| 1. |
- Chisari, Claudia, et al.
(author)
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A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes
- 2021
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In: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 22:12, s. 2863-2875
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Journal article (peer-reviewed)abstract
- Objective Psychosocial factors are related to pain and sex-related outcomes in provoked vulvodynia and possibly in mixed and spontaneous vulvodynia. However, a broader behavioral framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to vulvodynia, and their associations with vulvodynia outcomes. The study also explored potential differences across vulvodynia subtypes.Design An online cross-sectional study of 349 participants with vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out.Methods Participants completed self-report questionnaires, including questions on pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and for provoked and mixed/spontaneous vulvodynia subsamples.Results Perceived injustice, pain acceptance, and depression were “central” factors among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype.Conclusions Among the included variables, perceived injustice, pain acceptance, depression, and psychological flexibility appear to be important in vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.
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| 2. |
- Exposto, Fernando G, et al.
(author)
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Assessment of Pain Modulatory and Somatosensory Profiles in Chronic Tension-Type Headache Patients
- 2021
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In: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 22:10, s. 2356-2365
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients.METHODS: Fifteen CTTH patients diagnosed according to the International Classification of Headache Disorders-3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST), including temporal summation of pain (TSP), conditioned pain modulation (CPM), and psychological and sleep variables, was assessed in a single session. TSP and CPM were then combined to build pain modulation profiles (PMP) for each individual.RESULTS: No difference was found between groups for PMP, TSP, and CPM. However, 10 CTTH patients showed a pronociceptive PMP, with 8 related to a deficient CPM and 2 to both a deficient CPM and increased TSP. Increased cold detection thresholds were the most common sensory disturbance found in CTTH patients. Significant differences were seen between groups for pain catastrophizing, depression, and sleep quality although not all patient's scores were above the clinically meaningful cutoffs.CONCLUSIONS: In summary, CTTH patients presented with different PMP. These PMP may be related to increased TSP, deficient CPM, alterations in thermal detection that may be related to autonomic dysregulation, or a combination of all three. Overall, this suggests that due to their heterogeneous pathophysiology, CTTH patients should be managed according to their underlying pathophysiology and not with a one-size-fits-all approach.
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| 3. |
- Gentili, Charlotte, et al.
(author)
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ACTsmart : Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain — A Pilot Trial
- 2021
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In: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:2, s. 315-328
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Journal article (peer-reviewed)abstract
- BackgroundAcceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients’ everyday lives.ObjectiveACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain.MethodsThe study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models.ResultsThe sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = –1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up.ConclusionThe results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.
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| 4. |
- Kioskli, Kitty, et al.
(author)
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Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom : A Single-Arm Feasibility Trial
- 2020
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In: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 21:11, s. 2777-2788
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Journal article (peer-reviewed)abstract
- OBJECTIVE: This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified.METHODS: Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility.RESULTS: Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance.CONCLUSIONS: This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
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| 5. |
- Lahousse, A., et al.
(author)
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The Mediating Effect of Perceived Injustice and Pain Catastrophizing in the Relationship of Pain on Fatigue and Sleep in Breast Cancer Survivors: A Cross-Sectional Study
- 2022
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In: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 23:7, s. 1299-1310
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Journal article (peer-reviewed)abstract
- Objective Multidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that they play an important role in patients' pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep. Methods Cross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep. Results The indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < .01 and VAS*PI = 1.19; P < .01) and sleep (CSI*PI = 0.31; P < .01 and VAS*PI = 1.74; P < .01) were found significant for both pain measures (Central Sensitization Inventory [CSI] and Visual Analogue Scale [VAS]). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = .03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems. Conclusions PI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.
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| 6. |
- Lang, Victoria Ashley, 1994, et al.
(author)
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Mathematical and Computational Models for Pain: A Systematic Review
- 2021
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In: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:12, s. 2806-2817
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Journal article (peer-reviewed)abstract
- Objective. There is no single prevailing theory of pain that explains its origin, qualities, and alleviation. Although many studies have investigated various molecular targets for pain management, few have attempted to examine the etiology or working mechanisms of pain through mathematical or computational model development. In this systematic review, we identified and classified mathematical and computational models for characterizing pain. Methods. The databases queried were Science Direct and PubMed, yielding 560 articles published prior to January 1st, 2020. After screening for inclusion of mathematical or computational models of pain, 31 articles were deemed relevant. Results. Most of the reviewed articles utilized classification algorithms to categorize pain and no-pain conditions. We found the literature heavily focused on the application of existing models or machine learning algorithms to identify the presence or absence of pain, rather than to explore features of pain that may be used for diagnostics and treatment. Conclusions. Although understudied, the development of mathematical models may augment the current understanding of pain by providing directions for testable hypotheses of its underlying mechanisms. Additional focus is needed on developing models that seek to understand the underlying mechanisms of pain, as this could potentially lead to major breakthroughs in its treatment.
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| 7. |
- Liechti, Seraina, et al.
(author)
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Prognostic factors for quality of life after interdisciplinary pain rehabilitation in patients with chronic pain : a systematic review
- 2023
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In: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 24:1, s. 52-70
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVE: Health-related quality of life (hrQoL) is a core outcome in evaluating interdisciplinary pain rehabilitation (IPR). This systematic review aimed to identify prognostic factors for hrQoL at least six months after IPR in chronic pain patients.METHODS: A systematic search was conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science and Cochrane CENTRAL until September 2020. Included were prognostic studies on the outcome hrQoL in adults aged 18 to 67 years with chronic pain (excluding malignancies, systemic-, inflammatory or degenerative joint diseases) who had undergone IPR. Studies were assessed with The Quality in Prognostic Studies-tool. Potential prognostic factors at baseline for the domains pain, psychological and physical functioning were qualitatively synthesized for hrQoL. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the level of evidence.RESULTS: Fourteen studies on 6668 participants (mean age 37.4-52.8y), with musculoskeletal pain/fibromyalgia and a pain duration ranging between 13.1 to 177.4 months were considered eligible. With a very low certainty of evidence, pain intensity, emotional distress and physical functioning at baseline were inconsistent for prediction of hrQoL and pain duration was not predictive. With low certainty of evidence, fewer pain sites, lower levels of negative cognitive behavioral factors, and higher levels of positive cognitive behavioral factors predicted a better outcome.CONCLUSIONS: The overall certainty of evidence was low to very low, making it difficult to reach definitive conclusions at present. Future studies with a predefined core set of predictors investigating hrQoL in patients with chronic pain after IPR are needed.
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| 8. |
- Maathz, Pernilla, et al.
(author)
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Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain : A Prospective Investigation
- 2020
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In: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 21:12, s. 3596-3602
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Journal article (peer-reviewed)abstract
- ObjectivePersistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain.MethodsQuestionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up.ResultsHigher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up.ConclusionsThe findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.
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| 9. |
- Varallo, Giorgia, et al.
(author)
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Suicidal ideation in female individuals with fibromyalgia and comorbid obesity : prevalence and association with clinical, pain-related and psychological factors
- 2024
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In: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 25:3, s. 239-247
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity - a risk factor for suicidal ideation per se- could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation.METHODS: 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed i) the level of pain intensity, ii) depressive symptomatology, iii) sleep quality, and iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected.RESULTS: 37.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation.DISCUSSION: The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (i.e., independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.
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| 10. |
- Åkerblom, Sophia, et al.
(author)
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A network analysis of clinical variables in chronic pain: a study from the Swedish quality registry for pain rehabilitation (SQRP)
- 2021
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In: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:7, s. 1591-1602
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Journal article (peer-reviewed)abstract
- Background. Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results. We found that Acceptance, Pain Interference, and Depression were key, “central,” variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions. This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.
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