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Preliminary pre-treatment analysis of the demographic and psychosocial characteristics of rural Alabama patients with chronic pain
Abstracts (362) Antecedents and consequences of verbal pain catastrophizing J Lutz, A Cano, A Johansen, A Williams; Wayne State University, Detroit, MI Pain catastrophizing refers to a negative, exaggerated view of pain. The communal coping model suggests that pain catastrophizing functions to communicate distress to close others who can provide support. Catastrophizing is often measured with the Pain Catastrophizing Scale1 and consists of three domains: magnification (e.g. ‘‘I become afraid that the pain may get worse’’), rumination (‘‘I keep thinking about how much I want the pain to stop’’), and helplessness (‘‘It’s terrible and I think it’s never going to get any better’’). However, researchers have rarely examined spontaneous verbalizations of catastrophizing that occur during interactions with significant others. Furthermore, little is known about how significant others react to such verbalizations. The purpose of this study is to examine the rate of verbal catastrophizing as well as the antecedents and consequences of verbal catastrophizing in chronic pain couples. The sample consisted of 97 couples in which one spouse reported chronic pain. Couples engaged in 2 10-minute pain discussion tasks that were then coded for verbal catastrophizing and a number of spouse responses including validation and invalidation. It was expected that verbal catastrophizing occurs with some frequency and that certain sequences (e.g., spousal validation following patient catastrophizing) would be related to better pain adjustment. Verbal catastrophizing by the patient was evident in 56% (n = 54) of the couples. Validation was present in 30 of these couples whereas invalidation was present in 20 of these couples. Analyses also examined the association between certain antecedent –> catastrophizing and catastrophizing –> consequence sequences. The results of this study have implications for theoretical models of social interaction and pain as well as clinical work, as very little research exists on sequences of behavior in pain discussion tasks. (1. Sullivan, Bishop, Pivik; Psychological Assessment, 1995)
(363) Catastrophizing in fibromyalgia among veterans G Tan, A Sanders, M Jensen; MED VA Medical Center, Houston, TX Cognitive behavior therapy (CBT) postulates the central role of control appraisals and coping in pain management outcome. Although research has shown that catastrophizing plays a key role in determining the outcome of fibromyalgia program, it is less clear whether this would equally apply to the veteran population (who has been shown by previous research to be somewhat different than their civilian counter part; e g., greater self-reported pain severity, higher level of depression, higher rate of substance abuse, less coping resources). The current research aims at examining the role of control appraisal (control over pain, control over how pain affects life, and control over life in general), coping (catastrophizing), and quality of life measures (quality of social support and overall satisfaction with life) in terms of their relative contribution to the outcome of a fibromyalgia program for veterans. The participants consisted of a convenient sample of 22 veterans enrolled in a fibromyalgia education/support group for veterans. A regression analysis indicted that catastrophizing accounted for a majority of the variance (R2 = 0.50) attributable to self-reported pain intensity as assessed by the Brief Pain Inventory (BPI). After controlling for pain intensity, catastrophizing also accounted for a majority of the variance (R2 = 0.71) attributable to pain interference. No other variables entered the stepwise regression in both analyses; this is somewhat surprising given the importance of social support and life satisfaction to this group. The outcome confirms the need to focus on reducing catastrophizing as a central goal of fibromyalgia treatment even for veterans.
S65 (364) Pain-related anxiety as a mediator of the effects of mindfulness on physical and psychological functioning in chronic pain patients in Korea S Cho, S Lee, L McCracken, D Moon, E Heiby; University of Hawaii at Manoa, Honolulu, HI Recent correlational studies suggest that processes of mindfulness may improve physical and psychosocial functioning in patient with chronic pain. Here mindfulness includes the ability to be more present-focused and less reactive to some negative psychological experiences. Also, it has been well documented that pain-related anxiety is associated with general functioning in chronic pain patients. However, to our knowledge, possible interactions between mindfulness and pain-related anxiety, in their relations with physical and psychological functioning have not been investigated. Given that mindfulness involves reducing potential influences from aversive cognitions, sensations, and emotions on behavior, mindfulness may directly influence the experience of pain-related anxiety, and thereby enhance other aspects of physical and psycholosocial functioning. Thus, the purpose of this study was to investigate a potential mediating role of pain-related anxiety between mindfulness and patient functioning as measured by the Short Form-36 (SF-36) in chronic pain patients. A total of 166 patients with chronic pain (70.5% females; Mean age = 48.7 years, SD = 13.0) seeking treatment in a university pain management center located in Seoul, Korea were invited to participate in the study. The results of structural equation modeling indicated that a full mediation model and partial mediation model had excellent goodness-of-fit indexes on physical functioning (i.e., RMSEA = .00, CFI = 1.00, NNFI = 1.02 for both models) and adequate goodness-of-fit indexes on psychological functioning scores (i.e., RMSEA = .10, CFI = .95, NNFI = .91 for both models). Subsequently, a chi-square difference test showed that the full mediation model has advantage over the partial mediation model on both physical and psychological functioning scores. These findings suggest exploration of whether mindfulness improves physical and psychological functioning by reducing the disabling influences of pain-related anxiety and whether it would be useful to further introduce mindfulness-based treatments in pain management clinics in Korea and elsewhere.
(365) Preliminary pre-treatment analysis of the demographic and psychosocial characteristics of rural Alabama patients with chronic pain M Day, B Thorn, L Ward, M Kuhajda, C Cabbil, K Sweeney; The University of Alabama, Tuscaloosa, AL Rural residency, annual income < $25,000, and low education are associated with increased likelihood of chronic pain. Catastrophizing, a negative mental set about pain, is a robust predictor of pain intensity, disability, and adaptation to painful conditions, although no studies have examined this construct with rural patients. Research on pain and race indicates that African-Americans (AA) report greater pain in a variety of chronic pain conditions. Notably, socioeconomic status (SES) partially mediates racial differences in pain and is a differentiating factor in terms of vulnerability to negative cognitions. Educational attainment is a key component of SES, and individuals with lower education report more physical health problems. SES, rurality, and race are correlated, and their impact on the experience of chronic pain is compounded by widespread treatment disparities. This study reports preliminary pre-treatment descriptive analyses of a virtually unstudied population of patients with chronic pain. Sixty-seven rural Alabama patients completed validated measures of pain, interference, perceived disability, depression, quality of life, and catastrophizing. Calculated means, standard deviations, and coefficient alphas obtained were compared to published norms. Descriptive statistics and multiple regression analyses of their psychosocial measures and demographics are presented. Average age of study participants was 52-years, 87% were female, 84% were AA, 76% reported annual income between 00,000-12,999, and 62% were unemployed. Selfreported disability status was ‘‘on disability’’ (49%), ‘‘seeking disability’’ (19%) and ‘‘not on or not seeking disability’’ (32%). Although average years of education were 12.40, average reading level percentile was 17.65. Regression analyses showed: 1) Catastrophizing uniquely predicted depression, pain intensity, and pain interference, but not perceived disability; 2) Reading level percentiles approached significance as a unique predictor of pain intensity; 3) Pain intensity uniquely predicted perceived disability. These preliminary analyses provide insight into demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.
(363) Catastrophizing in fibromyalgia among veterans G Tan, A Sanders, M Jensen; MED VA Medical Center, Houston, TX Cognitive behavior therapy (CBT) postulates the central role of control appraisals and coping in pain management outcome. Although research has shown that catastrophizing plays a key role in determining the outcome of fibromyalgia program, it is less clear whether this would equally apply to the veteran population (who has been shown by previous research to be somewhat different than their civilian counter part; e g., greater self-reported pain severity, higher level of depression, higher rate of substance abuse, less coping resources). The current research aims at examining the role of control appraisal (control over pain, control over how pain affects life, and control over life in general), coping (catastrophizing), and quality of life measures (quality of social support and overall satisfaction with life) in terms of their relative contribution to the outcome of a fibromyalgia program for veterans. The participants consisted of a convenient sample of 22 veterans enrolled in a fibromyalgia education/support group for veterans. A regression analysis indicted that catastrophizing accounted for a majority of the variance (R2 = 0.50) attributable to self-reported pain intensity as assessed by the Brief Pain Inventory (BPI). After controlling for pain intensity, catastrophizing also accounted for a majority of the variance (R2 = 0.71) attributable to pain interference. No other variables entered the stepwise regression in both analyses; this is somewhat surprising given the importance of social support and life satisfaction to this group. The outcome confirms the need to focus on reducing catastrophizing as a central goal of fibromyalgia treatment even for veterans.
S65 (364) Pain-related anxiety as a mediator of the effects of mindfulness on physical and psychological functioning in chronic pain patients in Korea S Cho, S Lee, L McCracken, D Moon, E Heiby; University of Hawaii at Manoa, Honolulu, HI Recent correlational studies suggest that processes of mindfulness may improve physical and psychosocial functioning in patient with chronic pain. Here mindfulness includes the ability to be more present-focused and less reactive to some negative psychological experiences. Also, it has been well documented that pain-related anxiety is associated with general functioning in chronic pain patients. However, to our knowledge, possible interactions between mindfulness and pain-related anxiety, in their relations with physical and psychological functioning have not been investigated. Given that mindfulness involves reducing potential influences from aversive cognitions, sensations, and emotions on behavior, mindfulness may directly influence the experience of pain-related anxiety, and thereby enhance other aspects of physical and psycholosocial functioning. Thus, the purpose of this study was to investigate a potential mediating role of pain-related anxiety between mindfulness and patient functioning as measured by the Short Form-36 (SF-36) in chronic pain patients. A total of 166 patients with chronic pain (70.5% females; Mean age = 48.7 years, SD = 13.0) seeking treatment in a university pain management center located in Seoul, Korea were invited to participate in the study. The results of structural equation modeling indicated that a full mediation model and partial mediation model had excellent goodness-of-fit indexes on physical functioning (i.e., RMSEA = .00, CFI = 1.00, NNFI = 1.02 for both models) and adequate goodness-of-fit indexes on psychological functioning scores (i.e., RMSEA = .10, CFI = .95, NNFI = .91 for both models). Subsequently, a chi-square difference test showed that the full mediation model has advantage over the partial mediation model on both physical and psychological functioning scores. These findings suggest exploration of whether mindfulness improves physical and psychological functioning by reducing the disabling influences of pain-related anxiety and whether it would be useful to further introduce mindfulness-based treatments in pain management clinics in Korea and elsewhere.
(365) Preliminary pre-treatment analysis of the demographic and psychosocial characteristics of rural Alabama patients with chronic pain M Day, B Thorn, L Ward, M Kuhajda, C Cabbil, K Sweeney; The University of Alabama, Tuscaloosa, AL Rural residency, annual income < $25,000, and low education are associated with increased likelihood of chronic pain. Catastrophizing, a negative mental set about pain, is a robust predictor of pain intensity, disability, and adaptation to painful conditions, although no studies have examined this construct with rural patients. Research on pain and race indicates that African-Americans (AA) report greater pain in a variety of chronic pain conditions. Notably, socioeconomic status (SES) partially mediates racial differences in pain and is a differentiating factor in terms of vulnerability to negative cognitions. Educational attainment is a key component of SES, and individuals with lower education report more physical health problems. SES, rurality, and race are correlated, and their impact on the experience of chronic pain is compounded by widespread treatment disparities. This study reports preliminary pre-treatment descriptive analyses of a virtually unstudied population of patients with chronic pain. Sixty-seven rural Alabama patients completed validated measures of pain, interference, perceived disability, depression, quality of life, and catastrophizing. Calculated means, standard deviations, and coefficient alphas obtained were compared to published norms. Descriptive statistics and multiple regression analyses of their psychosocial measures and demographics are presented. Average age of study participants was 52-years, 87% were female, 84% were AA, 76% reported annual income between 00,000-12,999, and 62% were unemployed. Selfreported disability status was ‘‘on disability’’ (49%), ‘‘seeking disability’’ (19%) and ‘‘not on or not seeking disability’’ (32%). Although average years of education were 12.40, average reading level percentile was 17.65. Regression analyses showed: 1) Catastrophizing uniquely predicted depression, pain intensity, and pain interference, but not perceived disability; 2) Reading level percentiles approached significance as a unique predictor of pain intensity; 3) Pain intensity uniquely predicted perceived disability. These preliminary analyses provide insight into demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.