Pain Beliefs Research Articles

Factor structure, correlates, and incremental validity of the Pain Appraisal Inventory-Short Form.

We assessed the factor structure, correlates, and incremental validity of the Pain Appraisal Inventory in Chinese adult chronic pain samples. In an initial exploratory factor analysis sample (N = 301), the original two-component (threat, challenge) 16-item Pain Appraisal Inventory and a 10-item short form (Pain Appraisal Inventory-Short Form) were supported. Within a confirmatory factor analysis sample (N = 285), uniformly acceptable fits were observed only for the Pain Appraisal Inventory-Short Form. Furthermore, Pain Appraisal Inventory-Short Form threat and challenge subscales had significant correlations with conceptually related measures and added to prediction models for pain-related coping and adjustment, independent of other pain belief scales. Together, results indicated that the Pain Appraisal Inventory-Short Form has utility in Chinese chronic pain samples.

Exploring the lived experience and chronic low back pain beliefs of English-speaking Punjabi and white British people: a qualitative study within the NHS

IntroductionDisabling chronic low back pain (CLBP) is associated with negative beliefs and behaviours, which are influenced by culture, religion and interactions with healthcare practitioners (HCPs). In the UK, HCPs encounter...

The determination of the pain beliefs of the students at Akdeniz University Vocational School of Health Services

The purpose of this study is to determine the pain beliefs of Akdeniz University Vocational School of Health Services (AUVSHS) students. Fifty Physiotherapy Assistants students, 54 Paramedic students and 37 Elderly Care students who take pain education in their curriculum and 50 Child Development and Care students who do not take pain education were included in this study. The pain beliefs of the students were evaluated with Pain Beliefs Questionnaire. There was no statistically significant difference between organic (OBS) and psychological pain belief scores (PBS) of programs with and without pain education (p>0,05). There was statistically significant difference between OBS and PBS in favor of PBS in all programs (p<0,05). In conclusion, it was determined that pain beliefs in AUVSHS were similar in all programs. It is important to balance between organic and psychological pain beliefs. So we plan to develop new training strategies to balance student’s pain beliefs.

Pain beliefs of patients and the nonpharmacological methods they use to manage the pain

This study was performed to determine the pain beliefs of patients and nonpharmacological methods they use to manage their pain. This was a descriptive study conducted with the participation of 163 patients who were hospitalized in the medical and surgical clinics of a university hospital in May 2011. The study data were collected using personal information forms, a nonpharmacological methods form, and a pain belief scale. The data were evaluated using number, percentage, an independent sample t-test, and analysis of variance. The mean age of the patients was 52.7±16.6 years, and it was determined that 23.3% were hospitalized for urinary system diseases, while 21.5% were hospitalized for musculoskeletal system diseases. It was observed that 93.8% of the patients described experiencing pain in the past, while 22.7% described experiencing severe pain within the previous week. The types of pain most frequently described by the patients were headaches (24.8%), joint pain (21.6%), and lumbar pain (19.6%). It was determined that 72.3% of the patients used medication for pain, and that 49.1% also resorted to nonpharmacological methods for their pain. Frequently preferred nonpharmacological methods included hot and cold therapy, massage, and herbal methods. The mean organic score on the pain belief scale (23.6±4.57) was higher than the mean psychological score (19.9±2.64). Evaluating the pain beliefs of patients and the nonpharmacological methods used is important for effective management of pain.

Orthopaedic Section Poster Presentations (Abstracts OPO1-OPO300).

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPO designates an Orthopaedic Section poster presentation. J Orthop Sports Phys Ther 2018;48(1):A67-A202. doi:10.2519/jospt.2018.48.1.A67.

Fear-Avoidance Beliefs in Chronic Cervical Zygapophyseal Joint Pain Relieve With Medial Branch Block

Fear-Avoidance Beliefs in Chronic Cervical Zygapophyseal Joint Pain Relieve With Medial Branch Block

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'.

Background and aim: ‘Reasoning 4 Change’ (R4C) is a newly developed instrument, including four domains (D1–D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1–D4); inter-rater reliability (D2–D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67–0.91), satisfactory test-retest reliability (ICC range: 0.46–0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94–1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06–0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Effectiveness of Mindfulness-Based Cognitive Therapy on Hope and Pain Beliefs of Patients With Chronic Low Back Pain

Effectiveness of Mindfulness-Based Cognitive Therapy on Hope and Pain Beliefs of Patients With Chronic Low Back Pain

Unconventional Practitioners' Causal Beliefs and Treatment Strategies for Chronic Low Back Pain in Rural Nigeria.

Chronic low back pain (CLBP) is highly prevalent and CLBP disability reinforces poverty and Nigerian rural-urban inequality. Most rural Nigerian dwellers with CLBP consult unconventional practitioners due to difficulty in accessing conventional health care. This interaction may influence back pain beliefs and behaviours, and health outcomes including disability. In line with the recent Lancet Low Back Pain series call to address widespread misconceptions in the population and among health practitioners about low back pain, this study explored the beliefs and management strategies of unconventional practitioners consulted by people living with CLBP in rural Nigeria. Qualitative semi-structured face-to-face individual interviews. Thematic analysis of transcripts was performed using the Framework approach. Nine unconventional practitioners consented to participate in this study. Patent medicine sellers and herbalists had biomedical beliefs about CLBP and encouraged passivity and drug dependence in patients. Pastors adopted spiritual or biopsychosocial-spiritual management models and either encouraged spiritual CLBP causal beliefs and spiritual healing expectations; or patients’ resilience and acceptance, respectively. Unconventional practitioners’ CLBP beliefs and management strategies aligned with the beliefs and coping strategies of patients who consulted them. Unconventional practitioners’ beliefs and management strategies may therefore contribute to the adverse impact of CLBP in rural Nigeria.

A Preliminary Study of Chiropractors’ Beliefs About Biomedical and Biopsychosocial Pain: A Survey of University of Western States Alumni

ObjectiveThe purpose of this preliminary study was to investigate differences between doctors of chiropractic with respect to their preference for the biomedical or biopsychosocial attitude and belief models. MethodsAlumni of the University of Western States doctor of chiropractic program were asked to complete an online survey that included the Pain Attitudes and Beliefs Scale for Physiotherapists. This scale yields a biomedical score (10-60 scale) and a biopsychosocial score (9-54 scale). These scores are reported for 5 participant characteristics: sex, country of residence (USA vs other), chiropractic program completed (University of Western States vs other), decade of graduation, and years in practice. Secondarily, multiple linear regression was performed to evaluate the independent effects of participant characteristics on the 2 Pain Attitudes and Beliefs Scale for Physiotherapists scales. ResultsOf 3877 surveys, 233 were included in the analysis (response rate = 4.7%-7.4%). The mean biomedical scale score was 33.9 (standard deviation = 6.5), and the mean biopsychosocial scale score was 32.4 (standard deviation = 4.1). There was little variation in scores across the 5 participant characteristics (P > .05). Cronbach’s α for the biomedical scale reached an acceptable level of internal consistency (0.74). In contrast, Cronbach’s α for the biopsychosocial scale was 0.40. ConclusionThis preliminary study found that in a sample of chiropractic program alumni of the University of Western States, there were no differences with respect to preference for the biomedical or biopsychosocial attitude and belief models. A better understanding requires a larger study comparing attitudes/beliefs with behavior in practice.

Translation and Validation of the Toronto Pain Management Index, French-Canadian Version.

Background To provide effective pain management, nurses must have sufficient knowledge and adequate beliefs about pain management. In Quebec, however, nurses seem to be generally uninvolved in pain management, and there is little significant evidence shedding light on nurses' pain management knowledge and beliefs in postoperative settings. To perform such studies, a valid questionnaire in French to assess nurses' knowledge and beliefs is required. Some valid questionnaires are available in English, but none are available in French. Purpose This article describes the process of translation, adaptation, and preliminary validation of the Toronto Pain Management Index into French. Results For temporal stability of the Toronto Pain Management Index, French-Canadian version, the result of intraclass correlation coefficient for the total score of this questionnaire is 0.59 (CI: 0.44-0.72). Conclusion Following this process, the French version of this questionnaire has suitable face and content validity and can be used to evaluate nurses' knowledge and beliefs about pain management in postoperative settings.

Individuals\u2019 explanations for their persistent or recurrent low back pain: a cross-sectional survey

BackgroundMost people experience low back pain (LBP), and it is often ongoing or recurrent. Contemporary research knowledge indicates individual’s pain beliefs have a strong effect on their pain experience and management. This study’s primary aim was to determine the discourses (patterns of thinking) underlying people’s beliefs about what causes their LBP to persist. The secondary aim was to investigate what they believed was the source of this thinking.MethodsWe used a primarily qualitative survey design: 130 participants answered questions about what caused their LBP to persist, and where they learned about these causes. We analysed responses about what caused their LBP using discourse analysis (primary aim), and mixed methods involving content analysis and descriptive statistics to analyse responses indicating where participants learnt these beliefs (secondary aim).ResultsWe found that individuals discussed persistent LBP as 1) due to the body being like a ‘broken machine’, 2) permanent/immutable, 3) complex, and 4) very negative. Most participants indicated that they learnt these beliefs from health professionals (116, 89%).ConclusionsWe concluded that despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. Relatedly, they often see their condition as very negative. Contrary to current “best practice” guidelines for LBP management, a potential consequence of such beliefs is an avoidance of physical activities, which is likely to result in increased morbidity. That health professionals may be the most pervasive source of this thinking is a cause for concern. A small number of people attributed non-physical, unknown or complex causes to their persistent LBP – indicating that other options are possible.

Pain Beliefs and Quality of Life in Young People With Disabilities and Bothersome Pain.

Pain beliefs have been hypothesized to play an important role in pediatric pain. However, research examining the associations between pain-related beliefs and measures of function in youths with disabilities is limited. In total, 84 youths (mean age, 14.26 y; SD, 3.27) with physical disabilities who indicated they also had bothersome pain were interviewed and asked to rate their average pain intensity in the past week and to complete measures of pain-related beliefs and health-related quality of life. A number of pain beliefs were associated with different physical and psychosocial function domains, although different beliefs appeared to play different roles, depending on the function domain examined. Across all of the health-related quality-of-life domains studied, a belief that pain is influenced by one's emotions was associated with lower levels of function. No differences were found in pain beliefs related to age. In addition, a small difference in pain beliefs was found for sex; specifically, girls were more likely than boys to endorse the belief that pain is influenced by emotions. The findings provide new information regarding the role that pain beliefs have in predicting function and have important clinical implications regarding how youth with physical disabilities and pain might be most effectively treated.

Burnout in Nurses Working With Youth With Chronic Pain: A Pilot Intervention.

Nurse burnout is a significant issue, with repercussions for the nurse, patients, and health-care system. Our prior mixed-methods analyses helped inform a model of burnout in nurses working with youth with chronic pain. Our aims were to (a) detail the development of an intervention to decrease burnout; (b) evaluate the intervention's feasibility and acceptability; and (c) provide preliminary outcomes on the intervention. In total, 33 nurses working on a pediatric inpatient care unit that admits patients with chronic pain conditions participated in the single-session 90-min groups (eight to nine nurses per group). The intervention consisted of four modules including (1) helping patients view pain as multifaceted and shift attention to functioning; (2) teaching problem-solving and reflective listening skills; (3) highlighting positives about patients when venting with coworkers; and (4) improving nurses own self-care practices. Measures provided assessment of feasibility, acceptability, and effectiveness at baseline and 3 months postintervention in a single group, repeated measures design. Data support the feasibility and acceptability of the intervention. Pilot outcome results demonstrated improvements in the target behaviors of education on psychosocial influences, self-care, and venting to coworkers as well as self-compassion, general health, and burnout. There were no changes in pain beliefs or the target behaviors of focus on functioning, empathizing with patient, or highlighting positives. Our single-session tailored group treatment was feasible and acceptable, and pilot data suggest that it is beneficial, but a more comprehensive approach is encouraged to reduce burnout that might be related to multiple individual, unit, and system factors.

What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice?

BackgroundIt is commonly believed lifting is dangerous and the back should be straight during lifting. These beliefs may arise from healthcare professionals, yet no study has evaluated the lifting and back beliefs of manual handling advisors (MHAs) and physiotherapists (PTs). ObjectivesTo evaluate (i) what lifting technique MHAs and PTs perceive as safest, and why, and (ii) the back pain beliefs of MHAs and PTs. DesignData was collected via an electronic survey. MethodParticipants selected the safest lifting posture from four options: two with a straight back and two with a more rounded back, with justification. Back beliefs were collected via the Back-Pain Attitudes Questionnaire (Back-PAQ). Relationships were investigated using multiple linear and logistic regression models. Results400 PTs and MHAs completed the survey. 75% of PTs and 91% of MHAs chose a straight lifting posture as safest, mostly on the basis that it avoided rounding of the back. MHAs scored significantly higher than PTs on the Back-PAQ instrument (mean difference = 33.9), indicating more negative back beliefs. Those who chose the straight back position had significantly more negative back beliefs (mean 81.9, SD 22.7) than those who chose a round back lift (mean 61.7, SD 21.1). ConclusionAvoiding rounding the back while lifting is a common belief in PTs and MHAs, despite the lack of evidence that any specific spinal posture is a risk factor for low back pain. MHAs, and those who perceived a straight back position as safest, had significantly more negative back beliefs.

The prioritization of symptom beliefs over illness beliefs: The development and validation of the Pain Perception Questionnaire for Young People.

ObjectivesTo investigate the suitability of the revised Illness Perception Questionnaire (IPQ‐R) for use with adolescents with a long‐term pain condition and to validate a new questionnaire for use with this age group.DesignA three‐phase mixed‐methods study.MethodsPhase 1 comprised in‐depth qualitative analyses of audio‐recorded cognitive interviews with 20 adolescents with juvenile idiopathic arthritis who were answering IPQ‐R items. Transcripts were coded using framework analysis. A content analysis of their intended responses to individual items was also conducted. In Phase 2, a new questionnaire was developed and its linguistic and face validity were assessed with 18 adolescents without long‐term conditions. In Phase 3, the construct validity of the new questionnaire was assessed with 240 adolescents with juvenile idiopathic arthritis. A subset of 43 adolescents completed the questionnaire a second time to assess test–retest reliability. All participants were aged 11–16 years.ResultsParticipants described both conceptual and response format difficulties when answering IPQ‐R items. In response, the Pain Perception Questionnaire for Young People (PPQ‐YP) was designed which incorporated significant modifications to both wording and response formats when compared with the IPQ‐R. A principal component analysis of the PPQ‐YP identified ten constructs in the new questionnaire. Emotional representations were separated into two constructs, responsive and anticipatory emotions. The PPQ‐YP showed high test–retest reliability.ConclusionsSymptom beliefs appear to be more salient to adolescents with a long‐term pain condition than beliefs about the illness as a whole. A new questionnaire to assess pain beliefs of adolescents was designed. Further validation work may be needed to assess its suitability for use with other pain conditions. Statement of contribution What is already known on this subject? Versions of the adult Revised Illness Perception Questionnaire (IPQ‐R) have been adapted for adolescents and children by changing item wording; however, research to assess the degree to which the underlying IPQ‐R constructs are relevant to adolescents with a long‐term condition had not been performed. What the present study adds? In adolescents, beliefs about symptoms of their condition are more salient than beliefs about the illness as a whole.Question response formats for children and young people need to take account of age‐specific abilities.A new questionnaire has been designed for adolescents with pain. It is theoretically congruent with the CS‐SRM.

P83 - Are Positive or Negative Pain Beliefs Stronger Predictors of Treatment Outcome in Patients with Low Back Pain? Findings from the OIOC Registry

BACKGROUND CONTEXT: Robust evidence links maladaptive (negative) responses to low back pain (LBP) with the development of persistent LBP and disability. Emerging evidence demonstrates the importance of adaptive (positive) responses in determining good outcomes in patients with LBP. However, the relative importance of negative and positive beliefs is unclear.

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management.

Synopsis Low back pain (LBP) is the leading cause of disability worldwide. It often begins in adolescence, setting a course for later in life. We have tracked the course of LBP in the Raine Study cohort from the age of 14 years into early adulthood. Our work has found that LBP is already prevalent in individuals at 14 years of age and increases throughout adolescence and into early adulthood. It is often comorbid with other musculoskeletal pain. For some adolescents, LBP has little impact; for others, its impact includes care seeking, taking medication, taking time off from school and work, as well as modifying physical and functional activity. Of concern is the increasing prevalence of LBP with impact across adolescence, reaching adult rates by 22 years of age. The predictors of disabling LBP in adolescence are multidimensional. They include female sex, negative back pain beliefs, poor mental health status, somatic complaints, involvement in sports, and altered stress responses. Genetics also plays a role. Ironically, the factors that we have historically thought to be important predictors of LBP, such as "poor" spinal posture, scoliosis, carrying school bags, joint hypermobility, and poor back muscle endurance, are not strong predictors. This challenges our clinical beliefs and highlights that adolescent LBP needs a flexible and targeted multidimensional approach to assessment and management. In most cases, we recommend a cognitive functional approach that challenges negative LBP beliefs, educates adolescents regarding factors associated with their LBP, restores functional capacity where it is impaired, and encourages healthy lifestyle habits. J Orthop Sports Phys Ther 2017;47(10):741-751. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7376.

Kinesiophobia, functional disability and physical deconditioning evaluation in chronic low back pain

Chronic low back pain, which represents only 5 to 10% of the cases, is the cause of high health and social costs. Non-specific chronic low back pain has negative effects for physical activities and patient psychology. The aim of this study was to evaluate kinesiophobia, functional abilities and physical deconditioning in a population with chronic low back pain. The Tampa Scale of Kinesiophobia (TSK) Arabic version was used to evaluate pain beliefs and fear of movement/(re) injury. To evaluate functional abilities, we used both Oswestry Disability index (ODI) and Visual Analog Scale (VAS) of functional discomfort. Pain intensity was measured in calculating VAS of pain intensity. In order to assess endurance-responses, the following tests were used: Sorensen and Shirado tests. In addition, we studied relations between Kinesiophobia, Pain Intensity, Functional Disabilities and Endurance tests. To verify the significance of the correlations between the different variables, we used the Spearman correlation coefficient. The significance level was set at 5% ( P < 0.05). A total of 50 patients with non-specific chronic low back pain were recruited from Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital of Sfax, Tunisia. The average Kinesiophobia score was high in our patients (48.5 ± 10.2). The mean Oswestry index was 34.4 ± 12.5%, whereas the functional VAS was 5.86 ± 2.13. High positive correlation was founded between global score of TSK and ODI ( r = 0.6, P < 0.001). Moreover, TSK was significantly correlated with VAS of functional discomfort ( r = 0.7, P < 0.001) and VAS of pain intensity ( r = 0.46, P = 0.001). About endurance variables, TSK showed negative correlations according Shirado test ( r = −0.51, P < 0.001) and Sorensen test ( r = −0.39, P = 0.004) on a moderate to low level. Given these results, Kinesiophobia presents a real problem in chronic low back pain patients since it has been significantly correlated with functional abilities and physical deconditioning. We intend to propose multidisciplinary therapeutic management programs. These programs will rely on psychological education and cognitive-behavioral therapies that allow patients to change their erroneous beliefs and to promote functional recovery.

Translation and validation of the Tampa Scale of Kinesiophobia Arabic version in chronic low back pain

Fear of movement (kinesiophobia) has been proved in the literature as a predictor of chronic low back pain. The Tampa Scale of Kinesiophobia (TSK) is considered as one of the most suited questionnaires to evaluate pain beliefs and fear of movement/(re) injury in chronic low back pain. The aims of this study were to translate and validate the Arabic version of the TSK for Tunisian population. To translate TSK questionnaire, “validation transcultural method” was adopted. The development of Arabic version includes translation and back-translation, the expert interpretations and the pre-final version testing in order to evaluate its compliance with the original French version. Psychometric testing encompasses measurements by internal consistency reliability (Cronbach's alpha) and intra-observer reliability (intra-class coefficient ICC and the Bland and Altman method). Moreover, the construct validity (convergent and divergent) was investigated via the comparison between TSK and Pain Catastrophizing Scale (PCS), Beck depression scale, age and body mass index (BMI). A total of 50 patients with non-specific chronic low back pain were recruited from Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital of Sfax, Tunisia. The TSK questionnaire showed acceptable internal consistency (α = 0.87) and high intra-observer reliability (ICC = 0.86). Convergent validity was confirmed by significant correlations between TSK, PSC ( r = 0.84, P < 0.001) and Beck depression scale ( r = 0.86, P < 0.001). Divergent validity was proved by insignificant correlations between TSK, age ( r = −0.16) and BMI ( r = 0.03). To the best of our knowledge, we are the first who translate the TSK to Arabic version. It reveals good psychometric properties in chronic low back pain. Given these results, we intend to integrate the obtained tool to our professional plane. In fact, we think that our approach will pave the way to a wider reuse for other Arab populations, particularly for North Africans. A further study based on the factor analysis seems to be important for our research.