Reductions In Pain Catastrophizing Research Articles

Feasibility, Acceptability, and Preliminary Efficacy of a Positive Affect Skills Intervention for Adults With Fibromyalgia.

To examine the feasibility, acceptability, and preliminary efficacy of a positive affect skills intervention for middle-aged and older adults with fibromyalgia syndrome (FMS). Ninety-five participants with FMS aged 50 and older (94% female) were randomized to 1 of 2 conditions: (a) Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR; n = 49) or (b) emotion reporting/control (n = 46). LARKSPUR included 5 weeks of skill training that targeted 8 skills to help foster positive affect, including (a) noticing positive events, (b) savoring positive events, (c) identifying personal strengths, (d) behavioral activation to set and work toward attainable goals, (e) mindfulness, (f) positive reappraisal, (g) gratitude, and (h) acts of kindness. Outcome data were collected via online surveys at baseline, postintervention, and 1-month follow-up. Completion rates (88%) and satisfaction ratings (10-point scale) were high (LARKSPUR: M = 9.14, standard deviation (SD) = 1.49; control: M = 8.59, SD = 1.97). Improvements were greater in LARKSPUR participants compared with control participants on measures of positive affect (Cohen's d = 0.19 [0.15, 0.24]), negative affect (Cohen's d = -0.07 [-0.11, -0.02]), and pain catastrophizing (Cohen's d = -0.14 [-0.23, -0.05]). Improvements in positive affect (Cohen's d = 0.17 [0.13, 0.22]) and negative affect (Cohen's d = -0.11 [-0.15, -0.06]) were maintained at 1-month follow-up. Dose-response analyses indicated that intervention engagement significantly predicted pre-to-post and post-to-follow-up reductions in pain catastrophizing. The current preliminary findings add to existing literature and highlight the specific potential of internet-delivered positive affect skills programs for adults with FMS. NCT04869345.

Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. Trial numberNCT04140838. PerspectiveGroup videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.

"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.

BACKGROUND:Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery.METHODS:A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention (“My Surgical Success” [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, n = 37; HE, n = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor’s degree (69.0%). Outcomes were collected at 1–3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group.RESULTS:The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70–16.49).CONCLUSIONS:Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.

Evaluation of About Face: A Psychology and Physiotherapy Pain Management Program for Adults with Persistent Facial Pain.

To evaluate About Face, a pain management program aimed at increasing quality of life in adults living with persistent facial pain through psychology- and physiotherapy-based skill development. A total of 90 patients attended a six-session program with a 1-month follow-up between 2015 and 2019. Patients filled out self-reported outcome measures preprogram, postprogram, and at a 1-month follow-up visit. There was a significant reduction in pain catastrophizing and a significant increase in engagement in meaningful activity, as well as a reduction in pain-related interference. This evaluation adds to the small amount of existing literature on interventions aimed at increasing quality of life in patients living with persistent facial pain and provides suggestions for future research.

User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial.

BackgroundChronic pain imposes a large burden on individuals and society. A patient-centric digital chronic pain management app called Manage My Pain (MMP) can be used to enhance communication between providers and patients and promote self-management.ObjectiveThe purpose of this study was to evaluate the real-world engagement of patients in urban and rural settings in Ontario, Canada with the MMP app alongside their standard of care and assess the impact of its usage on clinical outcomes of pain and related mental health.MethodsA total of 246 participants with chronic pain at a rural and 2 urban pain clinics were recruited into this prospective, open-label, exploratory study that compared the use of MMP, a digital health app for pain that incorporates validated questionnaires and provides patients with summarized reports of their progress in combination with standard care (app group), against data entered on paper-based questionnaires (nonapp group). Participants completed validated questionnaires on anxiety, depression, pain catastrophizing, satisfaction, and daily opioid consumption up to 4.5 months after the initial visit (short-term follow-up) and between 4.5 and 7 months after the initial visit (long-term follow-up). Engagement and clinical outcomes were compared between participants in the two groups.ResultsA total of 73.6% (181/246) of the participants agreed to use the app, with 63.4% (111/175) of them using it for at least one month. Individuals who used the app rated lower anxiety (reduction in Generalized Anxiety Disorder 7-item questionnaire score by 2.10 points, 95% CI –3.96 to –0.24) at short-term follow-up and had a greater reduction in pain catastrophizing (reduction in Pain Catastrophizing Scale score by 5.23 points, 95% CI –9.55 to –0.91) at long-term follow-up relative to patients with pain who did not engage with the MMP app.ConclusionsThe use of MMP by patients with chronic pain is associated with engagement and improvements in self-reported anxiety and pain catastrophizing. Further research is required to understand factors that impact continued engagement and clinical outcomes in patients with chronic pain.Trial RegistrationClinicalTrials.gov NCT04762329; https://clinicaltrials.gov/ct2/show/NCT04762329

Treatment effects on pain catastrophizing and cutaneous allodynia symptoms in women with migraine and overweight/obesity.

Pain catastrophizing and cutaneous allodynia represent two risk factors for greater headache-related disability. Yet, there is limited knowledge of the extent to which these risk factors are modifiable and whether nonpharmacological treatment-related changes are associated with migraine improvements. Using data from the Women's Health and Migraine (WHAM) study, a randomized controlled trial that compared effects of behavioral weight loss (BWL) and migraine education (ME) in women with migraine and overweight/obesity, we tested whether: (a) BWL versus ME produced greater changes in pain catastrophizing and allodynia from baseline across posttreatment and follow-up time points, and (b) whether these improvements were associated with improvements in headache disability. Women (N = 110) were randomly assigned to 16 weeks of either BWL or ME and assessed at baseline, posttreatment, and follow up (32 weeks). Multilevel mixed effects modeling tested: (a) for between-groups differences in pain catastrophizing and allodynia changes over time, and (b) associations of changes in pain catastrophizing and allodynia with changes in headache disability, adjusting for migraine severity and weight loss. Both BWL and ME had significant reductions in pain catastrophizing and allodynia from baseline to posttreatment and follow up, and the improvements were comparable across conditions. Reductions in pain catastrophizing and cutaneous allodynia were associated with significant reductions in headache disability, even when controlling for intervention-related improvements in migraine and weight loss. Pain catastrophizing and allodynia are not only reduced after nonpharmacologic treatments for migraine, but greater improvements are associated with greater reductions in headache-related disability, independent of migraine severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Comparing the effectiveness of acceptance and commitment therapy and physiotherapy on quality of life and pain catastrophizing in patients with chronic pain

Background and aims: Chronic pain is a common health problem that affects various aspects of life. Acceptance and commitment therapy (ACT) seems to be helpful in improving the quality of life and pain catastrophizing in patients with chronic pain. The purpose of this study was to compare the efficacy of ACT and physiotherapy on quality of life and pain catastrophizing in patients with chronic pain. Methods: The subjects were 75 women suffering from chronic pain who were considered for physiotherapy. They were randomly divided into 3 groups including ACT, physiotherapy, and control groups. The control group consisted of 25 patients who were on the waiting list for physiotherapy. The first group participated in 8 sessions of ACT, the second group attended 10 sessions of physiotherapy, and the control group received no treatment. The Pain Catastrophizing Scale (PCS) developed by Sullivan et al and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire were used in this study. Results: The results showed that the quality of life in the ACT group was significantly higher than that in the physiotherapy group and control group (P<0.001). Moreover, there was no significant difference between the ACT and physiotherapy groups in reducing pain catastrophizing (P>0.05), while this difference was significant between the ACT and control groups (P<0.001). Conclusion: In general, ACT leads to a reduction in pain catastrophizing and an increase in the quality of life of patients with chronic pain. Therefore, beside the current therapy like physiotherapy, ACT can be used as another therapeutic choice for patients with chronic pain.

Interpersonal Dyadic Influences of Pain Catastrophizing Between Caregivers and Children With Chronic Pain.

Pain catastrophizing is an important predictor of pain-related outcomes. Caregiver and child levels of catastrophizing about child chronic pain are associated cross-sectionally, yet predictive associations testing interpersonal influences within caregiver-child dyads are lacking. The present study tested caregiver and child influences on partner catastrophizing about child pain over a period of 1 month following initiation of interdisciplinary pain treatment and examined whether the change in pain catastrophizing was associated with child pain interference. A total of 113 caregiver-child dyads (Mage=14.41) completed measures at the time of initiating care at a pediatric tertiary outpatient pain management clinic (baseline) and ∼1 month later. Caregivers and children independently reported on catastrophizing about child pain and child pain interference at baseline and 1-month follow-up. Caregiver and child pain catastrophizing decreased over 1 month following initial interdisciplinary pain evaluation, with average scores remaining in the moderate to high range. Change in caregiver, but not child, catastrophizing about child pain was predicted by partner baseline pain catastrophizing. Decreases in catastrophizing about child pain were associated with within-person improvement in ratings of child pain interference. In the short period following initial pain evaluation, caregivers and children evidenced reductions in pain catastrophizing, which were associated with increased child function. Findings highlight the important role of child cognitive-affective responses to pain in influencing caregiver catastrophizing about child pain. Understanding the individual contributions children and caregivers make to interpersonal pain processes will inform future family-level clinical interventions.

Associations among pain catastrophizing, muscle strength, and physical performance after total knee and hip arthroplasty

AIMTo investigate whether reductions in pain catastrophizing associated with physical performance in the early period after total knee arthroplasty (TKA) or total hip arthroplasty (THA).METHODSThe study group of 46 participants underwent TKA or THA. The participants were evaluated within 7 d before the operation and at 14 d afterwards. Physical performance was measured by the Timed Up and Go (TUG) test, and 10-m gait time was measured at comfortable and maximum speeds. They rated their knee or hip pain using a visual analog scale (VAS) for daily life activities. Psychological characteristics were measured by the Pain Catastrophizing Scale (PCS). Physical characteristics were measured by isometric muscle strength of knee extensors and hip abductors on the operated side. The variables of percent changes between pre- and post-operation were calculated by dividing post-operation score by pre-operation score.RESULTSPostoperative VAS and PCS were better than preoperative for both TKA and THA. Postoperative physical performance and muscle strength were poorer than preoperative for both TKA and THA. The percent change in physical performance showed no correlation with preoperative variables. In TKA patients, the percent change of PCS showed correlation with percent change of TUG (P = 0.016), 10-m gait time at comfortable speeds (P = 0.003), and 10-m gait time at maximum speeds (P = 0.042). The percent change of muscle strength showed partial correlation with physical performances. The percent change of VAS showed no correlation with physical performances. On the other hand, in THA patients, the percent change of hip abductor strength showed correlation with percent change of TUG (P = 0.047), 10-m gait time at comfortable speeds (P = 0.001), and 10-m gait time at maximum speeds (P = 0.021). The percent change of knee extensor strength showed partial correlation with physical performances. The percent change of VAS and PCS showed no correlation with physical performances.CONCLUSIONChanges in pain catastrophizing significantly associated with changes in physical performance in the early period after TKA. It contributes to future postoperative rehabilitation of arthroplasty.

(494) Optimizing resilience in orofacial pain and nociception (ORION): exploring the efficacy of a hope intervention for pain

Resilience is a dynamic process resulting in positive adjustment and adaptation after exposure to adversity. In recent years, there has been growing interest in the contribution of positive psychological factors to pain and pain-related coping; however, interventions built upon bolstering resilience have received less attention. Hope is a strength-based motivational state consisting of one’s belief in their ability to generate routes to achieve goals (pathways) and initiating directional activity towards attaining goals (agency). Emerging evidence supports the role of hope in psychosocial adjustment and adaptive pain coping, suggesting that approaches designed to foster hope and personal strengths may enhance pain adaptation. Therefore, the overall objective of this pilot study was to test the feasibility and efficacy of a resilience-oriented hope intervention for clinical pain, as well as psychosocial outcomes and experimental pain sensitivity in individuals with orofacial pain. Twenty-three participants (78% female) with temporomandibular disorder were randomized to a 3-session intervention intended to increase hope or a control intervention involving education about pain and stress. Prior to and after the intervention, participants attended two laboratory sessions whereby they completed psychosocial questionnaires and sensitivity to heat, cold, and pressure pain was assessed. Hope was measured by the Adult State Hope Scale. Results indicated that higher levels of hope were associated with greater pressure pain thresholds at all sites: temporalis, masseter, temporomandibular joint [TMJ], forearm, trapezius, tibialis anterior (r’s=.31-.49; p’s<.03). Compared to Pain Education, the Hope group exhibited an increase in hope, reductions in pain catastrophizing, as well as greater increases in heat pain tolerance and pressure pain thresholds at the tibialis anterior and TMJ. Although preliminary, these results suggest that resilience-oriented interventions may be beneficial in reducing pain and catastrophizing and could serve as a target for pain management. Funded by the APS Sharon S. Keller Chronic Pain Research grant.

(301) Threat-evoked pain facilitation is not influenced by experimental reductions in pain catastrophizing

Pain catastrophizing is a tendency to ruminate, exaggerate, and negatively assess one’s ability to cope when a painful stimulus is present and when anticipating it. Previous research has experimentally-evoked pain anticipation by manipulating the predictability (i.e., threat value) of a painful stimulus. These studies found that threat-related anticipation facilitates the nociceptive flexion reflex (NFR, measure of spinal nociception) and pain. Unfortunately, these studies did not assess catastrophizing to determine whether it contributes to threat-evoked pain facilitation.

Additional effect of occlusal splints on the improvement of psychological aspects in temporomandibular disorder subjects: A randomized controlled trial

ObjectiveTo measure the effect of occlusal splints as an additional treatment on psychological aspects in temporomandibular disorder patients. DesignA randomized controlled trial was performed comprising 60 adults diagnosed with masticatory myofascial pain according the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The participants were divided equally into 2 treatment groups, which received only counselling (Group 1) or occlusal splints in addition to counselling (Group 2). The assessments occurred at baseline and at 2 and 5 months after treatment. The outcomes were symptoms of anxiety and depression, as well as pain catastrophizing. Two-way ANOVA, Friedman and Mann–Whitney tests were used to perform the statistical analysis, considering a significance level of 5%. ResultsIn relation to the baseline assessment, 60% of the subjects had at least mild anxiety and 25% had at least mild depression, and the mean and standard deviation (SD) of pain catastrophizing was 2.41 (1.33) for Group 1 and 2.06 (1.04) for Group 2. Comparisons between baseline and the fifth-month evaluation showed an improvement in anxiety and depression symptoms only in Group 2 (p<0.05). Otherwise, there was a significant reduction in pain catastrophizing in both groups (p<0.05), with a mean (SD) of 1.14 (1.28) for Group 1 and 0.76 (0.82) for Group 2. ConclusionMinimally invasive strategies could provide an improvement in the psychological aspects of temporomandibular disorder patients, and the use of an occlusal splint seems to hasten the manifestation of these effects.

What is the Clinical Value of Assessing Pain-Related Psychosocial Risk Factors?

413 ISSN 1758-1869 10.2217/PMT.13.55 © 2013 Future Medicine Ltd Pain Manage. (2013) 3(6), 413–416 Twenty years ago, heated debates would arise during discussions of psychological influences on pain experience. Today there is little room for debate. Indeed, research has been consistent in showing that certain psychosocial variables can increase the risk of problematic pain outcomes [1]. This editorial will focus on two psychosocial variables that have emerged as significant predictors of problematic pain outcomes. These include catastrophic thinking and perceived injustice [1]. Numerous investigations suggest that individuals who engage in catastrophic or alarmist thinking about their symptoms, and who feel that they are suffering unjustly, are individuals at high risk for developing chronic pain and disability. The predictive value of catastrophizing, and perceived injustice for adverse pain outcomes has been so robust, that these psychosocial variables have risen to the status of ‘risk factors’ for problematic recovery [1]. Pain catastrophizing has been broadly defined as an exaggerated negative orientation to actual or anticipated pain comprising elements of rumination, magnification and helplessness [2]. Over 1000 studies have documented a relationship between pain catastrophizing and adverse pain outcomes [2,3]. Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6]. Perceived injustice has been conceptualized as a cognitive appraisal involving a tendency to magnify the severity of painrelated losses, a sense that losses are irreparable and blame attributions [7]. Research indicates that perceptions of injustice are associated with heightened pain severity, pain behaviors, self-reported disability, depressive symptoms and the persistence of post-traumatic stress symptoms [7]. Perceived injustice predicts prolonged occupational disability following injury, even when controlling for pain catastrophizing, fear of movement and depressive symptoms [7]. Reductions in Injustice Experiences Questionnaire (IEQ) scores have

Translational behavioral pain management: new directions and new opportunities

Translational behavioral pain management: new directions and new opportunities

Targeting Catastrophic Thinking to Promote Return to Work in Individuals With Fibromyalgia

In this study, a sample of 30 individuals with fibromyalgia (FM) were enrolled in a 10-week risk factor targeted intervention designed to promote return to work. Participants completed measures of pain severity, pain catastrophizing, fear of movement, depression, and self-reported disability at three points in time through the course of the intervention. Results showed that most individuals with FM were agreeable to participate in the return-to-work intervention. Treatment response of individuals with FM was compared to a matched sample of individuals with chronic low back pain (CLBP). Analysis of variance (ANOVA) revealed that both groups showed comparable reductions in pain catastrophizing, depression, and fear of movement through the course of treatment. Individuals with FM were less likely than individuals with CLBP to show clinically meaningful reductions in pain severity and self-reported disability. Patients with FM were less likely to return to work (23%) than participants with CLBP (50%). The findings suggest that although individuals with FM are more treatment resistant than individuals with CLBP, a significant proportion can still benefit from participation in a rehabilitation intervention with a stated objective of return to work. Implications of the findings for the structure and content of rehabilitation interventions for FM are discussed.

Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain?

Mechanisms underlying favorable outcomes of psychosocial interventions for chronic pain are unclear. Theory suggests changes in maladaptive cognitions represent therapeutic mechanisms specific to cognitive-behavioral therapy (CBT). We illustrate the importance of examining whether treatments work either uniquely via mechanisms specified by theory or via mechanisms common to different treatments. Secondary data analysis was conducted to examine the effects of reduction in pain catastrophizing on outcomes following CBT and Pain Education. Generally, reductions in pain catastrophizing were significantly related to outcome improvements irrespective of CBT or Pain Education condition. Results underscore the need to assess whether mechanisms presumed to operate specifically in one treatment do indeed predict outcomes and illustrate the importance of broadening the assessment of mechanisms beyond those specified by theory. Theory-specific, competing, and common mechanisms must all be assessed to determine why our treatments work.

Psychosocial factors appear to predict postoperative pain: Interesting, but how can such information be used to reduce risk?

Psychosocial factors have emerged as consistent predictors of acute and chronic postoperative pain, exerting at least moderate effects on these outcomes. Factors identified involve negative affectivity, stress and distress, and poor coping, suggesting that perceptual/cognitive, emotional, and behavioral factors play key roles in influencing postoperative pain. Building on research documenting such effects, we illustrate 2 pathways by which information on preoperative psychosocial factors (using pain catastrophizing as an example) can be used to advance research and clinical agendas. One pathway treats pain catastrophizing as an empiric marker of risk. We computed mean effect sizes (Cohen's D) linking pain catastrophizing to acute and chronic postsurgical pain and illustrate that a patient scoring above the median on a pain catastrophizing scale may incur twice the risk of developing chronic postsurgical pain than a patient below the median. The second pathway involves reducing the maladaptive patterns of pain-related thoughts and beliefs of a high pain catastrophizer via cognitive-behavioral therapies (CBT) to reduce the risk of chronic postoperative pain. By mapping effect sizes of CBT for reducing catastrophizing onto effect sizes of catastrophizing predicting pain, our calculations suggest that treating high catastrophizers with CBT may result in 50% fewer patients developing chronic postsurgical pain within this group. Thus, a definable and achievable amount of reduction in pain catastrophizing may translate into definable and achievable decreases in risk of chronic postoperative pain. Future research directions are outlined.

Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain

The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression. The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention. At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes. The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.

Reduction of Pain Catastrophizing Mediates the Outcome of Both Physical and Cognitive-Behavioral Treatment in Chronic Low Back Pain

The aim of this study was to examine whether treatments based on different theories change pain catastrophizing and internal control of pain, and whether changes in these factors mediate treatment outcome. Participants were 211 patients with nonspecific chronic low back pain (CLBP) participating in a randomized controlled trial, attending active physical treatment (APT, n = 52), cognitive-behavioral treatment (CBT, n = 55), treatment combining the APT and CBT (CT, n = 55), or waiting list (WL, n = 49). Pain catastrophizing decreased in all 3 active treatment groups and not in the WL. There was no difference in the change in internal control across all 4 groups. In all the active treatment groups, patients improved regarding perceived disability, main complaints, and current pain at post-treatment, and no changes were observed in the WL group. Depression only changed significantly in the APT group. Change in pain catastrophizing mediated the reduction of disability, main complaints, and pain intensity. In the APT condition, pain catastrophizing also mediated the reduction of depression. Not only cognitive-behavioral treatments but also a physical treatment produced changes in pain catastrophizing that seemed to mediate the outcome of the treatment significantly. The implications and limitations of these results are discussed. Perspective This article shows that treatment elements that do not deliberately target cognitive factors can reduce pain catastrophizing. Reduction in pain catastrophizing seemed to mediate the improvement of functioning in patients with chronic low back pain. The results might contribute to the development of more effective interventions.

Initial Depression Severity and the Trajectory of Recovery Following Cognitive-Behavioral Intervention for Work Disability

The present study examined the recovery trajectories of a group of mildly depressed and moderately-severely depressed injured workers enrolled in a 10-week community-based rehabilitation program. A sample of 168 individuals (75 women, 93 men) with a disabling musculoskeletal pain condition participated in the research. On the basis of BDI-II (1) scores at pre-treatment assessment, patients were classified as either mildly (BDI-II =9-16; N=68) or moderately-severely depressed (BDI-II >16; N: 100). Both groups showed significant reductions in depression, but individuals in the (initially) moderately-severely depressed group were more likely to score in the depressed range of the BDI-II at post-treatment than individuals who were initially mildly depressed. For the mildly depressed group, early treatment reductions in pain catastrophizing, and perceived disability predicted improvement in depression scores. For the moderately-severely depressed group, none of the early treatment changes predicted improvement in depression; only late treatment reductions in pain catastrophizing and fear of movement/re-injury predicted improvement in depression. Chi-square analysis revealed that patients who were no longer depressed at post-treatment had the highest probability of returning to work (91%), followed by (post-treatment) mildly depressed patients (60%), and finally (post-treatment) moderately-severely depressed patients (26%), chi(2)=38.9, p < 0.001. In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.