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Examining the contributions of coping style, pain appraisals, and emotional reactions to pain expressiveness
Abstracts
S71
(386) The mammography pain experiences of breast cancer survivors: testing a biopsychosocial model
(388) Health behaviors in older adults with pain and depression
C Scipio, R Shelby, F Keefe, M Soo; Duke University Medical Center, Durham, NC The experience of living as a breast cancer survivor can be very demanding, with a survivor facing many physical and psychosocial challenges. The process of undergoing annual mammography is one such challenge, since breast cancer survivors who have had lumpectomy have been found to report significantly more pain with mammography than healthy women. However, little is known about what factors influence the amount of mammography pain survivors report. Based on a biopsychosocial model of mammography pain, this study assessed if specific biological and psychosocial factors were associated with higher reported mammography pain in breast cancer survivors. Participants included 127 early stage breast cancer survivors who completed questionnaires assessing cancer treatment history, ongoing breast pain, mammographyrelated anxiety, and social support immediately prior to receiving a mammogram. They then underwent mammography and immediately completed questionnaires assessing mammography pain and mammography-related pain catastrophizing. It was hypothesized that higher ongoing breast pain, higher mammography-related anxiety, higher mammography-related pain catastrophizing, and lower social support would be related to higher mammography pain. Using path modeling and moderated mediation analyses, the relationships among these variables were examined. Results of path analyses revealed that higher mammography-related pain catastrophizing was significantly related to higher mammography pain directly (R = .39, p <.001), whereas higher ongoing breast pain (Z = 2.40, p <.05), and lower social support satisfaction (Z = -2.64, p <.01) related to higher mammography pain indirectly through pain catastrophizing. Moderated mediation analyses revealed that at high levels of mammography-related pain catastrophizing, the indirect relationship between higher social support and lower mammography pain was no longer significant. These results support the utility of a biopsychosocial model for the mammography pain experience of breast cancer survivors. An implication of these findings is that interventions designed to increase adaptive pain coping during mammography may be beneficial to breast cancer survivors undergoing the procedure.
K Dondanville, E Janke; Argosy University, Chicago Campus, Chicago, IL The experience of pain and depression in older adults impacts their quality of life, but little is known about its impact on additional health risk behaviors. From the 23 states completing the QOL module of the CDC’s 2002 BRFSS, a sample of 17,154 respondents aged $ 65 years was drawn. Data were analyzed to examine variation in health behaviors as a function of reported depressive symptoms and pain-related activity difficulty during the last 30 days. In order to examine relationships among pain/depression status and demographic and health behavior characteristics, respondents were sorted into a two pain group (infrequent pain = 0-13 pain days; frequent pain $ 14 pain days) by two depressive symptoms group (infrequent depression = 0-13 depressed days; frequent depression $ 14 depressed days) classification. Of the present sample, 13,763 (80.2%) were classified with infrequent pain, infrequent depression; 873 (5.1%) were classified with infrequent pain, frequent depression; 1,829 (10.7%) were classified with frequent pain, infrequent depression; and 689 (4.0%) were classified with frequent pain, frequent depression. Co-occurrence of frequent pain and frequent depression was found associated with female gender, lower educational attainment, divorce, underemployment and inability to work (p # .05). Increasing frequency of depressive symptom days and activity-interfering pain days significantly co-varied with physical inactivity, limited fruit/vegetable consumption, and increased rates of smoking. These cross-sectional survey data suggest a dose-response relationship between increasing days with pain-related activity difficulty, increasing days with symptoms of depression, and increased prevalence of select health risk behaviors in older adults.
(387) Examining the contributions of coping style, pain appraisals, and emotional reactions to pain expressiveness
F07 Pain in Children–Psychosocial
D LaChapelle, N Higgins, K Harman, T Hadjistavropoulos; University of New Brunswick, Fredericton, New Brunswick, Canada To successfully communicate the experience of pain, an individual must translate his or her sensory experience into a verbal or nonverbal expression that can be detected by observers. In the present study, we examined the extent to which patients’ coping styles, pain beliefs, and emotional reactions influenced one another and ultimately contributed to verbal and nonverbal pain expressions during a pain-eliciting physiotherapy exercise. Participants included 163 patients with back pain who completed a series of standardized questionnaires. Verbal (visual analogue scale) and nonverbal (facial grimacing) pain expressiveness were examined in response to the physiotherapy test. A series of regression analyses were used to examine the data. In the first analysis, the contribution of coping style to pain beliefs was examined. Results indicated that those who used praying to cope were more likely to believe other’s should provide help (i.e., were more solicitous) while those who used praying and did not use coping self-statements viewed medication as an appropriate treatment. In the second analysis, the contributions of both coping and beliefs to the patients’ emotional reactions were examined. In this analysis, both coping and beliefs were found to predict anger and anxiety. Greater use of praying, higher levels of solicitousness, and greater belief in medication all made unique contributions to anxiety while only a greater belief in medication uniquely contributed to anger. In the final regression series, the contributions of coping, beliefs, and emotion to expressiveness were examined. None of these variables were significant predictors of nonverbal expressiveness but higher levels of praying and higher levels of anxiety were both unique predictors of verbal expressiveness. These findings support the assertion that that verbal expressions of pain are more strongly mediated by cognitive and affective variables then are more reflexive non-verbal expressions.(Support was received from the Canadian Institutes for Health Research.)
(389) Pain catastrophizing and daily functioning in children and adolescents with chronic abdominal pain: the predictive role of helplessness J Varadarajan, R Ladwig, K Jastrowski Mano, K Hainsworth; Medical College of Wisconsin, Milwaukee, WI Chronic abdominal pain affects 25% of school-aged children, with no organic etiology identified in over 90%. Parental perceptions of child illness impact the child’s level of functioning. The purpose of this study was to determine whether parent or child pain catastrophizing predicted reports of daily functioning. Eighty-one youth seen in a chronic pain clinic for abdominal pain, and their mothers, completed parallel versions of the Pain Catastrophizing Scale (Total, Rumination, Magnification, and Helplessness scores), and youth/parent-proxy versions of the Child Activity Limitations Questionnaire (CALQ). A series of multiple regression analyses was conducted. Patient age (b = .494, p < .01) and youth-reported Helplessness (b = .403, p < .05) significantly predicted youth-reported daily functioning (CALQ scores). There was also a trend toward motherreported Helplessness, predicting their perception of youth daily functioning (b = .558, p = .08). Children aged 8-12 years reported significantly higher Helplessness scores than adolescents aged 13 -18 years (p < .02), which is consistent with research on worry in pediatric samples. These findings suggest that maternal feelings of helplessness regarding their child’s pain may negatively impact their child’s functioning. In addition, youth who reported greater feelings of helplessness also reported more problems related to their daily functioning. Helplessness on the part of both parents and youth is not uncommon in the absence of an organic etiology for pain. These findings suggest that physician acknowledgement of helplessness in youth with chronic pain and their parents should be a key component of management efforts. In addition, it may be helpful for care providers to redirect parent and youth focus toward treatment areas over which they have greater control, such as school attendance or physical activity. Such efforts may potentially impact both short and long-term daily functioning, as well as treatment success.
S71
(386) The mammography pain experiences of breast cancer survivors: testing a biopsychosocial model
(388) Health behaviors in older adults with pain and depression
C Scipio, R Shelby, F Keefe, M Soo; Duke University Medical Center, Durham, NC The experience of living as a breast cancer survivor can be very demanding, with a survivor facing many physical and psychosocial challenges. The process of undergoing annual mammography is one such challenge, since breast cancer survivors who have had lumpectomy have been found to report significantly more pain with mammography than healthy women. However, little is known about what factors influence the amount of mammography pain survivors report. Based on a biopsychosocial model of mammography pain, this study assessed if specific biological and psychosocial factors were associated with higher reported mammography pain in breast cancer survivors. Participants included 127 early stage breast cancer survivors who completed questionnaires assessing cancer treatment history, ongoing breast pain, mammographyrelated anxiety, and social support immediately prior to receiving a mammogram. They then underwent mammography and immediately completed questionnaires assessing mammography pain and mammography-related pain catastrophizing. It was hypothesized that higher ongoing breast pain, higher mammography-related anxiety, higher mammography-related pain catastrophizing, and lower social support would be related to higher mammography pain. Using path modeling and moderated mediation analyses, the relationships among these variables were examined. Results of path analyses revealed that higher mammography-related pain catastrophizing was significantly related to higher mammography pain directly (R = .39, p <.001), whereas higher ongoing breast pain (Z = 2.40, p <.05), and lower social support satisfaction (Z = -2.64, p <.01) related to higher mammography pain indirectly through pain catastrophizing. Moderated mediation analyses revealed that at high levels of mammography-related pain catastrophizing, the indirect relationship between higher social support and lower mammography pain was no longer significant. These results support the utility of a biopsychosocial model for the mammography pain experience of breast cancer survivors. An implication of these findings is that interventions designed to increase adaptive pain coping during mammography may be beneficial to breast cancer survivors undergoing the procedure.
K Dondanville, E Janke; Argosy University, Chicago Campus, Chicago, IL The experience of pain and depression in older adults impacts their quality of life, but little is known about its impact on additional health risk behaviors. From the 23 states completing the QOL module of the CDC’s 2002 BRFSS, a sample of 17,154 respondents aged $ 65 years was drawn. Data were analyzed to examine variation in health behaviors as a function of reported depressive symptoms and pain-related activity difficulty during the last 30 days. In order to examine relationships among pain/depression status and demographic and health behavior characteristics, respondents were sorted into a two pain group (infrequent pain = 0-13 pain days; frequent pain $ 14 pain days) by two depressive symptoms group (infrequent depression = 0-13 depressed days; frequent depression $ 14 depressed days) classification. Of the present sample, 13,763 (80.2%) were classified with infrequent pain, infrequent depression; 873 (5.1%) were classified with infrequent pain, frequent depression; 1,829 (10.7%) were classified with frequent pain, infrequent depression; and 689 (4.0%) were classified with frequent pain, frequent depression. Co-occurrence of frequent pain and frequent depression was found associated with female gender, lower educational attainment, divorce, underemployment and inability to work (p # .05). Increasing frequency of depressive symptom days and activity-interfering pain days significantly co-varied with physical inactivity, limited fruit/vegetable consumption, and increased rates of smoking. These cross-sectional survey data suggest a dose-response relationship between increasing days with pain-related activity difficulty, increasing days with symptoms of depression, and increased prevalence of select health risk behaviors in older adults.
(387) Examining the contributions of coping style, pain appraisals, and emotional reactions to pain expressiveness
F07 Pain in Children–Psychosocial
D LaChapelle, N Higgins, K Harman, T Hadjistavropoulos; University of New Brunswick, Fredericton, New Brunswick, Canada To successfully communicate the experience of pain, an individual must translate his or her sensory experience into a verbal or nonverbal expression that can be detected by observers. In the present study, we examined the extent to which patients’ coping styles, pain beliefs, and emotional reactions influenced one another and ultimately contributed to verbal and nonverbal pain expressions during a pain-eliciting physiotherapy exercise. Participants included 163 patients with back pain who completed a series of standardized questionnaires. Verbal (visual analogue scale) and nonverbal (facial grimacing) pain expressiveness were examined in response to the physiotherapy test. A series of regression analyses were used to examine the data. In the first analysis, the contribution of coping style to pain beliefs was examined. Results indicated that those who used praying to cope were more likely to believe other’s should provide help (i.e., were more solicitous) while those who used praying and did not use coping self-statements viewed medication as an appropriate treatment. In the second analysis, the contributions of both coping and beliefs to the patients’ emotional reactions were examined. In this analysis, both coping and beliefs were found to predict anger and anxiety. Greater use of praying, higher levels of solicitousness, and greater belief in medication all made unique contributions to anxiety while only a greater belief in medication uniquely contributed to anger. In the final regression series, the contributions of coping, beliefs, and emotion to expressiveness were examined. None of these variables were significant predictors of nonverbal expressiveness but higher levels of praying and higher levels of anxiety were both unique predictors of verbal expressiveness. These findings support the assertion that that verbal expressions of pain are more strongly mediated by cognitive and affective variables then are more reflexive non-verbal expressions.(Support was received from the Canadian Institutes for Health Research.)
(389) Pain catastrophizing and daily functioning in children and adolescents with chronic abdominal pain: the predictive role of helplessness J Varadarajan, R Ladwig, K Jastrowski Mano, K Hainsworth; Medical College of Wisconsin, Milwaukee, WI Chronic abdominal pain affects 25% of school-aged children, with no organic etiology identified in over 90%. Parental perceptions of child illness impact the child’s level of functioning. The purpose of this study was to determine whether parent or child pain catastrophizing predicted reports of daily functioning. Eighty-one youth seen in a chronic pain clinic for abdominal pain, and their mothers, completed parallel versions of the Pain Catastrophizing Scale (Total, Rumination, Magnification, and Helplessness scores), and youth/parent-proxy versions of the Child Activity Limitations Questionnaire (CALQ). A series of multiple regression analyses was conducted. Patient age (b = .494, p < .01) and youth-reported Helplessness (b = .403, p < .05) significantly predicted youth-reported daily functioning (CALQ scores). There was also a trend toward motherreported Helplessness, predicting their perception of youth daily functioning (b = .558, p = .08). Children aged 8-12 years reported significantly higher Helplessness scores than adolescents aged 13 -18 years (p < .02), which is consistent with research on worry in pediatric samples. These findings suggest that maternal feelings of helplessness regarding their child’s pain may negatively impact their child’s functioning. In addition, youth who reported greater feelings of helplessness also reported more problems related to their daily functioning. Helplessness on the part of both parents and youth is not uncommon in the absence of an organic etiology for pain. These findings suggest that physician acknowledgement of helplessness in youth with chronic pain and their parents should be a key component of management efforts. In addition, it may be helpful for care providers to redirect parent and youth focus toward treatment areas over which they have greater control, such as school attendance or physical activity. Such efforts may potentially impact both short and long-term daily functioning, as well as treatment success.