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946 THE EFFECTS OF DISTRACTION ON PAIN: THE INFLUENCE OF THREAT VALUE AND PERSONAL VULNERABILITY VARIABLES
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
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devices delivering therapy content, internet therapy modules and home monitoring equipment. Professional involvement was reported in 73% of interventions. High levels of attrition emerged as a common limitation of the research. Conclusions: Technology-based behaviour change interventions potentially provide individuals with more accessible and immediate therapy content. However, our review failed to find any studies that examined long-term behaviour change in a chronic pain sample. Future research should explore what attributes of human interaction facilitate traditional therapy, and how these features may be translated to a technological platform within a chronic pain context. This review was supported by a grant from the Engineering and Physical Sciences Research Council, UK (EP/F001916).
than 6 hours. Pain correlates with no restful sleep (less than 6 hours), poor physical activity and patients who reported anxiety. Conclusion: Pain treatment was primordial in this kind of patients. Furthermore, pain correlated with a lot of variables, for this reason it is important to treat total pain, including all these variables mentioned before.
944 RELAXATION TRAINING IN CHRONIC PAIN PATIENTS: TRAITS OF PERSONALITY AS CRITERIA OF SELECTION A. Millet, C. Hirsch, N. Cantagrel *. CETD. Toulouse University Hospital, Toulouse, France
One of the factor has been identified that might affect the ability to direct attention away from pain, and particularly its threat value (Eccleston & Crombez, 1999). Between others relationships, threat value could be determinated by the own characteristics of pain stimuli or by stable dispositional variables related to a perception of high threat value: anxiety sensitivity and fear to pain. The aim of this study was 1) to investigate the effect of distraction on different aspects of the pain experience (pain tolerance, pain intensity, general anxiety and catastrophic thoughts), and 2) to examine whether this effect is modulated by anxiety sensitivity and fear of pain. The threat value of the pain stimuli was manipulated using instructions and fear of pain and anxiety sensitivity were considered as covariates. The distraction manipulation had a main effect on less pain intensity, more tolerance and less catastrophic thoughts and no interaction between distraction and threat was found. However, the effect of threat manipulation on tolerance and pain reports was mediated by fear of pain. Also, the effect of threat manipulation on general anxiety was mediated by anxiety sensitivity. Results indicated that dispositional trait variables seem to have a high relevance in the explanation of the threat value of pain.
To improve the efficacy of relaxation training proposed to some chronic pain patients, we tried to find a relationship between personality and success or failure of this therapeutics. In a prospective study, each new patient addressed for a training relaxation passed psychometric evaluation to determine personality. This test was correlated to the response at the training relaxation. Method: 6 chronic non-cancer pain patients were included. Each patient passed a personality test: Neo Personality Inventory Revised (Neo PI-R) to determine the five different parts of personality. A psychologist conducted the relaxation training. The clinical observation was based on: observance at the protocol of relaxation, repetition of the training at home, maintained protocol after the end of learning stage and efficacy of the therapeutic (improvement of quality of life and pain score). 3 patients obtained satisfactory results. Failure of this therapeutic was concluded for the other. Results: Some traits of personality appear to be more often associated with success of training relaxation: self-discipline, capacity to resolve problems, rigor and motivation. In the opposite, emotional instability, impulsiveness, difficulty of adaptation and anxiety can predict the failure of this therapeutic method. Elaboration of selection criteria for relaxation training seems important to improve the response to this therapeutic. Objective psychometric testing may have an interest to select patient. More patient is necessary to confirm these results. 945 PAIN PREVALENCE IN PALLIATIVE CARE J. Romero Cotelo *, Y. Romero Rodr´ıguez, J. Mart´ın de Rosales, ´ Mart´ın Sanchez, Fa. ´ Lopez ´ Tapia, Ma.A. ´ R. Galvez. ´ Unidad del Dolor Hospital Virgen de las Nieves. Pain and Palliative Care Unit, Hospital Universitario Virgen de las Nieves, Unidad de Dolor y Cuidados Paliativos, Granada, Spain Background and Aims: Cancer is the second highest cause of mortality in most developed countries. Dealing with the diagnostic of cancer is a very feared and stressful situation, especially because cancer is synonymous to painful death. The goal of this study is to describe a sample of 420 patients who were treated in 2008 in a unit of palliative care in Granada, the prevalence of pain, and their correlation with other variables. Methods: A transversal study. The doctor interviewed patients and their families for demographic data, and the rest of variables were colleted from their clinical history. Results: The average age is 72.91, majority males and the most frequent cancer corresponds to digestive area (35, 5%). Pain is present in most of the patient (78%) and the average pain intensity is from moderate to intense (EVA 8). An 60% stated to sleep less
946 THE EFFECTS OF DISTRACTION ON PAIN: THE INFLUENCE OF THREAT VALUE AND PERSONAL VULNERABILITY VARIABLES 1 *, S. Van Damme2 , M.R. Esteve Zarazaga3 , A.M. Masedo Gutierrez ´ J.J. Lillo Framil4 , I. Garc´ıa Ruiz. 1 Universidad de M´ alaga, M´ alaga, Spain; 2 Ghent University, Ghent, Belgium; 3 University of M´ alaga, M´ alaga, Spain; 4 Centro de Salud Cruz de Humilladero, M´ alaga, Spain
947 DOES THE BIO-PSYCHOSOCIAL MODEL HELP TO LEGITIMISE UNEXPLAINED BACK PAIN? F. Toye *, K. Barker. Nuffield Orthopaedic Centre, Oxford, United Kingdom Background and Aim: The aim was to explore whether the biopsychosocial model was accepted by patients attending a chronic pain management programme. What developed was an exploration of the continuing daily struggle to construct legitimacy in the face of disbelief. Loss of legitimacy may result from lack of fit with the cultural model used to explain pain. Method: We interviewed a purposive sample of 20 patients attending chronic pain management at 3 stages over one year. We transcribed and analysed each interview before completing the next, so that subsequent interviews could be shaped by evolving theory. We used the methods of Grounded Theory to analyse the data, and used NVivo a computerised programme, to assist. Results: Strategies to establish legitimacy were paradoxical: First, although medical tests legitimised illness, patients recognised that wanting a positive result was counter-intuitive, and accepted that psychosocial factors contributed to pain. Second, although seeing a person is in pain was necessary, patients described how you should not look too ill. They often concealed their symptoms to avoid stigma. Third, although meeting others with unexplained pain proved that they were not ‘faking’, paradoxically they described how they were not like the others. Finally, although retaining self was paramount, patients described how it was important to accept their loss. Conclusion: There seems to be a lack of cultural fit between the psychosocial and biomedical model that is not resolved by the bio-
S267
devices delivering therapy content, internet therapy modules and home monitoring equipment. Professional involvement was reported in 73% of interventions. High levels of attrition emerged as a common limitation of the research. Conclusions: Technology-based behaviour change interventions potentially provide individuals with more accessible and immediate therapy content. However, our review failed to find any studies that examined long-term behaviour change in a chronic pain sample. Future research should explore what attributes of human interaction facilitate traditional therapy, and how these features may be translated to a technological platform within a chronic pain context. This review was supported by a grant from the Engineering and Physical Sciences Research Council, UK (EP/F001916).
than 6 hours. Pain correlates with no restful sleep (less than 6 hours), poor physical activity and patients who reported anxiety. Conclusion: Pain treatment was primordial in this kind of patients. Furthermore, pain correlated with a lot of variables, for this reason it is important to treat total pain, including all these variables mentioned before.
944 RELAXATION TRAINING IN CHRONIC PAIN PATIENTS: TRAITS OF PERSONALITY AS CRITERIA OF SELECTION A. Millet, C. Hirsch, N. Cantagrel *. CETD. Toulouse University Hospital, Toulouse, France
One of the factor has been identified that might affect the ability to direct attention away from pain, and particularly its threat value (Eccleston & Crombez, 1999). Between others relationships, threat value could be determinated by the own characteristics of pain stimuli or by stable dispositional variables related to a perception of high threat value: anxiety sensitivity and fear to pain. The aim of this study was 1) to investigate the effect of distraction on different aspects of the pain experience (pain tolerance, pain intensity, general anxiety and catastrophic thoughts), and 2) to examine whether this effect is modulated by anxiety sensitivity and fear of pain. The threat value of the pain stimuli was manipulated using instructions and fear of pain and anxiety sensitivity were considered as covariates. The distraction manipulation had a main effect on less pain intensity, more tolerance and less catastrophic thoughts and no interaction between distraction and threat was found. However, the effect of threat manipulation on tolerance and pain reports was mediated by fear of pain. Also, the effect of threat manipulation on general anxiety was mediated by anxiety sensitivity. Results indicated that dispositional trait variables seem to have a high relevance in the explanation of the threat value of pain.
To improve the efficacy of relaxation training proposed to some chronic pain patients, we tried to find a relationship between personality and success or failure of this therapeutics. In a prospective study, each new patient addressed for a training relaxation passed psychometric evaluation to determine personality. This test was correlated to the response at the training relaxation. Method: 6 chronic non-cancer pain patients were included. Each patient passed a personality test: Neo Personality Inventory Revised (Neo PI-R) to determine the five different parts of personality. A psychologist conducted the relaxation training. The clinical observation was based on: observance at the protocol of relaxation, repetition of the training at home, maintained protocol after the end of learning stage and efficacy of the therapeutic (improvement of quality of life and pain score). 3 patients obtained satisfactory results. Failure of this therapeutic was concluded for the other. Results: Some traits of personality appear to be more often associated with success of training relaxation: self-discipline, capacity to resolve problems, rigor and motivation. In the opposite, emotional instability, impulsiveness, difficulty of adaptation and anxiety can predict the failure of this therapeutic method. Elaboration of selection criteria for relaxation training seems important to improve the response to this therapeutic. Objective psychometric testing may have an interest to select patient. More patient is necessary to confirm these results. 945 PAIN PREVALENCE IN PALLIATIVE CARE J. Romero Cotelo *, Y. Romero Rodr´ıguez, J. Mart´ın de Rosales, ´ Mart´ın Sanchez, Fa. ´ Lopez ´ Tapia, Ma.A. ´ R. Galvez. ´ Unidad del Dolor Hospital Virgen de las Nieves. Pain and Palliative Care Unit, Hospital Universitario Virgen de las Nieves, Unidad de Dolor y Cuidados Paliativos, Granada, Spain Background and Aims: Cancer is the second highest cause of mortality in most developed countries. Dealing with the diagnostic of cancer is a very feared and stressful situation, especially because cancer is synonymous to painful death. The goal of this study is to describe a sample of 420 patients who were treated in 2008 in a unit of palliative care in Granada, the prevalence of pain, and their correlation with other variables. Methods: A transversal study. The doctor interviewed patients and their families for demographic data, and the rest of variables were colleted from their clinical history. Results: The average age is 72.91, majority males and the most frequent cancer corresponds to digestive area (35, 5%). Pain is present in most of the patient (78%) and the average pain intensity is from moderate to intense (EVA 8). An 60% stated to sleep less
946 THE EFFECTS OF DISTRACTION ON PAIN: THE INFLUENCE OF THREAT VALUE AND PERSONAL VULNERABILITY VARIABLES 1 *, S. Van Damme2 , M.R. Esteve Zarazaga3 , A.M. Masedo Gutierrez ´ J.J. Lillo Framil4 , I. Garc´ıa Ruiz. 1 Universidad de M´ alaga, M´ alaga, Spain; 2 Ghent University, Ghent, Belgium; 3 University of M´ alaga, M´ alaga, Spain; 4 Centro de Salud Cruz de Humilladero, M´ alaga, Spain
947 DOES THE BIO-PSYCHOSOCIAL MODEL HELP TO LEGITIMISE UNEXPLAINED BACK PAIN? F. Toye *, K. Barker. Nuffield Orthopaedic Centre, Oxford, United Kingdom Background and Aim: The aim was to explore whether the biopsychosocial model was accepted by patients attending a chronic pain management programme. What developed was an exploration of the continuing daily struggle to construct legitimacy in the face of disbelief. Loss of legitimacy may result from lack of fit with the cultural model used to explain pain. Method: We interviewed a purposive sample of 20 patients attending chronic pain management at 3 stages over one year. We transcribed and analysed each interview before completing the next, so that subsequent interviews could be shaped by evolving theory. We used the methods of Grounded Theory to analyse the data, and used NVivo a computerised programme, to assist. Results: Strategies to establish legitimacy were paradoxical: First, although medical tests legitimised illness, patients recognised that wanting a positive result was counter-intuitive, and accepted that psychosocial factors contributed to pain. Second, although seeing a person is in pain was necessary, patients described how you should not look too ill. They often concealed their symptoms to avoid stigma. Third, although meeting others with unexplained pain proved that they were not ‘faking’, paradoxically they described how they were not like the others. Finally, although retaining self was paramount, patients described how it was important to accept their loss. Conclusion: There seems to be a lack of cultural fit between the psychosocial and biomedical model that is not resolved by the bio-