Social pain and physical pain: shared paths to resilience
2016; 6 (1): 63-74
Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli.
Journal of behavioral medicine
Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study.
2015; 156 (12): 2627-2633
Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted five studies designed to develop and validate the Sensory Hypersensitive Scale (SHS); a 25-item self-report measure of sensory hypersensitivity. The SHS assesses both general sensitivity and modality-specific sensitivity (e.g. touch, taste, and hearing). 1202 participants (157 individuals with chronic pain) completed the SHS, which demonstrated an adequate overall internal reliability (Cronbach's alpha) of 0.81, suggesting the tool can be used as a cross-modality assessment of sensitivity. SHS scores demonstrated only modest correlations (Pearson's r) with depressive symptoms (0.19) and anxiety (0.28), suggesting a low level of overlap with psychiatric complaints. Overall SHS scores showed significant but relatively modest correlations (Pearson's r) with three measures of sensory testing: cold pain tolerance (-0.34); heat pain tolerance (-0.285); heat pain threshold (-0.271). Women reported significantly higher scores on the SHS than did men, although gender-based differences were small. In a chronic pain sample, individuals with fibromyalgia syndrome demonstrated significantly higher SHS scores than did individuals with osteoarthritis or back pain. The SHS appears suitable as a screening measure for sensory hypersensitivity, though additional research is warranted to determine its suitability as a proxy for central sensitization.
View details for DOI 10.1007/s10865-016-9720-3
View details for PubMedID 26873609
Nonlinear Effects of Noxious Thermal Stimulation and Working Memory Demands on Subjective Pain Perception
2015; 16 (7): 1301-1310
Individuals with chronic pain show a greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The current study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of PROMIS Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress appears to be disruption of social relationships, rather than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.
View details for DOI 10.1097/j.pain.0000000000000313
View details for PubMedID 26230739
Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study.
journal of pain
2015; 16 (3): 291-8 e1
A bidirectional relationship between working memory (WM) and acute pain has long been assumed, but equivocal evidence exists regarding this relationship. This study characterized the relationship between WM and acute pain processing in healthy individuals using an adapted Sternberg WM task.Participants completed a Sternberg task while receiving noxious thermal stimulation. Participants received a pseudorandom presentation of four different temperatures (baseline temperatures and individually determined low-, medium-, and high-temperature stimuli) and four levels of Sternberg task difficulty (0-, 3-, 6-, and 9-letter strings).Twenty-eight healthy participants were recruited from Stanford University and the surrounding community to complete this study.A nonlinear interaction between intensity of thermal stimulation and difficulty of the Sternberg task was noted. Increased cognitive load from the Sternberg task resulted in increased perception of pain in low-intensity thermal stimulation but suppressed pain perception in high-intensity thermal stimulation. Thermal stimulation had no significant effect on participants' response time or accuracy on the Sternberg task regardless of intensity level.Pain perception appears to decrease as a function of WM load only for sufficiently noxious stimuli. However, increasing noxious stimuli did not affect cognitive performance. These complex relationships may reflect a shared cognitive space that can become "overloaded" with input of multiple stimuli of sufficient intensity.
View details for DOI 10.1111/pme.12774
View details for Web of Science ID 000358017000013
View details for PubMedID 25929747
Physical and Psychological Correlates of Fatigue and Physical Function: A Collaborative Health Outcomes Information Registry (CHOIR) Study
JOURNAL OF PAIN
2015; 16 (3): 291-298
The Psychosocial Context of Financial Stress: Implications for Inflammation and Psychological Health.
Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. Methods: These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic.Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference, and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference.Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic non-cancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain, and may provide directions for future clinical and theoretical research in the area of chronic non-cancer pain.Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic non-cancer pain.
View details for DOI 10.1016/j.jpain.2014.12.004
View details for PubMedID 25536536
Respiratory Sinus Arrhythmia: a Marker of Resilience to Pain Induction
INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE
2014; 21 (6): 961-965
Associations Between Financial Stress and Interpersonal Events: A Daily Diary Study of Middle-Aged Adults and Their Life Circumstances
PSYCHOLOGY AND AGING
2014; 29 (4): 803-813
Psychological distress may contribute to chronic activation of acute-phase inflammation. The current study investigated how financial stressors influence psychosocial functioning and inflammation. This study examined a) the direct relations between financial stress and inflammation; b) whether the relationships between financial stress and inflammation are mediated in part by negative interpersonal events, psychological distress, and psychological well-being; and c) whether social standing in one's community moderates the relations between financial stress and psychological distress, psychological well-being, and markers of inflammation (interleukin-6 [IL-6] and C-reactive protein).Stressful financial and interpersonal events over the previous year, perceived social status, indices of psychological well-being and distress, and levels of IL-6 and C-reactive protein were assessed in a community sample of 680 middle-aged adults (ages 40-65 years).Structural equation modeling analyses revealed significant relations among financial stress, interpersonal stress, and psychological distress and well-being, and complex relationships between these variables and inflammatory markers. Psychological well-being mediated the association between financial stress and IL-6 ([mediation] ab = 0.012, standard error [SE] = 0.006, p = .048). Furthermore, individuals with higher perceived social standing within their communities exhibited a stronger relation between negative financial events and both interpersonal stressors (interaction B = 0.067, SE = 0.017, p < .001) and C-reactive protein (interaction B = 0.051, SE = 0.026, p = .050).Financial stress demonstrates complex relations with inflammation, due partly to psychological well-being and social perceptions. Findings are discussed with regard to the social context of stress and physiological factors pertinent to stress adaptation and inflammation.
View details for DOI 10.1097/PSY.0000000000000276
View details for PubMedID 26569541
A multilevel structural equation modeling analysis of vulnerabilities and resilience resources influencing affective adaptation to chronic pain.
2014; 155 (2): 292-8
This study examined the relationships between daily negative financial events and positive and negative interpersonal events, as well as the moderating effects of life circumstances, for a sample of 182 adults between the age of 40 and 65 providing 30 days of diary data collected between 2008 and 2011. There was a significant and positive relationship between daily negative interpersonal events and daily levels of both negative interpersonal events and positive interpersonal events; these relationships varied by income, employment status, parenting roles, and the experience of major financial challenges over the previous year. The moderating effect of income was nonlinear but its effect disappeared when the interaction between major financial challenges over the previous year and daily negative financial events was entered into the model. The results were interpreted in the context of the stress proliferation and resource mobilization theoretical models and directions for future studies were delineated with respect to individual- and community-level factors that influence the role of financial events on the daily social worlds of middle-aged adults. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
View details for DOI 10.1037/a0037961
View details for Web of Science ID 000346277900006
View details for PubMedID 25365693
From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing
JOURNAL OF PAIN RESEARCH
2014; 7: 219-226
The processes of individual adaptation to chronic pain are complex and occur across multiple domains. We examined the social, cognitive, and affective context of daily pain adaptation in individuals with fibromyalgia and osteoarthritis. By using a sample of 260 women with fibromyalgia or osteoarthritis, we examined the contributions of pain catastrophizing, negative interpersonal events, and positive interpersonal events to daily negative and positive affect across 30days of daily diary data. Individual differences and daily fluctuations in predictor variables were estimated simultaneously by utilizing multilevel structural equation modeling techniques. The relationships between pain and negative and positive affect were mediated by stable and day-to-day levels of pain catastrophizing as well as day-to-day positive interpersonal events, but not negative interpersonal events. There were significant and independent contributions of pain catastrophizing and positive interpersonal events to adaptation to pain and pain-related affective dysregulation. These effects occur both between persons and within a person's everyday life.
View details for DOI 10.1016/j.pain.2013.10.007
View details for PubMedID 24120460
Psychological therapies for the management of chronic pain.
Psychology research and behavior management
2014; 7: 115-124
Pain catastrophizing (PC) - a pattern of negative cognitive-emotional responses to real or anticipated pain - maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled "From Catastrophizing to Recovery" [FCR].To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC.Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student's t-test contrasts were used to compare scores across time points.All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen's d=0.85 and d=1.15).Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.
View details for DOI 10.2147/JPR.S62329
View details for Web of Science ID 000364587600005
View details for PubMedID 24851056
Proinflammatory cytokines and DHEA-S in women with fibromyalgia: impact of psychological distress and menopausal status
JOURNAL OF PAIN RESEARCH
2014; 7: 707-716
Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.
View details for DOI 10.2147/PRBM.S44762
View details for PubMedID 24748826
Psychological Resilience, Pain Catastrophizing, and Positive Emotions: Perspectives on Comprehensive Modeling of Individual Pain Adaptation
CURRENT PAIN AND HEADACHE REPORTS
2013; 17 (3)
Though fibromyalgia is not traditionally considered an inflammatory disorder, evidence for elevated inflammatory processes has been noted in this disorder in multiple studies. Support for inflammatory markers in fibromyalgia has been somewhat equivocal to date, potentially due to inattention to salient patient characteristics that may affect inflammation, such as psychiatric distress and aging milestones like menopause. The current study examined the relationships between proinflammatory cytokines and hormone levels, pain intensity, and psychological distress in a sample of 34 premenopausal and postmenopausal women with fibromyalgia. Our results indicated significant relationships between interleukin-8 and ratings of pain catastrophizing (r=0.555, P<0.05), pain anxiety (r=0.559, P<0.05), and depression (r=0.551, P<0.05) for postmenopausal women but not premenopausal women (r,0.20 in all cases). Consistent with previous studies, ratios of interleukin-6 to interleukin-10 were significantly lower in individuals with greater levels of depressive symptoms (r=-0.239, P<0.05). Contrary to previous research, however, dehydroepiandrosterone sulfate did not correlate with pain intensity or psychological or biological variables. The results of the current study highlight the importance of psychological functioning and milestones of aging in the examination of inflammatory processes in fibromyalgia.
View details for DOI 10.2147/JPR.S71344
View details for Web of Science ID 000364591400001
View details for PubMedID 25506243
State and Trait Pain Catastrophizing and Emotional Health in Rheumatoid Arthritis
ANNALS OF BEHAVIORAL MEDICINE
2013; 45 (1): 69-77
Pain is a complex construct that contributes to profound physical and psychological dysfunction, particularly in individuals coping with chronic pain. The current paper builds upon previous research, describes a balanced conceptual model that integrates aspects of both psychological vulnerability and resilience to pain, and reviews protective and exacerbating psychosocial factors to the process of adaptation to chronic pain, including pain catastrophizing, pain acceptance, and positive psychological resources predictive of enhanced pain coping. The current paper identifies future directions for research that will further enrich the understanding of pain adaptation and espouses an approach that will enhance the ecological validity of psychological pain coping models, including introduction of advanced statistical and conceptual models that integrate behavioral, cognitive, information processing, motivational and affective theories of pain.
View details for DOI 10.1007/s11916-012-0317-4
View details for Web of Science ID 000315630200002
View details for PubMedID 23338769
Phone-based interventions with automated mindfulness and mastery messages improve the daily functioning for depressed middle-aged community residents
Journal of Psychotherapy Integration
2012; 22: 206-228
Independent Validation of the MMPI-2-RF Somatic/Cognitive and Validity Scales in TBI Litigants Tested for Effort
2011; 25 (3): 463-476
Pain catastrophizing is a powerful predictor of pain adaptation, and both stable and time-varying aspects may influence overall emotional well-being.This study aims to test the independent influences of state and trait pain catastrophizing on the relationship between daily intensity and negative affect, positive affect, and depressive symptoms.Daily diary data were collected for 30 days from a sample of 231 adults with a diagnosis of rheumatoid arthritis.State pain catastrophizing accounted for a significant proportion of the relationship between daily pain and each of the three examined daily outcomes. Greater trait pain catastrophizing significantly increased the effect of state pain catastrophizing on the relationship between pain intensity and the outcome variables in cross-sectional and time-lagged models.The results of the current study indicate that state pain catastrophizing plays a prominent role in the adaptation to daily pain fluctuations, particularly for those with a propensity to catastrophize.
View details for DOI 10.1007/s12160-012-9408-z
View details for Web of Science ID 000314293300008
View details for PubMedID 22915012
Resilience: A New Paradigm for Adaptation to Chronic Pain
CURRENT PAIN AND HEADACHE REPORTS
2010; 14 (2): 105-112
The MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is replacing the MMPI-2 as the most widely used personality test in neuropsychological assessment, but additional validation studies are needed. Our study examines MMPI-2-RF Validity scales and the newly created Somatic/Cognitive scales in a recently reported sample of 82 traumatic brain injury (TBI) litigants who either passed or failed effort tests (Thomas & Youngjohn, 2009). The restructured Validity scales FBS-r (restructured symptom validity), F-r (restructured infrequent responses), and the newly created Fs (infrequent somatic responses) were not significant predictors of TBI severity. FBS-r was significantly related to passing or failing effort tests, and Fs and F-r showed non-significant trends in the same direction. Elevations on the Somatic/Cognitive scales profile (MLS-malaise, GIC-gastrointestinal complaints, HPC-head pain complaints, NUC-neurological complaints, and COG-cognitive complaints) were significant predictors of effort test failure. Additionally, HPC had the anticipated paradoxical inverse relationship with head injury severity. The Somatic/Cognitive scales as a group were better predictors of effort test failure than the RF Validity scales, which was an unexpected finding. MLS arose as the single best predictor of effort test failure of all RF Validity and Somatic/Cognitive scales. Item overlap analysis revealed that all MLS items are included in the original MMPI-2 Hy scale, making MLS essentially a subscale of Hy. This study validates the MMPI-2-RF as an effective tool for use in neuropsychological assessment of TBI litigants.
View details for DOI 10.1080/13854046.2011.554444
View details for Web of Science ID 000289636100009
View details for PubMedID 21391149
Chronic pain is an affliction that affects a large proportion of the general population and is often accompanied by a myriad of negative emotional, cognitive, and physical effects. However, current pain adaptation paradigms do not account for the many chronic pain patients who demonstrate little or no noticeable impairment due to the effects of chronic pain. This paper offers resilience as an integrative perspective that can illuminate the traits and mechanisms underlying the sustainability of a good life and recovery from distress for individuals with chronic pain.
View details for DOI 10.1007/s11916-010-0095-9
View details for Web of Science ID 000275964100005
View details for PubMedID 20425199