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The relationship among PTSD symptoms, chronic pain acceptance, and disability
S58
Abstracts
(328) Pain catastrophizing, pain sensitivity, and the menstrual cycle
(330) Acceptance predicts physical self-efficacy in patients with chronic pain
S Martin, E Bartley, and J Rhudy; The University of Tulsa, Tulsa, OK
T Stein, P Tsui, and N Sonty; Columbia University Medical Center, New York, NY
Pain catastrophizing is a maladaptive coping strategy associated with enhanced pain. The menstrual cycle is also known to influence pain, with increased pain sensitivity generally experienced during the luteal phase compared to the follicular phase. This study assessed whether pain catastrophizing and the pain catastrophizing-pain sensitivity relationship varies by menstrual cycle phase. 41 healthy, regularly-cycling, female participants attended 3 laboratory visits. During Visit 1, participants were instructed how to monitor their menstrual cycle and completed the Pain Catastrophizing Scale (PCS) with traditional instructions to assess trait-like pain catastrophizing (T-Catas). Visits 2 & 3 were pain testing sessions conducted during follicular and luteal phases (testing order counterbalanced). During each testing session, pain sensitivity was assessed from the nociceptive flexion reflex (NFR) threshold, electrocutaneous pain threshold and tolerance, and MPQ sensory and affective ratings of electrocutaneous stimuli. Moreover, situation-specific catastrophizing (SS-Catas) was assessed at each testing session by asking participants to fill out the PCS while thinking back on their catastrophic cognitions during the electrocutaneous stimulations. Results indicated that SS-Catas did not vary by menstrual phase (p=0.89). T-Catas was significantly associated with electrocutaneous pain threshold and tolerance (ps<0.03), whereas SS-Catas was significantly associated with MPQ ratings (ps<0.001). Surprisingly, SS-Catas was associated with higher NFR thresholds (p=0.009). Relationships between catastrophizing and pain outcomes did not differ by menstrual phase, except the relationship between SS-Catas and sensory ratings (p<.001). Results indicated this relationship was stronger during the luteal phase than the follicular phase. Together, these results suggest T-Catas is a better predictor of pain sensitivity (threshold and tolerance), whereas SS-Catas is a better predictor of retrospective pain evaluations (sensory and affective ratings). Moreover, SS-Catas may exacerbate pain during the luteal phase by augmenting the sensory component of pain.
In the context of pain, acceptance emphasizes altering the way in which one’s psychological experiences influence behavior, rather than focusing on changing the content of these experiences. Theoretically, this increases one’s willingness to engage in activities that provoke pain-related anxiety rather than avoiding them. Self-efficacy refers to the belief in one’s ability to pursue activities despite pain. Although chronic pain has been associated with elevated levels of disability, distress, and catastrophization, acceptance and self-efficacy have been associated with better outcomes in several domains. Previous research suggests that perceived self-efficacy and acceptance of chronic pain are two separate but moderately correlated constructs. This research, which is part of a larger ongoing study, examined the roles of acceptance, anxiety, and level of education in predicting physical self-efficacy in a sample of 30 outpatients presenting to a hospital-based pain clinic. Measures included the Chronic Pain Acceptance Questionnaire (CPAQ), Beck Anxiety Inventory (BAI), and Chronic Pain Self Efficacy Scale (CPSES). Socio-demographic information was also collected. A multiple linear regression was performed and the resultant overall model was highly significant (p< .001), explaining 72% of the variance in physical self efficacy in this sample. Level of education (B = .31, p < .05) and CPAQ total score (B = .48, p <. 001) were significant predictors, and anxiety approached significance (B = -.23, p = .06), suggesting that higher levels of education and acceptance of chronic pain, as well as lower levels of anxiety, were predictive of greater confidence in the ability to perform physical tasks. Our findings confirm that acceptance and self-efficacy are moderately correlated but distinct constructs that are important for chronic pain patients. Acceptance of chronic pain was associated with increased self-efficacy related to performing physical tasks, and this effect was more pronounced in those with higher levels of education.
(329) Facilitating acquisition of self-management skills for chronic pain: evaluation of the item structure of a graphical tool for education and performance feedback
(331) The relationship among PTSD symptoms, chronic pain acceptance, and disability
D Martin; Teesside University, Middlesbrough, UK Acquiring new skills is fundamental in pain self-management. To facilitate this a graphical tool for education and performance feedback has been developed based on a set of questions asking people to rate their ability in sixteen elements of self-management: relaxation, activities of daily living, exercise, pacing, goal-setting, sleep hygiene, understanding pain triggers, flare-up management, understanding medication, understanding pain, dealing with others, dealing with difficult thoughts and feelings, stress-management, adaptation, confidence, and attitude. The items were generated by self-management trainers and refined through discussion with people with chronic pain and health professionals. This study examined psychometric properties of the question set. 70 adult men and women in self-management programmes delivered by Pain Association Scotland completed the question set. As part of the programme they scored their ability in each of the items on a 0-10 scale. Cronbach’s alpha was 0.91. Apart from sleep hygiene and relaxation, all items showed item-total correlations >0.35 and squared multiple correlations 0.40.8. An exploratory principal components analysis with varimax rotation yielded three factors explaining 61% of variance. The first factor was mental function (24.8% variance). Items loading >0.6 were sleep hygiene, dealing with others, dealing with difficult thoughts and feelings, adaptation, confidence, and attitude. Stress-management loaded at 0.56. The second factor was knowledge (22.0% variance). Items loading >0.6 were flare-up management, understanding medication, and understanding pain. Relaxation and understanding pain triggers loaded at 0.5 and 0.57 respectively. The third factor was physical function (14.5% variance). Activities of daily living, exercise and goal-setting loaded at least 0.6. Pacing loaded 0.3-0.4 on each factor. In conclusion, the question set offered useful information about acquisition of a general ability in self-management as well as information about constituent skills.
P Tsui, T Stein, and N Sonty; Columbia Presbyterian Pain Management Center, New York, NY The co-occurrence of chronic pain and Post Traumatic Stress Disorder (PTSD) has been estimated to be from 9% to 50%. Theoretical models have described how symptoms of PTSD and chronic pain may each negatively impact the course of the other disorder; yet, the mechanism for this relationship is not well understood. This study examined whether symptoms of PTSD, as well as pain intensity, vigilance, and pain awareness would be associated with chronic pain-related disability and acceptance. We hypothesized that first, the above variables would predict disability, and second, that they would predict chronic pain acceptance. The current sample consisted of 30 outpatients at a hospitalbased pain management clinic. Data were collected as part of a larger study. Participants completed the Pain Disability Index (PDI), Chronic Pain Acceptance Questionnaire (CPAQ), Pain Vigilance and Awareness Questionnaire (PVAQ), and PTSD Checklist – Civilian (PCL-C). Self-reported pain intensity was measured on a scale from 0 (no pain) to 10 (worst pain). Linear multiple regression analyses were performed to test the above hypotheses. The overall model for the first hypothesis was significant (p = .008), where hyperarousal (B = 4.20, p = .029) was predictive of disability and highest reported pain intensity approached significance (B = .07, p = .069). The overall model for the second hypothesis was also significant (p = .02), where hyperarousal (B = -3.81, p = .035) and highest reported pain (B = -4.61, p = .023) significantly predicted chronic pain acceptance. The results indicated that hyperarousal significantly predicted increased pain related disability and decreased acceptance, and that in a larger sample, pain intensity might significantly predict disability. Hyperarousal is an important variable to explore when considering the link between chronic pain and PTSD. Better understanding of the above may be beneficial for treating individuals presenting with both disorders.
Abstracts
(328) Pain catastrophizing, pain sensitivity, and the menstrual cycle
(330) Acceptance predicts physical self-efficacy in patients with chronic pain
S Martin, E Bartley, and J Rhudy; The University of Tulsa, Tulsa, OK
T Stein, P Tsui, and N Sonty; Columbia University Medical Center, New York, NY
Pain catastrophizing is a maladaptive coping strategy associated with enhanced pain. The menstrual cycle is also known to influence pain, with increased pain sensitivity generally experienced during the luteal phase compared to the follicular phase. This study assessed whether pain catastrophizing and the pain catastrophizing-pain sensitivity relationship varies by menstrual cycle phase. 41 healthy, regularly-cycling, female participants attended 3 laboratory visits. During Visit 1, participants were instructed how to monitor their menstrual cycle and completed the Pain Catastrophizing Scale (PCS) with traditional instructions to assess trait-like pain catastrophizing (T-Catas). Visits 2 & 3 were pain testing sessions conducted during follicular and luteal phases (testing order counterbalanced). During each testing session, pain sensitivity was assessed from the nociceptive flexion reflex (NFR) threshold, electrocutaneous pain threshold and tolerance, and MPQ sensory and affective ratings of electrocutaneous stimuli. Moreover, situation-specific catastrophizing (SS-Catas) was assessed at each testing session by asking participants to fill out the PCS while thinking back on their catastrophic cognitions during the electrocutaneous stimulations. Results indicated that SS-Catas did not vary by menstrual phase (p=0.89). T-Catas was significantly associated with electrocutaneous pain threshold and tolerance (ps<0.03), whereas SS-Catas was significantly associated with MPQ ratings (ps<0.001). Surprisingly, SS-Catas was associated with higher NFR thresholds (p=0.009). Relationships between catastrophizing and pain outcomes did not differ by menstrual phase, except the relationship between SS-Catas and sensory ratings (p<.001). Results indicated this relationship was stronger during the luteal phase than the follicular phase. Together, these results suggest T-Catas is a better predictor of pain sensitivity (threshold and tolerance), whereas SS-Catas is a better predictor of retrospective pain evaluations (sensory and affective ratings). Moreover, SS-Catas may exacerbate pain during the luteal phase by augmenting the sensory component of pain.
In the context of pain, acceptance emphasizes altering the way in which one’s psychological experiences influence behavior, rather than focusing on changing the content of these experiences. Theoretically, this increases one’s willingness to engage in activities that provoke pain-related anxiety rather than avoiding them. Self-efficacy refers to the belief in one’s ability to pursue activities despite pain. Although chronic pain has been associated with elevated levels of disability, distress, and catastrophization, acceptance and self-efficacy have been associated with better outcomes in several domains. Previous research suggests that perceived self-efficacy and acceptance of chronic pain are two separate but moderately correlated constructs. This research, which is part of a larger ongoing study, examined the roles of acceptance, anxiety, and level of education in predicting physical self-efficacy in a sample of 30 outpatients presenting to a hospital-based pain clinic. Measures included the Chronic Pain Acceptance Questionnaire (CPAQ), Beck Anxiety Inventory (BAI), and Chronic Pain Self Efficacy Scale (CPSES). Socio-demographic information was also collected. A multiple linear regression was performed and the resultant overall model was highly significant (p< .001), explaining 72% of the variance in physical self efficacy in this sample. Level of education (B = .31, p < .05) and CPAQ total score (B = .48, p <. 001) were significant predictors, and anxiety approached significance (B = -.23, p = .06), suggesting that higher levels of education and acceptance of chronic pain, as well as lower levels of anxiety, were predictive of greater confidence in the ability to perform physical tasks. Our findings confirm that acceptance and self-efficacy are moderately correlated but distinct constructs that are important for chronic pain patients. Acceptance of chronic pain was associated with increased self-efficacy related to performing physical tasks, and this effect was more pronounced in those with higher levels of education.
(329) Facilitating acquisition of self-management skills for chronic pain: evaluation of the item structure of a graphical tool for education and performance feedback
(331) The relationship among PTSD symptoms, chronic pain acceptance, and disability
D Martin; Teesside University, Middlesbrough, UK Acquiring new skills is fundamental in pain self-management. To facilitate this a graphical tool for education and performance feedback has been developed based on a set of questions asking people to rate their ability in sixteen elements of self-management: relaxation, activities of daily living, exercise, pacing, goal-setting, sleep hygiene, understanding pain triggers, flare-up management, understanding medication, understanding pain, dealing with others, dealing with difficult thoughts and feelings, stress-management, adaptation, confidence, and attitude. The items were generated by self-management trainers and refined through discussion with people with chronic pain and health professionals. This study examined psychometric properties of the question set. 70 adult men and women in self-management programmes delivered by Pain Association Scotland completed the question set. As part of the programme they scored their ability in each of the items on a 0-10 scale. Cronbach’s alpha was 0.91. Apart from sleep hygiene and relaxation, all items showed item-total correlations >0.35 and squared multiple correlations 0.40.8. An exploratory principal components analysis with varimax rotation yielded three factors explaining 61% of variance. The first factor was mental function (24.8% variance). Items loading >0.6 were sleep hygiene, dealing with others, dealing with difficult thoughts and feelings, adaptation, confidence, and attitude. Stress-management loaded at 0.56. The second factor was knowledge (22.0% variance). Items loading >0.6 were flare-up management, understanding medication, and understanding pain. Relaxation and understanding pain triggers loaded at 0.5 and 0.57 respectively. The third factor was physical function (14.5% variance). Activities of daily living, exercise and goal-setting loaded at least 0.6. Pacing loaded 0.3-0.4 on each factor. In conclusion, the question set offered useful information about acquisition of a general ability in self-management as well as information about constituent skills.
P Tsui, T Stein, and N Sonty; Columbia Presbyterian Pain Management Center, New York, NY The co-occurrence of chronic pain and Post Traumatic Stress Disorder (PTSD) has been estimated to be from 9% to 50%. Theoretical models have described how symptoms of PTSD and chronic pain may each negatively impact the course of the other disorder; yet, the mechanism for this relationship is not well understood. This study examined whether symptoms of PTSD, as well as pain intensity, vigilance, and pain awareness would be associated with chronic pain-related disability and acceptance. We hypothesized that first, the above variables would predict disability, and second, that they would predict chronic pain acceptance. The current sample consisted of 30 outpatients at a hospitalbased pain management clinic. Data were collected as part of a larger study. Participants completed the Pain Disability Index (PDI), Chronic Pain Acceptance Questionnaire (CPAQ), Pain Vigilance and Awareness Questionnaire (PVAQ), and PTSD Checklist – Civilian (PCL-C). Self-reported pain intensity was measured on a scale from 0 (no pain) to 10 (worst pain). Linear multiple regression analyses were performed to test the above hypotheses. The overall model for the first hypothesis was significant (p = .008), where hyperarousal (B = 4.20, p = .029) was predictive of disability and highest reported pain intensity approached significance (B = .07, p = .069). The overall model for the second hypothesis was also significant (p = .02), where hyperarousal (B = -3.81, p = .035) and highest reported pain (B = -4.61, p = .023) significantly predicted chronic pain acceptance. The results indicated that hyperarousal significantly predicted increased pain related disability and decreased acceptance, and that in a larger sample, pain intensity might significantly predict disability. Hyperarousal is an important variable to explore when considering the link between chronic pain and PTSD. Better understanding of the above may be beneficial for treating individuals presenting with both disorders.