. Measurements and FindingsOnline surveys were administered to women diagnosed with vulvodynia and pain-free control participants during pregnancy and at three and six months postpartum. The survey contained both investigator-developed items and validated questionnaires, including the Pain Anxiety Symptoms Scale (PASS-20), the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) to assess fear of childbirth, the Generalized Anxiety Disorder-7 (GAD-7) measure to assess symptoms of anxiety, and the Patient Health Questionnaire (PHQ-9) to assess symptoms of depression. Linear mixed models with random intercepts for longitudinal analyses indicated statistical improvements for most of the vulvar pain outcomes in the postpartum period amongst women with vulvodynia, including reduced pain intensity at three (p = 0.005) and six months (p = 0.013) postpartum for those women who delivered vaginally. The mean change in pain intensity corresponded though to only a minimal clinical change. Compared to controls, women with vulvodynia reported higher levels of fear of childbirth on the W-DEQ (p = 0.024). In both groups, increases in general anxiety on the GAD-7 were found from pregnancy to three (p = 0.005) and six months (p = 0.033) postpartum. Mode of birth moderated the findings for pain-related anxiety as measured by the PASS-20: only individuals who delivered via caesarean section reported increases in pain anxiety between pregnancy and six months postpartum (p < 0.001). Key ConclusionsPregnant women with vulvodynia experienced postpartum improvements in vulvar pain symptoms. Mode of birth may play a role in symptom trajectory. Implications for PracticeIndividuals with vulvodynia often have concerns about how pregnancy and childbirth will impact their symptoms. The current findings can be used to help such individuals make reproductive decisions knowing there may be improvements in vulvar pain and increases in anxiety that can occur postpartum. The statistical versus clinical significance of the pain intensity results also highlight the importance of asking each individual what changes in pain symptoms they experience and the meaning of such changes for that person.

Pain-Related Anxiety in Chronic Vulvar Pain Conditions Associated with Vulvodynia

ABSTRACT Introduction Chronic, idiopathic vulvar pain (vulvodynia) is often treated as a unilateral condition. However, there are likely multiple causes to vulvar pain, relating to nerves, muscles, hormones, and inflammation, as well as psychosocial factors. Pain-related anxiety is a known contributor to the cycle of chronic pain. Rates of pain-related anxiety have been explored in vulvodynia associated with hypertonic pelvic floor muscle dysfunction; however, the roles in other associated genitopelvic pain conditions are still unknown. Objective Evaluate pain-related anxiety in the context of chronic vulvar pain conditions associated with vulvodynia: pudendal neuralgia (PN), hypertonic pelvic floor dysfunction (PFD), provoked vestibulodynia (PVD), and lichen sclerosus (LS). Methods A retrospective chart review was conducted for all new patients presenting to two metropolitan gynecology clinics specializing in vulvar pain for one full year. Patients were evaluated by a vulvar pain specialist to receive a specific vulvar pain diagnosis based on history and physical examination. Pain-related anxiety scores were measured with the Pain Anxiety Symptoms Scale-20 (PASS-20) prior to evaluation. Adult women presenting with vulvar pain who completed the PASS-20 and received a diagnosis of hypertonic pelvic floor muscle dysfunction were included in the study. Patients with concomitant vulvovaginal infections were excluded. Patients were grouped according to diagnosis: pudendal neuralgia (PN), overactive pelvic floor dysfunction alone (PFD), provoked vestibulodynia (PVD), or vulvar lichen sclerosus (LS). Independent two-tailed t-tests and one-way ANOVAs were performed comparing the distributions and scores for each of the four aspects of the PASS-20. Results 126 patients were included in the analysis: PN (17), PFD (43), PVD (57), and LS (9). Pain-related anxiety was highest for those with PN (mean score=47.18, SD=24.66) with 76.5% scoring above the 30-point cutoff for maladaptive levels of pain-related anxiety. This was followed by those with PFD (mean=37.02, SD=18.91, 65.1% scored &amp;gt;30), PVD (mean=32.53, SD=17.60, 43.9% scored &amp;gt;30), and LS (mean=23.44, SD=19.98, 33.3% scored &amp;gt;30). The PN group scored highest in cognitive, fear, and physiological anxiety, while the PFD group scored higher in escape and avoidance. One-way ANOVAs with post-hoc analysis yielded significant differences between the cognitive anxiety scores of PN vs PFD (p=0.03), PN vs PVD (p&amp;lt;0.01), and PN vs LS (p&amp;lt;0.01); as well as with the physiological anxiety scores of PN vs PFD (p=0.02), PN vs PVD (p=0.01), and PN vs LS (p&amp;lt;0.01). Comparing PFD and PVD, those with PFD alone had significantly higher scores in cognitive anxiety (t(498) = 2.12, p&amp;lt;0.04) and fear of pain (t(495) = 2.76, p&amp;lt;0.006). Conclusions Vulvar pain conditions in addition to hypertonic PFD can differentially impact pain-related anxiety. Notably, patients with PN have higher cognitive, physiologic, and fear-related anxiety compared to patients with other distressing vulvar pain conditions. Differences in pain-related anxiety between the additional vulvar pain conditions and PFD alone may reflect the severity of hypertonic PFD, which was not delineated in this study. These findings highlight the importance of identifying all causes of genitopelvic pain in the evaluation of vulvodynia, as well as acknowledging and addressing the role of pain-related anxiety in chronic genitopelvic pain. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Good Clean Love and Mahana Therapeutics; Consultant to SST, Ipsen, Amag, Lupin, an employee of Dare, and received research funding from Elen, Ipsen, En

Potential Role of Pain Catastrophic Thinking in Comorbidity Patients of Depression and Chronic Pain.

BackgroundAlthough comorbidity of major depressive disorder (MDD) and chronic pain (CP) has been well-studied, their association with pain catastrophizing is largely elusive. This study aimed to investigate the potential effects of pain catastrophizing in patients with a comorbidity.MethodsIn total, 140 participants were included in this study and divided into three groups according to the Diagnostic and Statistical Manual of Mental Disorders and the International Association for the study of pain (i.e., the comorbidity group: patients with depression with chronic pain, n = 45; depression group: patients with depression without chronic pain, n = 47; and healthy controls: n = 48). The Hamilton Depression Rating Scale (HAMD)-24 and Hamilton Anxiety Rating Scale (HAMA)-14 were used by professional psychiatrists to evaluate the severity of depression and anxiety. Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were conducted by patients' self-report to assess the symptom severity. The pain intensity numerical rating scale (PI-NRS) was used to assess the pain intensity. Pain Catastrophizing Scale (PCS) and Pain Anxiety Symptoms Scale (PASS) were used to estimate pain-related negative thinking.ResultsThe results showed that PASS and PCS scores were significantly different among the three groups. Particularly, the scores in the comorbidity group were the highest. The Pearson correlation analysis revealed a positive correlation between PCS (including the patients' helplessness, magnification, rumination, and total scores) and the severity of depression symptoms, anxiety symptoms, and pain intensity (P < 0.05). A stepwise regression analysis further demonstrated that the total PCS score, high monthly income level, and BDI score had positive impacts on PASS (P < 0.05). We also found that the total BDI score, disease course ≥1 year, and pain intensity had positive effects on PCS (P < 0.05), whereas years of education (≤ 12 years) had a negative effect on PCS (P = 0.012). In all, we have clearly demonstrated that PCS and PASS could serve as potentially predictive factors in patients suffering from comorbidity of MDD and CP.ConclusionOur results suggested that the pain-related catastrophic thinking and anxiety were more severe in the comorbidity group than in MDD-only group and healthy group. Pain-related catastrophizing thoughts and anxiety may have potentially effects on the comorbidity of depression and chronic pain.