Alicia E. López-Martínez

Perceived Social Support and Coping Responses Are Independent Variables Explaining Pain Adjustment Among Chronic Pain Patients

UNLABELLED The purpose of the present study was to test a hypothetical model of the relationships between perceived social support, coping responses to pain, pain intensity, depressed mood, and functional disability (functional status and functional impairment) in a population of patients with chronic pain in a Spanish Clinical Pain Unit. It was postulated that social support and pain coping responses both independently influence reported pain intensity, depressed mood, and functional disability. Analyses were performed by Structural Equation Modelling. The results indicated that satisfaction with social support is significantly associated with a depressed mood and pain intensity, but not with functional disability. Although this effect is independent of the use of active coping responses by patients, there is a modest but significant relationship between social support and passive coping strategies, indicating that higher levels of perceived social support are related to less passive pain coping strategies. The findings underscore the potential importance of psychosocial factors in adjustment to chronic pain and provide support for a biopsychosocial model of pain. PERSPECTIVE This article tested a hypothetical model of the relationships between social support, pain coping, and chronic pain adjustment by using Structural Equation Modelling. The results indicate that perceived social support and pain coping are independent predictors of chronic pain adjustment, providing support for a biopsychosocial model of pain.

Adjustment to chronic pain: The role of pain acceptance, coping strategies, and pain-related cognitions

Background: Previous research has found that acceptance of pain is more successful than coping variables in predicting adjustment to pain.Purpose: To compare the influence of acceptance, pain-related cognitions and coping in adjustment to chronic pain.Methods: One hundred seventeen chronic pain patients attending the Clinical Pain Unit were administered a battery of questionnaires assessing pain acceptance, active and passive coping, pain-related cognitions, and adjustment.Results: The influence of acceptance, coping, and cognition on all the adjustment variables was considered simultaneously via Structural Equation Modeling using LISREL 8.30 software. A multigroup analysis showed that the male and female samples did not significantly differ regarding path coefficients. The final model showed that acceptance of pain determined functional status and functional impairment. However, coping measures had a significant influence on measures of emotional distress. Catastrophizing self-statements significantly influenced reported pain intensity and anxiety; resourcefulness beliefs had a negative and significant influence on depression.Conclusions: These findings suggest that acceptance may play a critical role in the maintenance of functioning and, with this aim, acceptance-based treatments are promising to avoid the development of disability. They also lend support to the role of control beliefs and of active coping to maintain a positive mood. Acceptance and coping are presented as complementary approaches.

Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain

Anxiety sensitivity has been included in the fear‐avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect‐related regulatory process that involves unwillingness to endure private experiences. The role of these constructs as vulnerability variables has not been investigated in chronic pain patients. The aim of this study was to investigate the role of anxiety sensitivity and experiential avoidance as dispositional variables in pain fear‐avoidance. Two alternative hypothetical models were tested: one in which anxiety sensitivity and experiential avoidance would be independently associated with pain fear‐avoidance; and second, one in which experiential avoidance would mediate the relationship between anxiety sensitivity and pain fear‐avoidance.

Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain

BackgroundPrior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability.PurposeThe aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed.MethodsThe sample was composed of 686 patients with chronic spinal pain. Structural equation modelling analyses were used to test the hypothetical model.ResultsExperiential avoidance was associated with pain fear-avoidance, and resilience was strongly associated with pain acceptance. Pain acceptance was negatively associated with negative mood, functional impairment and pain intensity. However, pain fear-avoidance was positively and significantly associated with negative mood but had no association with pain intensity. There was a path from functional impairment to pain fear-avoidance.ConclusionsResilience and experiential avoidance appear as variables which could explain individual differences in pain experience.

Trauma Exposure and Health: The Role of Depressive and Hyperarousal Symptoms

Posttraumatic stress disorder (PTSD) and depressive symptoms have been theorized to mediate the relationship between trauma exposure and physical health symptoms. Although empirical evidence supports this premise, studies conducted to date have employed statistical mediation analyses that are now broadly criticized. Furthermore, the mediating roles of both PTSD and depressive symptoms have seldom been examined concurrently, and it remains unclear which PTSD symptom clusters uniquely mediate this relationship. The aim of the present study was to examine the mediating role of reexperiencing, avoidance/numbing, hyperarousal, and depressive symptoms in the relationship between trauma exposure and physical health symptoms. Participants were 516 Spanish female undergraduate students. Physical health symptoms were compared between those who reported trauma exposure (n = 266) and those who did not (n = 250). Data from trauma-exposed participants were analyzed using regression models with bootstrapping to test mediation. Results of the analyses showed that the trauma-exposed group reported significantly more physical health symptoms (r(2) = .035). Hyperarousal and depressive symptoms uniquely mediated the relationship between trauma exposure and physical health symptoms. Our findings clarify some of the mechanisms by which negative health consequences occur subsequent to trauma exposure.

An examination of the structural link between post‐traumatic stress symptoms and chronic pain in the framework of fear‐avoidance models

The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post‐traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re‐experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear‐avoidance models.

The contribution of posttraumatic stress symptoms to chronic pain adjustment.

OBJECTIVES To examine whether there are differences between non-trauma-exposed, trauma-exposed without posttraumatic stress symptoms (PSS), and trauma-exposed with PSS chronic musculoskeletal pain patients in vulnerability, protective, and pain-adjustment variables; to test the interactive relationship between PSS and the vulnerability and protective psychological variables across pain adjustment in the group of trauma-exposed-patients. METHOD Seven hundred and fourteen patients with chronic musculoskeletal pain were assessed. Of these, 346 patients (244 women and 102 men) completed the study (117 non-trauma-exposed, 119 trauma-exposed without PSS, and 110 trauma-exposed with PSS). The instruments used were the Stressful Life Event Screening Questionnaire Revised, Davidson Trauma Scale, Anxiety Sensitivity Index, Acceptance and Action Questionnaire, Pain Catastrophizing Scale, Fear-Avoidance Beliefs Questionnaire, Pain Anxiety Symptoms Scale, Pain Vigilance and Awareness Questionnaire, Resilience Scale, Chronic Pain Acceptance Questionnaire, Pain Numerical Rating Scale, Roland Morris Disability Questionnaire, and Hospital Anxiety and Depression Scale. RESULTS Eight ANCOVAs showed that there were statistically significant differences in vulnerability, protection, and pain adjustment variables between the trauma-exposed with PSS patients and the other 2 groups. The moderated multiple regression analyses showed that PSS added a significantly incremental variance to pain intensity, emotional distress, and disability when interacting with vulnerability and protection variables. CONCLUSION The current study supports the models of posttraumatic stress and chronic pain, such as the mutual maintenance and the shared vulnerability theories, providing an initial comprehensive framework for understanding the comorbidity of both disorders.

The role of experiential avoidance, resilience and pain acceptance in the adjustment of chronic back pain patients who have experienced a traumatic event: a path analysis.

BackgroundThe degree to which shared vulnerability and protective factors for chronic pain and trauma-related symptoms contribute to pain adjustment in chronic pain patients who have experienced a traumatic event remains unclear.PurposeThe purpose is to test a hypothetical model of the contribution of experiential avoidance, resilience and pain acceptance to pain adjustment in a sample of 229 chronic back pain patients who experienced a traumatic event before the onset of pain.MethodsStructural equation modelling was used to test the linear relationships between the variables.ResultsThe empirical model shows significant relationships between the variables: resilience on pain acceptance and trauma-related symptoms, experiential avoidance on trauma-related symptoms and experiential avoidance, pain acceptance and trauma-related symptoms on pain adjustment.ConclusionsThis study demonstrates the role of a vulnerability pathway (i.e. experiential avoidance) and a protective pathway (i.e. resilience and pain acceptance) in adaptation to pain after a traumatic event.

Association of Trauma, Posttraumatic Stress Disorder, and Experimental Pain Response in Healthy Young Women

Background:Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response. Objectives:To examine differences in pain response and in certain psychological variables between trauma-exposed women (TEW) with PTSD, TEW without PTSD, and non–trauma-exposed women (NTEW) and to explore the role of these psychological variables in the differences in pain response between the groups. Methods:A total of 122 female students completed a cold pressor task (42 TEW with PTSD, 40 TEW without PTSD, and 40 NTEW). Anxiety sensitivity, experiential avoidance, trait and state dissociation, depressive symptoms, state anxiety, catastrophizing, and arousal were assessed. Results:TEW with PTSD reported significantly higher pain unpleasantness than NTEW, but not more than that of TEW without PTSD. They also presented higher trait dissociation, state anxiety, depressive symptoms, and skin conductance than the other 2 groups and higher anxiety sensitivity than TEW without PTSD. TEW without PTSD reported more pain unpleasantness than NTEW, but they recovered faster from pain. However, these differences were not explained by any psychological variable. Conclusions:The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.

Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor

Understanding which factors predict individual dissociative response during stressful situations is important to clarify the nature of dissociation and the mechanisms associated to its use as a coping strategy. The present study examined (1) whether experiential avoidance (EA), anxiety sensitivity (AS), depressive symptoms, and state anxiety concurrently predicted trait dissociation (TD)-absorption, amnesia, depersonalization, and total TD scores-and laboratory induced dissociation (LID); and (2) whether TD and catastrophizing predicted LID. We also examined whether catastrophizing mediated the relationships between both AS and depressive symptoms and LID. A total of 101 female undergraduate students participated in a cold pressor task, which significantly induced dissociation. Results of hierarchical regression analyses showed that AS at Time 1 (9 months before the experimental session), as well as depressive symptoms and catastrophizing at the time of the experiment (Time 2), predicted LID at Time 2. Depressive symptoms at Time 2 predicted total TD, absorption, and amnesia scores. AS at Time 1 and depressive symptoms at Time 2 predicted depersonalization. AS, depressive symptoms, and catastrophizing seem to facilitate the use of dissociative strategies by healthy individuals, even in response to non-traumatic but discomforting stress.