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(526) Exposure treatment of pain-related fear for children with chronic pain
Abstracts
(524) The impact of catastrophizing and fear of pain and (re) injury on pain intensity, perceived disability, and recovery expectancies among individuals with spinal cord injury L Murray, T Roth, A Wike, S Finley, A Garner, A Warren, K Monden, Z Trost, and R Hamilton; Baylor Institute of Rehabilitation at Baylor University Medical Center, Dallas, TX Pain catastrophizing and kinesiophobia (fear of pain and re/injury due to movement) are consistently associated with negative psychosocial and functional outcomes in a variety of musculoskeletal conditions. While many individuals with spinal cord injury (SCI) report significant pain experience, research on these pain-related constructs remains limited in this population. The current study examined associations between fear of pain and (re)injury (Tampa Scale of Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale) and pain outcomes, perceived disability, and recovery expectancies among individuals (n = 36) undergoing inpatient rehabilitation following SCI. Bivariate analyses indicated that pain catastrophizing, but not fear of pain, was significantly associated with greater current pain intensity (0-10 NRS, Present Pain Intensity Index of the Short Form McGill Pain Questionnaire; MPQ-SF-PPI; r = .51 and .40, respectively). Both pain catastrophizing and fear of pain were significantly associated with greater level of perceived disability (Perceived Disability Questionnaire; r = .44 and .55, respectively). Hierarchical regression analyses indicated that pain catastrophizing uniquely accounted for variance in current pain intensity (NRS; MPQ-SF-PPI) above and beyond demographic variables and injury-related variables, including level of SCI and time since injury (R2change = .17 and .29, respectively). Regression analyses controlling for demographic and injury-related variables as well as current pain intensity indicated that participants’ fear of pain but not pain catastrophizing significantly accounted for variance in perceived disability (R2change = .15). Finally, analysis of recovery expectancies revealed that pain catastrophizing was associated with less positive expectancies regarding resumption of work responsibilities (r = -.40). Fear of pain was likewise strongly associated with reduced expectancies in the domain of sexual function (r = -.56). The current study offers preliminary understanding of the influence of pain catastrophizing and kinesiophobia on perceived disability immediately post-injury and expectations for recovery after an acquired SCI.
(525) Efficacy and prediction of pain, mood, and function outcomes upon completion of an interdisciplinary chronic pain rehabilitation program. K Jaremko, L Scheidler, J Scheman, and E Covington; Cleveland Clinic, Cleveland, OH Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. Statistical and clinically significant improvements, in addition to the predictive potential of patient characteristics and baseline pain, mood, and function, were investigated using repeated measures, paired t-tests, binary logistic regression, and ANOVA. Depression (18.4611.1 v. 6.867.3), anxiety (12.469.9 v. 5.966.7), disability scores (44.061.0 v. 21.3614.9), and pain (6.862.1 v. 3.662.5) were significantly reduced over the course of CPRP (p<0.001). Marital status (Wilks’ Lambda= 0.89, F(4,228)=3.407, p=0.010) and primary pain condition (Wilks’ Lambda= 0.83, F(12,228)=1.925, p=0.033) impacted mood with the most significant improvement in depression of single individuals and anxiety of fibromyalgia patients. Clinically significant improvement of at least one level of depression was enhanced by acceptance type coping and was diminished by substance abuse coping, higher disability levels, and post-traumatic stress disorder symptoms at admission (X2(4)=32.6, p<0.001). Older age, single status, and planning style coping at admission predicted clinically lower disability by discharge (X2(4)=15.2, p=0.004). Improvement of pain and anxiety level were negatively impacted by each additional year of chronic pain an individual had already experienced (X2(1)=5.9, p=0.015 and X2(1)=11.0, p=0.001). Taken together, this study indicates the potential pain, mood, and function benefit of an interdisciplinary program and may enable improved risk stratification and personalization of chronic pain treatment. (1. Zheng, Headache, 2013.)
The Journal of Pain
S107
(526) Exposure treatment of pain-related fear for children with chronic pain L Simons, A Smith, M Hogan, A Norton, E Hung, J Beebe, C Ploski, and M Basch; Boston Children’s Hospital, Boston, MA Pain-related fear has been identified as an important factor that increases the likelihood of poor outcomes among individuals who experience pain. The primary objective of this study is to implement graded in-vivo exposure in children with chronic pain and examine clinically meaningful changes in our primary outcome, fear of pain, and secondary outcomes, disability and pain. Treatment is a 12-session individualized outpatient program delivered 1-2 times per week. Using a rigorous small sample randomized baseline design (baseline ranging from 7 to 21 days) we collected data at baseline, end of treatment, and 3month follow-up. Data consisted of the Fear of Pain Questionnaire (FOPQ; Simons et al., J Pain 2011), Photographs of Daily Activities ratings (PHODA; Verbunt et al., Euro J Pain 2014), Functional Disability Inventory (FDI; Walker et al., JPP 1991), Numerical Pain Rating Scale (Von Baeyer et al., Pain 2009), and daily diaries. We set a criterion of 30% improvement from baseline to be considered clinically significant change. Patients (n=10 enrolled thus far) are predominantly female (82%) and range in age from 8-21 years. Duration of pain ranges from 6 months to 5 years. Primary pain diagnoses include: neuropathic (n=5), back (n=1), abdominal/flank (n=2), and headache (n=2). All seven patients who have thus far completed treatment reported clinically significant improvement in the primary outcome: fear of pain. Among the secondary outcomes, four reported clinically significant improvements in functional disability and three reported clinically significant improvements in pain. Two patients are currently actively enrolled in treatment and one patient dropped out during treatment due to developing mononucleosis. Thus far four patients have reached 3-month follow-up and have maintained treatment gains. The current treatment intervention represents an innovative outpatient treatment model of integrating physical therapists and psychologists to help complex pain patients overcome their fears and make breakthroughs in their functioning.
(527) Do maladaptive self-regulatory responses to pain anxiety predict exercise among adults with arthritis? M Cary, J Sessford, N Gyurcsik, and L Brawley; University of Saskatchewan, Saskatoon, Saskatchewan, Canada Adults often report that arthritis pain intensity interferes with their exercise, which is an advocated disease self-management strategy. Surprisingly, pain rarely predicts participation levels. It could be that the anxiety people feel about anticipated pain deters exercise decisions or perhaps how individuals respond to their anxiety. According to the fear avoidance model and social cognitive theory, pain anxiety and maladaptive self-regulatory responses to anxiety (e.g., stopping exercise) may predict exercise. The study purpose was to examine whether pain anxiety and maladaptive self-regulatory responses predicted exercise, after controlling for pain intensity, among adults with self-reported, medically-diagnosed arthritis. Participants were 136 adults (Mage= 49.75 6 13.88 years) who completed two online surveys: (1) baseline: pain intensity, pain anxiety, and maladaptive self-regulatory responses to pain anxiety, and (2) prospective exercise: next two weeks. A hierarchical multiple regression predicting exercise was conducted in which pain intensity was entered in step 1, followed by pain anxiety and maladaptive self-regulatory responses in step 2. The overall model was significant, R2 adj. =.13, p <.001. The addition of pain anxiety and maladaptive responses contributed significant variance (R2 change = .12, p <.001). However, in the full model, maladaptive responses was the sole significant contributor (Bstandardized = -.40, p <.001). Findings are the first in exercise to illustrate that individuals who used maladaptive strategies to respond to their pain anxiety also exercised least. Future research to test an exercise plus counselling approach to help people forego the use of maladaptive responses to their pain anxiety is needed. Such exercise-enhanced counselling, if effective, could be used in real-world settings, such as physiotherapy clinics, to increase exercise adherence among adults with arthritis, leading to better disease management. Funding: Canadian Institutes of Health Research and Saskatchewan Health Research Foundation
(524) The impact of catastrophizing and fear of pain and (re) injury on pain intensity, perceived disability, and recovery expectancies among individuals with spinal cord injury L Murray, T Roth, A Wike, S Finley, A Garner, A Warren, K Monden, Z Trost, and R Hamilton; Baylor Institute of Rehabilitation at Baylor University Medical Center, Dallas, TX Pain catastrophizing and kinesiophobia (fear of pain and re/injury due to movement) are consistently associated with negative psychosocial and functional outcomes in a variety of musculoskeletal conditions. While many individuals with spinal cord injury (SCI) report significant pain experience, research on these pain-related constructs remains limited in this population. The current study examined associations between fear of pain and (re)injury (Tampa Scale of Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale) and pain outcomes, perceived disability, and recovery expectancies among individuals (n = 36) undergoing inpatient rehabilitation following SCI. Bivariate analyses indicated that pain catastrophizing, but not fear of pain, was significantly associated with greater current pain intensity (0-10 NRS, Present Pain Intensity Index of the Short Form McGill Pain Questionnaire; MPQ-SF-PPI; r = .51 and .40, respectively). Both pain catastrophizing and fear of pain were significantly associated with greater level of perceived disability (Perceived Disability Questionnaire; r = .44 and .55, respectively). Hierarchical regression analyses indicated that pain catastrophizing uniquely accounted for variance in current pain intensity (NRS; MPQ-SF-PPI) above and beyond demographic variables and injury-related variables, including level of SCI and time since injury (R2change = .17 and .29, respectively). Regression analyses controlling for demographic and injury-related variables as well as current pain intensity indicated that participants’ fear of pain but not pain catastrophizing significantly accounted for variance in perceived disability (R2change = .15). Finally, analysis of recovery expectancies revealed that pain catastrophizing was associated with less positive expectancies regarding resumption of work responsibilities (r = -.40). Fear of pain was likewise strongly associated with reduced expectancies in the domain of sexual function (r = -.56). The current study offers preliminary understanding of the influence of pain catastrophizing and kinesiophobia on perceived disability immediately post-injury and expectations for recovery after an acquired SCI.
(525) Efficacy and prediction of pain, mood, and function outcomes upon completion of an interdisciplinary chronic pain rehabilitation program. K Jaremko, L Scheidler, J Scheman, and E Covington; Cleveland Clinic, Cleveland, OH Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. Statistical and clinically significant improvements, in addition to the predictive potential of patient characteristics and baseline pain, mood, and function, were investigated using repeated measures, paired t-tests, binary logistic regression, and ANOVA. Depression (18.4611.1 v. 6.867.3), anxiety (12.469.9 v. 5.966.7), disability scores (44.061.0 v. 21.3614.9), and pain (6.862.1 v. 3.662.5) were significantly reduced over the course of CPRP (p<0.001). Marital status (Wilks’ Lambda= 0.89, F(4,228)=3.407, p=0.010) and primary pain condition (Wilks’ Lambda= 0.83, F(12,228)=1.925, p=0.033) impacted mood with the most significant improvement in depression of single individuals and anxiety of fibromyalgia patients. Clinically significant improvement of at least one level of depression was enhanced by acceptance type coping and was diminished by substance abuse coping, higher disability levels, and post-traumatic stress disorder symptoms at admission (X2(4)=32.6, p<0.001). Older age, single status, and planning style coping at admission predicted clinically lower disability by discharge (X2(4)=15.2, p=0.004). Improvement of pain and anxiety level were negatively impacted by each additional year of chronic pain an individual had already experienced (X2(1)=5.9, p=0.015 and X2(1)=11.0, p=0.001). Taken together, this study indicates the potential pain, mood, and function benefit of an interdisciplinary program and may enable improved risk stratification and personalization of chronic pain treatment. (1. Zheng, Headache, 2013.)
The Journal of Pain
S107
(526) Exposure treatment of pain-related fear for children with chronic pain L Simons, A Smith, M Hogan, A Norton, E Hung, J Beebe, C Ploski, and M Basch; Boston Children’s Hospital, Boston, MA Pain-related fear has been identified as an important factor that increases the likelihood of poor outcomes among individuals who experience pain. The primary objective of this study is to implement graded in-vivo exposure in children with chronic pain and examine clinically meaningful changes in our primary outcome, fear of pain, and secondary outcomes, disability and pain. Treatment is a 12-session individualized outpatient program delivered 1-2 times per week. Using a rigorous small sample randomized baseline design (baseline ranging from 7 to 21 days) we collected data at baseline, end of treatment, and 3month follow-up. Data consisted of the Fear of Pain Questionnaire (FOPQ; Simons et al., J Pain 2011), Photographs of Daily Activities ratings (PHODA; Verbunt et al., Euro J Pain 2014), Functional Disability Inventory (FDI; Walker et al., JPP 1991), Numerical Pain Rating Scale (Von Baeyer et al., Pain 2009), and daily diaries. We set a criterion of 30% improvement from baseline to be considered clinically significant change. Patients (n=10 enrolled thus far) are predominantly female (82%) and range in age from 8-21 years. Duration of pain ranges from 6 months to 5 years. Primary pain diagnoses include: neuropathic (n=5), back (n=1), abdominal/flank (n=2), and headache (n=2). All seven patients who have thus far completed treatment reported clinically significant improvement in the primary outcome: fear of pain. Among the secondary outcomes, four reported clinically significant improvements in functional disability and three reported clinically significant improvements in pain. Two patients are currently actively enrolled in treatment and one patient dropped out during treatment due to developing mononucleosis. Thus far four patients have reached 3-month follow-up and have maintained treatment gains. The current treatment intervention represents an innovative outpatient treatment model of integrating physical therapists and psychologists to help complex pain patients overcome their fears and make breakthroughs in their functioning.
(527) Do maladaptive self-regulatory responses to pain anxiety predict exercise among adults with arthritis? M Cary, J Sessford, N Gyurcsik, and L Brawley; University of Saskatchewan, Saskatoon, Saskatchewan, Canada Adults often report that arthritis pain intensity interferes with their exercise, which is an advocated disease self-management strategy. Surprisingly, pain rarely predicts participation levels. It could be that the anxiety people feel about anticipated pain deters exercise decisions or perhaps how individuals respond to their anxiety. According to the fear avoidance model and social cognitive theory, pain anxiety and maladaptive self-regulatory responses to anxiety (e.g., stopping exercise) may predict exercise. The study purpose was to examine whether pain anxiety and maladaptive self-regulatory responses predicted exercise, after controlling for pain intensity, among adults with self-reported, medically-diagnosed arthritis. Participants were 136 adults (Mage= 49.75 6 13.88 years) who completed two online surveys: (1) baseline: pain intensity, pain anxiety, and maladaptive self-regulatory responses to pain anxiety, and (2) prospective exercise: next two weeks. A hierarchical multiple regression predicting exercise was conducted in which pain intensity was entered in step 1, followed by pain anxiety and maladaptive self-regulatory responses in step 2. The overall model was significant, R2 adj. =.13, p <.001. The addition of pain anxiety and maladaptive responses contributed significant variance (R2 change = .12, p <.001). However, in the full model, maladaptive responses was the sole significant contributor (Bstandardized = -.40, p <.001). Findings are the first in exercise to illustrate that individuals who used maladaptive strategies to respond to their pain anxiety also exercised least. Future research to test an exercise plus counselling approach to help people forego the use of maladaptive responses to their pain anxiety is needed. Such exercise-enhanced counselling, if effective, could be used in real-world settings, such as physiotherapy clinics, to increase exercise adherence among adults with arthritis, leading to better disease management. Funding: Canadian Institutes of Health Research and Saskatchewan Health Research Foundation