Pain Anxiety Symptoms Scale Research Articles

Fear-avoidance and Pelvic Floor Muscle Function are Associated With Pain Intensity in Women With Vulvodynia.

To investigate the association between fear-avoidance variables, pelvic floor muscle (PFM) function, pain intensity in women with provoked vestibulodynia (PVD), as well as the moderator effect of partner support. A sample of 173 women diagnosed with PVD participated in the study. Fear-avoidance variables were assessed with validated self-administered questionnaires: pain catastrophizing (Pain Catastrophizing Scale), pain-related fear (Pain Anxiety Symptoms Scale), and partner support (Partner Support Questionnaire). Pain intensity was evaluated using a numerical rating scale. PFM function, including maximal strength, speed of contraction, flexibility, and muscle tone, was evaluated with a dynamometric speculum. Pain catastrophizing was significantly associated with pain intensity (β=0.310, P<0.001), partner support (β=0.194, P=0.004), and PFM flexibility (β=-0.255, P<0.001). Fear-avoidance, PFM variables, and partner support explained 28.3% of the variance in pain during intercourse (P<0.001). The addition of PFM was of particular interest as it explained a significant addition of 9% of the variance in pain intensity. Partner support was found to moderate the association between pain intensity and catastrophizing. Among women with high partner support, catastrophizing was not significantly related to pain (b=0.150, P=0.142). When partner support was low, catastrophizing was significantly related to pain (b=0.068, P<0.001). Findings of this study support that the symptomatology of PVD can be explained partly by fear-avoidance variables and PFM function. This study supports the significant role of PFM function and its importance in the pathophysiology of PVD. It also sheds light on the role of partner support and its moderating effect on pain catastrophizing.

The analgesic effect of music on cold pressor pain responses: The influence of anxiety and attitude toward pain.

ObjectiveThe analgesic effect of music has been recognized for pain relief, but individual differences and adjuvant methods are poorly understood. This study employed a cold-pressor task (CPT) to observe the effects of music (without considering personal preferences) on pain experience and how this is affected by individuals’ general (and pain-specific) anxiety symptomology.MethodsFifty participants were each presented with three conditions (randomized into different orders): music-listening, news-listening, and no sound (control). Pain responses, including pain tolerance time (PT), pain intensity (PI), and pain unpleasantness (PU), were assessed using CPT and compared with a 3x3 crossover design. Participants also completed the anxiety sensitivity index (ASI-16) and pain anxiety symptom scale (PASS-20).ResultsCPT pain responses during the music intervention were significantly different from responses during the news intervention and control conditions, respectively. Among participants with normal anxiety levels, pain responses during the music condition differed significantly from the news and control groups; this was not the case for the anxiety risk group. Pain responses during the music condition for those with normal levels of pain-specific anxiety differed significantly from the control, but this was not the case for the risk group.ConclusionsMusic appears to influence diminished pain responses relative to the absence of an intervention. However, this was not the case when individuals listened to news stories. These effects were more robust for individuals experiencing normal levels of general and pain-specific anxiety. Thus, music (even outside one’s own preferences) was an effective adjuvant method for managing pain, especially among those without significant anxiety symptomology.

Psychological Factors Associated With Ultramarathon Runners’ Supranormal Pain Tolerance: A Pilot Study

Athletes seem to have higher pain tolerance than the normally active population. It is unknown whether psychological factors contribute to their supranormal pain tolerance. The aim of this pilot study was to examine pain-related psychological processes in ultramarathon runners (‘ultrarunners’) and to explore whether psychological factors mediate the elevated pain tolerance displayed by ultrarunners. Forty participants took part in the study: 20 ultrarunners and 20 age- and gender-matched controls. Participants underwent the cold pressor test using water cooled to 0.1 to 0.5°C and completed the Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, and Pain Resilience Scale. Immersion time on the cold pressor test was significantly longer for the ultrarunners (P = .007) and they also had lower scores on all Pain Anxiety Symptoms Scale-20 subscales (P ≤ .030). The 2 groups did not differ significantly on the other questionnaires. Mediation analysis revealed that reduced pain-related escape and avoidance behaviors accounted for 40% of the difference in immersion time between the groups (P = .020). Our results suggest that ultrarunners have lower levels of pain-related anxiety than the general population and that their supranormal pain tolerance is partially mediated by reduced pain-related escape and avoidance behaviors. PerspectiveThis study investigated whether psychological factors contribute to the supranormal pain tolerance displayed by ultrarunners. It found that ultrarunners have lower levels of pain-related anxiety than nonrunning controls and that reduced pain-related escape and avoidance behaviors partially mediate their elevated pain tolerance.

Preoperative predictors of patient satisfaction after carpal tunnel release.

We investigated preoperative factors among demographic and clinical characteristics, as well as psychological factors that influence postoperative patient satisfaction, with the goal of assisting preoperative patient consultation for CTR. We included 92 hands from 60 patients diagnosed with idiopathic carpal tunnel syndrome. We selected the following factors as possible preoperative predictors for patient satisfaction: age, sex, duration of symptoms, static two-point discrimination, the Semmes-Weinstein monofilament test, grip strength, electrophysiological category and scores for the Boston Carpal Tunnel Questionnaire, the Pain Anxiety Symptoms scale and the Center for the Epidemiological Study of Depression scale. We used a cumulative logit model with generalized estimation equations to identify the predictors of patient satisfaction after CTR. Univariate analyses demonstrated significant correlations of patient satisfaction with age, preoperative grip power and preoperative CES-D. Multivariate analyses showed that age and preoperative CES-D scores were significantly correlated with patient satisfaction. Age and depression level were preoperative predictors influencing satisfaction after CTR. IV.

Pain catastrophizing, neuroticism, fear of pain, and anxiety: Defining the genetic and environmental factors in a sample of female twins.

The objective of the present study was to establish the heritability of pain catastrophizing and its subdomains of helplessness, magnification, and rumination and to further explore the genetic and environmental sources that may contribute to pain catastrophizing as well as to its commonly reported psycho-affective correlates, including neuroticism, anxiety sensitivity, and fear of pain. N = 2,401 female twin individuals from the TwinsUK registry were subject to univariate and multivariate twin analyses. Well validated questionnaires including the Pain Catastrophizing Scale, the Pain Anxiety Symptom Scale, the Ten Item Personality Index, and the Anxiety Sensitivity Index were used to assess the study variables. Moderate estimates of heritability for pain catastrophizing (36%) and the three subdomains of helplessness (35%), rumination (27%), and magnification (36%) were detected. The high correlations observed between the three subdomains were explained mainly by overlapping genetic factors, with a single factor loading on all three phenotypes. High genetic correlations between pain catastrophizing and its psycho-affective correlates of fear of pain and anxiety sensitivity were found, while the genetic overlap between neuroticism and pain catastrophizing was low. Each measure of negative affect demonstrated relatively distinct environmental contributing factors, with very little overlap. This is the first study to show shared genetic factors in the observed association between pain catastrophizing and other measures of negative affect. Our findings provide deeper insight into the aetiology of pain catastrophizing and confirm that it is at least partially distinct from other measures of negative affect and personality that may influence the development and treatment of chronic pain conditions. Further research in males is warranted to check the comparability of the findings.

(184) - The effects of pain-related anxiety on hypnosis treatment responses in adults with and without sickle cell disease

Pain is the most common symptom in sickle cell disease (SCD) and individuals with SCD exhibit pain hypersensitivity. Hypnosis can have beneficial effects on pain modulation, but it is unknown whether pain-related anxiety—a cognitive-affective factor also associated with pain modulation—attenuates the effects of hypnosis in individuals with SCD. This study examined if pain-related anxiety alters the effects of hypnosis on laboratory pain responsivity in adults with and without SCD. The sample included 14 adults with SCD and 14 race-matched healthy controls. Participants completed the Pain Anxiety Symptoms Scale (PASS-20) at baseline. Pain tolerance (°C), threshold (°C), and intensity (0–100) were collected during a standardized thermal pain protocol before and during a hypnosis session. Change in pain outcomes indicated participants' responses to hypnosis. Nonparametric tests were used and a median split determined within-group levels of pain-related anxiety. Pain-related anxiety did not significantly differ across SCD and non-SCD groups, and was not associated with pre-hypnosis pain tolerance or threshold in either group. In adults with SCD who had lower levels of pain-related anxiety, pain tolerance increased 5.68°C during hypnosis compared to 1.97°C in those with high anxiety (Z = -1.98, p < .05). The effect on pain threshold approached significance (1.97°C vs. -.38°C, Z = -1.85, p = .06). There was no effect of pain-related anxiety on change in pain responsivity in healthy controls. Results partially align with other pain anxiety research and suggest that higher pain-related anxiety may be particularly important to consider in individuals with SCD as it may attenuate pain modulatory effects of hypnosis. Further, in individuals with higher pain-related anxiety, a single hypnosis session may be insufficient to reduce modulatory effects of anxiety on pain responsivity. Thus, examination of long-term treatment effects in a larger sample is needed to confirm underlying mechanisms affecting hypnosis treatment responses in individuals SCD. Funding: NHLBI-1U54HL117718.

Effect of fentanyl buccal tablet on pain-related anxiety: A 4-week open-label study among opioid-tolerant patients with chronic and breakthrough pain

To evaluate the effect of fentanyl buccal tablet (FBT) on pain-related anxiety in opioid-tolerant patients with chronic pain and breakthrough pain (BTP). This study consisted of a screening visit, open-label titration period, and 4-week open-label treatment period. Thirty-one US study centers. Opioid-tolerant adults with chronic, persistent pain experiencing 1-4 BTP episodes per day at baseline. Two hundred eighteen patients were enrolled in this study; 180 completed the titration period; and 169 completed the treatment period. Patients were treated with FBT (100-800 microg) for BTP episodes for 4 weeks while continuing their around-the-clock opioid regimens. Change from baseline in the Pain Anxiety Symptoms Scale (PASS) total score at the final visit. Based on a mean baseline PASS total score of 82.6, study patients had a high level of anxiety; 92 patients (42 percent) had a history of anxiety disorders. The change from baseline in PASS total score was not statistically significant (mean change, -1.6; p = 0.322). Numerical improvements were reported in some secondary measures (eg, Beck Depression Inventory total score /mean change, -1.1; p = 0.038) and categorical measures (eg, Pain Flare Treatment Satisfaction, Patient Assessment of Function, and Clinician Assessment of Patient Function ratings). FBT was generally well tolerated, with no serious adverse events related to study drug. Four weeks of treatment with FBT did not reduce anxiety to a clinically meaningful extent, although improvement was reported in several secondary measures of functioning. Further research is needed to assess the impact of treatment for BTP on anxiety symptoms in opioid-tolerant patients with BTP.

Psychological Status Is Associated With Symptom Severity in Patients With Carpal Tunnel Syndrome.

The purpose of this study was to investigate whether psychological status is associated with symptom severity or functional disability of carpal tunnel syndrome (CTS) patients. Sixty patients diagnosed with CTS and treated with carpal tunnel release (CTR) were asked to complete a self-administered questionnaire consisting of 3 validated measures obtained before and 3 months after surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to assess symptoms (BCTQ-S) and functional disabilities (BCTQ-F), and the Center for Epidemiologic Studies Depression Scale (CES-D) and Pain Anxiety Symptoms Scale (PASS) were administered to assess depression and pain anxiety. The preoperative scores and those obtained 3 months after CTR were compared. Bivariate and multivariable regression analyses were performed to determine whether the variance of CES-D and PASS scores are associated with the variance of symptom severity or functional disability of CTS patients. The CES-D and PASS scores significantly improved after surgery. In a multivariable linear regression model, the CES-D and PASS scores were significantly associated with the BCTQ-S scores both before and 3 months after surgery. In addition, the changes in CES-D and PASS scores were significantly associated with the change in BCTQ-S scores. The depression level and pain anxiety of CTS patients were significantly improved at 3 months after CTR. The depression level and pain anxiety were significantly associated with the CTS symptoms in both the preoperative and the postoperative period. In addition, the improvement of depression and pain anxiety were associated with the improvement of CTS symptoms. Thus, our findings indicate that the depression and pain anxiety of CTS patients are associated with the symptom severity of CTS. Prognostic II.

Reliability and Validity of the Pain Anxiety Symptom Scale in Persian Speaking Chronic Low Back Pain Patients

Psychometric testing of the Persian version of Pain Anxiety Symptom Scale 20. The aim of this study was to assess the reliability and construct validity of the PASS-20 in nonspecific chronic low back pain (LBP) patients. The PASS-20 is a self-report questionnaire that assesses pain-related anxiety. The Psychometric properties of this instrument have not been assessed in Persian-speaking chronic LBP patients. One hundred and sixty participants with chronic LBP completed the Persian version of PASS-20, Tampa Scale of Kinesiophobia (TSK), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), trait form of the State-Trait Anxiety (STAI-T), Oswestry Low Back Pain Disability Index (ODI), Beck Depression Inventory (BDI-II), and Visual Analogue Scale (VAS). To evaluate test-retest reliability, 60 patients filled out the PASS-20, 6 to 8 days after the first visit. Test-retest reliability (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and minimal detectable change [MDC]), internal consistency, dimensionality, and construct validity were examined. The ICCs of the PASS-20 subscales and total score ranged from 0.71 to 0.8. The SEMs for PASS-20 total score was 7.29 and for the subscales ranged from 2.43 to 2.98. The MDC for the total score was 20.14 and for the subscales ranged from 6.71 to 8.23. The Cronbach alpha values for the subscales and total score ranged from 0.70 to 0.91. Significant positive correlations were found between the PASS-20 total score and PCS, TSK, FABQ, ODI, BDI, STAI-T, and pain intensity. The Persian version of the PASS-20 showed acceptable psychometric properties for the assessment of pain-related anxiety in Persian-speaking patients with chronic LBP. 3.

Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia

BackgroundIn young and middle-aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety. ObjectiveThe objective of this study was to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic healthy controls. Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess whether patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain. DesignProspective case series with control comparison. SettingTwo tertiary university physiatry outpatient clinics. ParticipantsA total of 50 hip pain patients aged 18-40 years and 50 gender- and age-matched healthy controls. MethodsPatients were enrolled if 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiner. Comparisons of insomnia and anxiety were completed between 50 hip pain patients and 50 controls and between patients with different types of hip deformity. Main Outcome MeasuresInsomnia Severity Index (ISI) and Pain Anxiety Symptoms Scale (PASS). ResultsA total of 50 hip pain patients (11 male and 39 female) with mean age of 31.2 ± 8.31 years enrolled. Hip pain patients slept significantly less (P = .001) per night than controls. Patients experienced significantly greater insomnia (P = .0001) and anxiety (P = .0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between different types of hip deformity. ConclusionHip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated either conservatively or surgically for their hip disorder. Level of EvidenceII

Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables.

Psychological variables and acute post-operative pain are of proven relevance for the prediction of persistent post-operative pain. We aimed at investigating whether pain-specific psychological variables like pain catastrophizing add to the predictive power of acute pain and more general psychological variables like depression. In all, 104 young male patients undergoing thoracic surgery for pectus excavatum correction were studied on the pre-operative day (T0) and 1week (T1) and 3months (T2) after surgery. They provided self-report ratings (pain-related: Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale=PASS, Pain Vigilance and Awareness Questionnaire=PVAQ; general psychological: Screening for Somatoform Symptoms, State-Anxiety Inventory-X1, Center for Epidemiologic Studies Depression Scale=CES-D). Additional predictors (T1) as well as criterion variables (T2) were pain intensity (Numerical Rating Scale) and pain disability (Pain Disability Index). Three months after surgery, 25% of the patients still reported clinically relevant pain (pain intensity ≥3) and over 50% still reported pain-related disability. Acute post-operative pain as well as general psychological variables did not allow for a significant prediction of persistent post-operative pain; in contrast, pain-related psychological variables did. The best single predictors were PASS for pain intensity and PVAQ for pain disability. Pain-related psychological variables derived from the fear-avoidance model contributed significantly to the prediction of persistent post-operative pain. The best possible compilation of these measures requires further research. More general psychological variables may become relevant predictors later in the medical history. Our results suggest that pain-specific psychological variables such as pain anxiety and pain hypervigilance add significantly to the prediction of persistent post-operative pain and might even outperform established predictors such as acute pain and general psychological variables. Clinicians might benefit from the development of time-economic screening tools based on these variables.

Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment

To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care.

The Influence of State and Trait Anxiety on the Memory of Pain.

The study aimed to assess the accuracy of memories of both pain and the state anxiety that accompanies experimentally induced pain and to investigate the factors that influence the memory of experimental pain. Forty-nine healthy female volunteers participated in the study. The participants received three electrocutaneous pain stimuli during the first phase of the study and rated the pain intensity, pain unpleasantness, and state anxiety they felt at that moment. Trait pain anxiety was measured by the Pain Anxiety Symptoms Scale and the Fear of Pain Questionnaire. During the second phase of the study, three or six months later (depending on the experimental group), the participants were asked to rate the pain intensity, pain unpleasantness, and state anxiety they had felt during the first phase of the study. Recalled pain intensity and unpleasantness and the state anxiety that accompanied the pain experience were remembered accurately, regardless of the recall delay. Both recalled pain intensity and unpleasantness were predicted by experienced pain, experienced and recalled state anxiety, and trait pain anxiety, that is, scores for physiological anxiety, cognitive anxiety, escape/avoidance, and severe pain. The present study demonstrates that a specific type of trait anxiety (pain anxiety) influences the memory of pain. The study is not only the first to investigate the influence of trait anxiety on the memory of experimental pain, it also is the first study to determine the effect of a specific form of anxiety (pain anxiety) on the memory of experimentally induced pain.

Validations and psychological properties of a simplified Chinese version of pain anxiety symptoms scale (SC-PASS).

The Pain Anxiety Symptoms Scale (PASS) has been developed to evaluate pain anxiety, which leads to avoidance of daily activities and normal movements. However, a simplified Chinese version of PASS is still not available. Physicians are not aware of which patients are prone to anxiety, and what the risk factors are.To cross-culturally adapt the PASS into a simplified Chinese version and test the reliability and validity. Factors affecting pain anxiety were also explored.The PASS was first translated into a simplified Chinese version according to a forward-backward method. Then, validations were tested including content validity, construct validity, and reliability. Content validity was analyzed by response trend. Construct validity was analyzed by confirmatory factor analysis (CFA), exploratory factor analysis, and priori hypotheses testing. Reliability was analyzed by internal consistency and test-retest reliability. Risk factors of catastrophizing were analyzed by performing multivariate liner regression.A total of 219 patients were included in the study. The scores of items were well distributed. Both CFA and exploratory factor analysis suggested a 2nd-order, 4-factor model, accounting for 65.42% of the total variance according to principle component analysis. SC-PASS obtained good reliability with a Cronbach α = 0.92 and ICC = 0.90. College education, long pain duration, and both married and divorced status were risk factors. Factors reduced pain-related anxiety were no medication assumption, female sex, widowed status, non-Han ethnicity, and having no religious belief.The SC-PASS was applicable in Chinese patients and it was suitable for the clinical uses in mainland China.

Assessing Pain Anxiety in Adolescents: Further Evidence for the Utility of the Child Pain Anxiety Symptoms Scale.

Emotional responses to pain are known to play an important role in the development and maintenance of pain. To better understand the role that pain anxiety plays in chronic pain, as well as to evaluate treatments that might treat it effectively, reliable and valid measures of pain anxiety are needed. Thus, the aim of this study was to provide additional evidence regarding the psychometric properties of the Child Pain Anxiety Symptoms Scale (CPASS) in a sample of adolescents. A total of 357 adolescents ages 12 to 19 years completed measures of pain anxiety (CPASS), pain-related catastrophizing (PCS-C), anxiety sensitivity (CASI), and sleep quality (NRS-Sleep). We used confirmatory factor analyses to evaluate the factor structure of CPASS items. We also tested the reliability and the validity of CPASS scores. Confirmatory factor analyses suggested a 4-factor structure with a single higher-order factor (CFI=0.91, TLI=0.95, RMSEA=0.078). The total score of CPASS showed good internal consistency (α=0.87) and adequate validity as evidenced by (1) moderate to high correlations between CPASS-PCS-C (r=0.74, P<0.001) and CPASS-CASI (r=0.48, P<0.001) and (2) the magnitude of the correlations between CPASS-PCS-C and CPASS-CASI being significantly greater than that between CPASS and NRS-Sleep (z=14.70 and 8.96, respectively; P<0.001). The findings support the reliability and the validity of CPASS as a measure of pain-related anxiety in adolescents.

Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic

PurposeThe aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya.MethodsParticipants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion.ResultsThe internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales.ConclusionThe Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.

Upper Extremity Disability Is Associated With Grip Strength and Psychological Stress in Carpal Tunnel Syndrome According to a Patient-reported Questionnaire

Objective: We investigated which clinical factors influenced upper extremity disability in carpal tunnel syndrome (CTS). Materials and Methods: We analyzed 45 hands with CTS of patients enrolled in a prospective cohort study conducted from December 2012 to January 2015. The age among the participant group of 40 females and 5 males ranged from 30 to 86 (mean, 60.3 years). Forty-three patients were right-handed. Twenty-seven had bilateral CTS (36 hands). Operations were performed on 25 right and 20 left hands. Thirty-nine hands were classified as “Extreme CTS” (absence of median motor and sensory responses) according to the severity scale proposed by Padua. Hand10 was used as a validated upper-extremity disability assessment tool. Clinical assessments were comprised of patients’ characteristic, physical and psychological parameters. Patients’ characteristic consisted of age, body mass index, and duration of symptom. Physical parameters included grip strength, key pinch strength, pulp pinch strength, Semmes Weinstein Monofilament Test, static 2 point discrimination test (s2PD test), numerical rating scale for numbness, visual analogue scale for pain (pain VAS), and Japanese version of Short-Form McGill Pain Questionnaire (SF-MPQ). Psychological parameters included Japanese version of Self-rating Depression Scale, Japanese version of Pain Anxiety Symptom Scale–20 (PASS-20), and Stress Response Scale–18 (SRS-18). These assessments were conducted on the day before operation. Statistical Analysis: Factors that were significantly associated with Hand10 scores in bivariate analysis (Pearson correlation test or Spearman rank correlation test as appropriate) were entered into a multivariable analysis. A multiple regression analysis was used to identify factors that were independently associated with Hand10 scores. Results: Hand10 scores showed no statistical differences in terms of unilateral/bilateral CTS and sex differences. Single regression analysis showed that Hand10 scores correlated significantly with the pain VAS, SF-MPQ, PASS-20, SRS-18, s2PD at index and middle scores, and grip strength. Multiple regression analysis showed that grip strength ( B = 1.47, β = 0.49, P = .00) and SRS-18 score ( B = −0.91, β = −0.36, P = .02) were significant correlation factors for the Hand10 score ( R2 = 0.49). Conclusions: In patients with CTS, grip strength and psychological stress are significant correlating factors of disability according to a patient-administered upper extremity assessment.

Inter-individual responses to experimental muscle pain: Baseline anxiety ratings and attitudes to pain do not determine the direction of the sympathetic response to tonic muscle pain in humans

We have recently shown that intramuscular infusion of hypertonic saline, causing pain lasting ~60min, increases muscle sympathetic nerve activity (MSNA) in one group of subjects, yet decreases it in another. Across subjects these divergent sympathetic responses to long-lasting muscle pain are consistent over time and cannot be foreseen on the basis of baseline MSNA, blood pressure, heart rate or sex. We predicted that differences in anxiety or attitudes to pain may account for these differences. Psychometric measures were assessed prior to the induction of pain using the State and Trait Anxiety Inventory (STAI), Pain Vigilance and Awareness Questionnaire (PVAQ), Pain Anxiety Symptoms Scale (PASS) and Pain Catastrophising Scale (PCS); PCS was also administered after the experiment. MSNA was recorded from the common peroneal nerve, before and during a 45-minute intramuscular infusion of hypertonic saline solution into the tibialis anterior muscle of 66 awake human subjects. Forty-one subjects showed an increase in mean burst amplitude of MSNA (172.8±10.6%) while 25 showed a decrease (69.9±3.8%). None of the measured psychological parameters showed significant differences between the increasing and the decreasing groups. We conclude that inter-individual anxiety or pain attitudes do not determine whether MSNA increases or decreases during long-lasting experimental muscle pain in healthy human subjects.

Pain Catastrophizing and Anxiety are Associated With Heat Pain Perception in a Community Sample of Adults With Chronic Pain.

The principle aim of this study was to investigate the associations between heat pain (HP) perception, pain catastrophizing, and pain-related anxiety in a heterogenous cohort of community-dwelling adults with chronic pain admitted to a 3-week outpatient pain rehabilitation program. All adults consecutively admitted to an outpatient pain rehabilitation program from July 2009 through January 2011 were eligible for study recruitment (n=574). Upon admission, patients completed the Pain Catastrophizing Scale (PCS), the short version of the Pain Anxiety Symptoms Scale (PASS-20), and HP perception was assessed using a standardized quantitative sensory testing (QST) method of levels. Greater PCS scores were significantly correlated with lower standardized values of HP threshold (HP 0.5) (P=0.006) and tolerance (HP 5) (P=0.003). In a multiple variable model adjusted for demographic and clinical factors known to influence HP perception, every 10-point increase in the PCS was associated with a -0.124 point change in HP 0.5 (P=0.014) and a -0.142 change in HP 5 (P=0.014) indicating that participants with higher PCS scores had lower HP thresholds and tolerances, respectively. Similarly, greater PASS-20 scores significantly correlated with lower standardized values of HP 0.5 and HP 5. In a multiple variable model, every 10-point increase in the PASS-20 was associated with a -0.084 point change in HP 0.5 (P=0.005) and a -0.116 point change in HP 5 (P=0.001) indicating that participants with higher PASS-20 scores had lower HP thresholds and tolerances, respectively. The findings of this study extend the use of a standardized method for assessing HP in a heterogenous sample of adults with chronic pain. Although pain catastrophizing shares significant variance with pain-related anxiety, our findings suggest that either measure would be appropriate for use in future studies that incorporate the QST method of levels.

Gait Speeds Associated with Anxiety Responses to Pain in Osteoarthritis Patients.

Patients with lower limbs osteoarthritis (OA) had slower walking speeds than healthy. Gait speed, which is associated with leg muscle strength, is a consistent predictor of health and functional status. The effects of pain and pain-related psychological constructs for gait speeds have been uncertain. Therefore, we investigated whether gait speed in patients with OA of lower limbs is associated with pain-related psychological constructs using a performance-based measure. The study group comprised 59 patients with advanced knee or hip OA. Gait speeds were measured at comfortable and maximum levels during 10-m walks. Covariates included 1) pain intensity measured with a visual analogue scale (VAS), 2) psychological constructs measured with a short-version pain anxiety symptoms scale (PASS-20) and the hospital anxiety and depression scale (HADS), and 3) bilateral knee extensor and hip abductor muscle strength. Each variable was subjected to multivariate analysis with gait speed. Single regression analysis showed that gait speeds were significantly correlated with VAS and PASS-20 scores, and muscle strength, not with HADS. Multiple regression analysis showed that PASS-20 score was significant correlating factor for gait speeds. Anxiety-related responses to pain were significant correlating factor for gait speeds, in patients with OA of lower limbs.