Almudena López-López

Cognitive-affective assets and vulnerabilities: Two factors influencing adaptation to Fibromyalgia

This study set to explore whether variables related to cognitive-affective assets would complement measures of psychological vulnerability for the prediction of physical functioning and pain tolerance in 138 women with Fibromyalgia Syndrome (FMS). Depression, anxiety, stress response and negative affect were defined a priori as measures of vulnerability, while pain self-efficacy, internality and positive affect were identified as assets. Confirmatory factor analyses supported the validity of the hypothesised two-factor structure in FMS. A structural equation model (SEM) revealed that the two factors were associated with different outcomes in FMS as predictors. Pain and associated symptoms appeared related to psychological vulnerabilities in FMS patients, whereas physical functioning and tolerance for pain were better predicted by assets. These results are discussed with reference to current theoretical models concerning the role of psychological factors in FMS, and intervention methods designed to improve quality of life and reduce pain in FMS patients.

Effects of Spray and Stretch on Postneedling Soreness and Sensitivity After Dry Needling of a Latent Myofascial Trigger Point

OBJECTIVES To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity. DESIGN A 72-hour follow-up, single-blind randomized controlled trial. SETTING University community. PARTICIPANTS Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle. INTERVENTION All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention. MAIN OUTCOME MEASURES Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised. RESULTS Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F3,204.8=3.19; P<.05; ηp(2)=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F2.6,175=1.9; P=.131; ηp(2)=.02). CONCLUSIONS The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.

Generalized hypervigilance in fibromyalgia patients: An experimental analysis with the emotional Stroop paradigm

OBJECTIVE In recent years, a good deal of serious research has been carried out on the hypothesized presence of generalized hypervigilance to sensory stimulation in fibromyalgia (FM). However, there are no studies which, following an operationalization of generalized hypervigilance as a propensity to attend to any task-irrelevant stimuli presented, make use of interference paradigms as the most appropriate experimental models for its analysis. The purpose of this study was to test the hypothesis of generalized hypervigilance in FM using the emotional modification of the Stroop task and to explore the possible mediating role of anxiety. METHODS To this end, 25 women diagnosed with fibromyalgia and 25 matched controls were shown 32 stimulus words equally distributed in four categories: fibromyalgia symptoms, arousing-negative (A-), arousing-positive (A+), and neutral (N). These words had been selected on the basis of the results of an independent study. In addition to the emotional Stroop task, measures of trait and state anxiety were included. RESULTS The results showed the possible presence of a generalized hypervigilance response in fibromyalgia patients based on significant slowness in the color-naming. This effect was mediated by the degree of perceived unpleasantness of the A-stimuli. However, the expected mediation effect of anxiety was not found. CONCLUSIONS These results suggest the presence of a generalized hypervigilance response in FM patients that is not mediated by anxiety. Implications for the correct functioning of controlled self-regulatory processes in fibromyalgia and similar pathologies are discussed.

Pain and symptoms of depression in older adults living in community and in nursing homes: the role of activity restriction as a potential mediator and moderator

BACKGROUND Chronic pain is likely to lead to depressive symptoms, but the nature of this relationship is not completely clear. The aim of the present study is to analyze the role of activity restriction in the pain-depression relationship in older people, and to test the hypothesis that this role is more relevant in community-dwelling older people than in nursing home residents. METHOD Depressive symptoms, pain intensity, and activity restriction were measured in a sample of 208 older adults with osteoarthritis, 102 living in nursing homes (NH), and 106 in the community. Analyses were carried out using moderation and moderated mediation analyses approach, treating activity restriction as a confounder. RESULTS RESULTS showed a significant confounding effect of activity restriction, interaction effect between pain intensity and activity restriction on depression, and modifying effect of pain intensity on depression by adding activity restriction into the model. These results suggest a potential mediating and moderating effects of activity restriction. Moreover, analyses suggest that, surprisingly, the strength of the mediation could be higher in nursing homes. CONCLUSIONS Overall, it may be that what is really important to emotional well-being is not so much pain itself, but rather the way in which the pain alters older peoples lives. The greater strength of the mediation in NH might be understood within the scope of self-determination theory. Generally speaking, the NH context has been considered as a coercive setting, promoting non-autonomous orientation. In this context, when events are objectively coercive, people may lack perceived autonomy and hence be at greater risk of depression.

Brain correlates of cognitive inhibition in fibromyalgia: Emotional intrusion of symptom-related words

Evidence coming from neuropsychological studies has showed the presence of cognitive alterations in fibromyalgia. Such dysfunctions are especially remarkable when the set in motion of executive control processes, such as inhibition, is required to perform successfully; however, neural data related to these mechanisms are very scarce. Present study tried to characterize cognitive inhibition mechanisms, as part of the attentional control functions, in patients with fibromyalgia. Participants (two groups: fibromyalgia patients and healthy control participants) were asked to perform in an emotional Stroop task while event-related potentials (ERP) were recorded. Four different emotional interference conditions were created: fibromyalgia symptom-related words, arousing-negative, arousing-positive and neutral words. Brain activity and behavioral data were analyzed. Principal component analyses were employed to reliably define ERP components along with a source-estimation technique. Symptom-related words elicited greater frontal P450 amplitudes and enhanced activation within right inferior frontal gyrus as compared to the rest of stimuli. This effect was only true for the fibromyalgia group. Behavioral contrasts, however, did not produce significant differences. Scalp and source estimation findings suggest the presence of a specific difficulty in cognitive inhibition in fibromyalgia patients (under conditions intimately linked with the core concerns of their disease). Data point to the involvement of right inferior frontal cortices in this inefficient mechanism, which might cause an enhanced and dysfunctional effort of processing to achieve only a comparable performance to healthy people. Implications of these results are discussed. Nevertheless, further investigations are needed to better understand dysfunctional cognition in fibromyalgia.

Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

Discrepancy between radiographic damage and functional disability in elderly people with osteoarthritis: the role of pain coping strategies.

The aim of this study is twofold. First, to assess the level of agreement between radiographic damage and functional disability in older people with osteoarthritis. And second, to assess the role of coping skills and sensory pain parameters as sources of disagreement between these variables. To achieve this objective we assess, in a sample of 104 older people with osteoarthritis, the following variables: functional capacity, radiographic damage, pain coping strategies, pain intensity, pain frequency and pain duration. The results show a non-linear relationship between radiographic damage and functional disability, modified by the levels of the two variables. There was maximum agreement between low levels of radiographic damage and of functional impairment, whilst agreement decreased for moderate and high levels of radiographic damage. Certain coping strategies may help to explain this disparity.

Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders

Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM) and chronic temporomandibular disorders (TMD). Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM) and tibialis (STT) muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p < .05) except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r = 0.46; p < .01) were obtained, and the strongest association was between kinesiophobia and magnification (r = 0.52; p < .01). The strongest associations among physical variables were found between the STM on both sides (r = 0.93; p < .01) and between the left and right STT (r = 0.76; p < .01). Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.

The Role of Psychological Factors in the Perception of Postneedling Soreness and the Influence of Postneedling Intervention

Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments.

Stress, Coping, and Personality in Patients with Epicrania Fugax, and Their Relation to the Clinical Characteristics of Pain

Objective. The aim of the present work is to analyze certain psychological features in a group of patients diagnosed with Epicrania fugax (EF; that has been recently included in the appendix of the International Classification of Headache Disorders, third edition, beta version), as well as their association with diverse demographic and clinical characteristics of the sample. Design. Case-control. Method. Perceived Stress Scale (PSS), Stress Coping (COPE), Big Five Personality Traits (NEO-FFI), Depression (BDI-II), and Trait Anxiety (STAI) were evaluated in 23 patients with EF and 23 matched healthy controls. Differences between EF patients and controls were analyzed using the Mann-Whitney U test. Differences in psychological features as a function of the demographic and clinical characteristics were examined using one-way Analysis of Variance (ANOVA), Mann-Whitney U test, or Pearson’s correlations. Results. The two groups differed significantly from each other in Denial, Trait anxiety, and Depression. Low-frequency epicrania patients scored significantly higher than controls in Perceived stress, Neuroticism, Denial, Self-blame, Trait anxiety, and Depression and higher than high-frequency EF in Venting. Conclusions. The results initially suggest the absence of substantial differences between patients suffering of EF and healthy controls. On the contrary, low-frequency EF patients show a distinctive “negative (unhealthy) psychological profile,” in opposition to high-frequency EF patients. This circumstance highlights the potential need to consider low- frequency EF patients as a target for psychological intervention in combination with the most common medical procedures. Longitudinal studies are necessary to correctly elucidate the influence of these psychological variables on the course of EF.