Dean A. Tripp

Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders

Introduction: One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work. Methods: Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4–100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada. Results: In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35–0.95) and pain severity (OR = 0.64, 95% CI = 0.43–0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07–0.46) were significant predictors of return to work. Conclusions: The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes. Significance: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.

Interstitial Cystitis/Painful Bladder Syndrome and Associated Medical Conditions With an Emphasis on Irritable Bowel Syndrome, Fibromyalgia and Chronic Fatigue Syndrome

PURPOSE We characterized and compared the impact of clinical phenotypic associations between interstitial cystitis/painful bladder syndrome and controls in relation to potentially related conditions, particularly irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. MATERIALS AND METHODS Female patients with interstitial cystitis/painful bladder syndrome and controls with no interstitial cystitis/painful bladder syndrome completed a biopsychosocial phenotyping questionnaire battery which included demographics/history form, self-reported history of associated conditions, and 10 validated questionnaires focused on symptoms, suffering/coping and behavioral/social factors. RESULTS Questionnaires were completed by 205 patients with interstitial cystitis/painful bladder syndrome and 117 controls matched for age. Prevalence of self-reported associated condition diagnosis in interstitial cystitis/painful bladder syndrome vs controls was irritable bowel syndrome 38.6% vs 5.2%, fibromyalgia 17.7% vs 2.6% and chronic fatigue syndrome 9.5% vs 1.7% (all p <0.001). In the interstitial cystitis/painful bladder syndrome cohort 50.3% reported no other associated condition, 24.4% had interstitial cystitis/painful bladder syndrome + irritable bowel syndrome only, 2.5% had interstitial cystitis/painful bladder syndrome + fibromyalgia only, 1.5% had interstitial cystitis/painful bladder syndrome + chronic fatigue syndrome only, while 20.2% had multiple associated conditions. As the number of associated conditions increased (ie localized, regional, systemic), pain, stress, depression and sleep disturbance increased while social support, sexual functioning and quality of life deteriorated. Anxiety and catastrophizing remained increased in all groups. Symptom duration was associated with this apparent phenotypic progression. CONCLUSIONS Irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome are more prevalent in patients with interstitial cystitis/painful bladder syndrome than in asymptomatic control subjects, and result in significant impact. There are at least 3 distinct clinical phenotypes based on identification of overlapping syndrome patterns. A suggestion that remains to be proven with longitudinal studies is that there may be progression over time from an organ centric to a regional and finally to a systemic pain syndrome with progression of symptom severity, and deterioration of cognitive and psychosocial parameters.

Differential predictors of pain and disability in patients with whiplash injuries

The psychological predictors of pain and disability were examined in a sample of people who sustained whiplash injuries during rear-end motor vehicle accidents. Sixty-five patients referred to a specialty pain clinic with a diagnosis of whiplash injury completed measures of depression, anxiety, catastrophizing, pain and perceived disability. Regression analysis revealed that psychological variables accounted for 18% of the variance in pain ratings. The magnification subscale of the Pain Catastrophizing Scale was the only variable that contributed significant, unique variance to the prediction of pain. Psychological variables accounted for 37% of the variance in perceived disability scores. In the latter analysis, however, none of the independent variables contributed significant, unique variance to the prediction of perceived disability. Psychological variables accounted for significant variance in disability ratings, even when controlling for pain intensity. Discussion focuses on the need to draw clearer distinctions between determinants of pain and disability, and directions for interventions aimed at minimizing disability following whiplash injury are suggested.

Psychosocial phenotyping in women with interstitial cystitis/painful bladder syndrome: a case control study.

PURPOSE We characterized and compared psychosocial phenotypes in a female interstitial cystitis/painful bladder syndrome cohort and an age matched cohort without that diagnosis. MATERIALS AND METHODS Female patients with interstitial cystitis/painful bladder syndrome and controls without the condition completed a psychosocial phenotyping questionnaire battery, including a demographics/history form and validated questionnaires focused on a range of presenting symptoms, psychosocial parameters and quality of life. Specific measures included interstitial cystitis symptom and problem index, McGill Pain Questionnaire, Medical Outcomes Study Sleep Scale, Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, Female Sexual Functioning Index and Multidimensional Scale of Perceived Social Support and Medical Outcomes Study Short Form-12 quality of life. Direct comparisons and correlations were made to establish group differences and the strength of associations for psychosocial parameters in patients with interstitial cystitis/painful bladder syndrome. RESULTS Questionnaires completed by 207 patients with interstitial cystitis/painful bladder syndrome were compared to those of 117 controls matched for age, partner status and education. Compared to controls patients reported significantly more pain (total, sensory and affective), worse physical quality of life, increased sleep dysfunction, depression, catastrophizing, anxiety, stress and moderately more sexual/social function problems. These suffering, coping and social parameters correlated with the degree of general pain but stress, anxiety, depression and catastrophizing further correlated with IC specific symptoms and strongly with decreased quality of life. Pain was strongly associated with physical quality of life, while depression, catastrophizing and stress, and to a lesser extent social support were associated with poor mental quality of life. CONCLUSIONS Patients with interstitial cystitis/painful bladder syndrome have significant cognitive and psychosocial alterations compared to controls.

Catastrophic thinking and heightened perception of pain in others

Abstract Past research has shown that pain catastrophizing contributes to heightened pain experience. The hypothesis advanced in this study was that individuals who score high on measures of pain catastrophizing would also perceive more intense pain in others. The study also examined the role of pain behaviour as a determinant of the relation between catastrophizing and estimates of others’ pain. To test the hypothesis, 60 undergraduates were asked to view videotapes of individuals taking part in a cold pressor procedure. Each individual in the videotapes was shown three times over the course of a 1 min immersion such that the same individual was observed experiencing different levels of pain. Correlational analyses revealed a significant positive correlation between levels of pain catastrophizing and inferred pain intensity, r = .31, p < .01. Follow‐up analyses indicated that catastrophizing was associated with a heightened propensity to rely on pain behaviour as a basis for drawing inferences about others‘ pain experience. Catastrophizing was associated with more accurate pain inferences on only one of three indices of inferential accuracy. The pattern of findings suggests that increasing reliance on pain behaviour as a means of inferring others’ pain will not necessarily yield more accurate estimates. Discussion addresses the processes that might underlie the propensity to attend more to others’ pain behaviour, and the clinical and interpersonal consequences of perceiving more pain in others.

Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study

To examine the cross‐sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome

To examine interactions between demographic, pain, urinary, psychological and environmental predictors of quality of life (QOL) in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Prevalence and determinants of pain and pain-related disability in urban and rural settings in southeastern Ontario

BACKGROUND Canadian chronic pain prevalence estimates range from 11% to 66%, are affected by sampling and measurement bias, and largely represent urban settings. OBJECTIVES To estimate chronic pain prevalence and factors associated with pain in southeastern Ontario, a region with a larger rural than urban residence. METHODS A systematic sampling with a random start was used to contact households. A telephone-administered questionnaire using the Graded Chronic Pain Scale, with questions on health care and medication use, health status, depression and demographics, was administered to consenting adults (18 to 94 years of age; mean age 50.2+/-16.6 years). RESULTS The response rate was 49% (1067 of 2167), with 76% reporting some pain over the past six months. Low pain intensity with low pain interference prevalence was 34% (grade I), high pain intensity with low pain interference was 26% (grade II), and high pain intensity with high pain interference was 17% (grades III and IV). Of those reporting pain, 49% reported chronic pain (ie, pain for a minimum of 90 days over the past six months) representing 37% of the sample. Being female, unmarried, lower income, poorer self-reported health status and rural residence were associated with increasing pain. Once depression was considered in this pain analysis, residence was no longer significant. Lower rates of health care utilization were reported by rural residents. In those reporting the highest pain grades, poor health, greater medication and health care use, depression and more pain sites were associated with higher odds for pain-related disability. CONCLUSION There is an elevated prevalence of pain in this almost equally split rural/urban region. Further examination of health care utilization and depression is suggested in chronic pain prevalence research.

Comparisons of Catastrophizing, Pain Attitudes, and Cold-Pressor Pain Experience Between Chinese and European Canadian Young Adults

UNLABELLED Experimental pain research indicates ethnic differences in pain experience. Most of the cross-cultural pain research studied African Americans and Hispanics with little data available for Asian groups. This study examined differences in pain catastrophizing, pain attitudes, and pain responses between Chinese and European Canadian young adults. Prior to completing a cold-pressor (CP) task, 80 Chinese and 80 European Canadian undergraduate students were administered measures of pain catastrophizing and pain attitudes, including stoicism and cautiousness. Pain threshold, pain tolerance, and pain intensity were measured during the CP task. The Short Form-McGill Pain Questionnaire was administered immediately postimmersion to measure sensory and affective pain. While there was no group difference in pain threshold and pain intensity, Chinese participants displayed lower pain tolerance and reported higher SF-MPQ-Affective than European Canadians. Regarding psychological variables, there was no difference in stoicism and cautiousness between groups, but Chinese participants reported greater pain catastrophizing. Mediational analysis indicated that pain catastrophizing mediated the group differences in SF-MPQ-Affective score. The implications of the findings and future research were discussed. PERSPECTIVE The study found ethnic differences in cold-pressor responses, in which Chinese undergraduates reported higher levels of pain compared to their Euro-Canadian counterparts. The finding that pain catastrophizing mediated the ethnic difference in SF-MPQ-Affective scores indicated the importance of examining the role of catastrophizing in pain reports from Chinese and Euro-Canadian patients.

Sexual Functioning, Catastrophizing, Depression, and Pain, as Predictors of Quality of Life in Women With Interstitial Cystitis/Painful Bladder Syndrome

OBJECTIVES To study the association of sexual dysfunction with quality of life (QOL) while simultaneously examining the shared influence of empirically supported variables that are also associated with diminished interstitial cystitis/painful bladder syndrome (IC/PBS) QOL (ie, pain, catastrophizing, depression). Previous research has indicated that sexual dysfunction is prevalent, bothersome, and an important predictor of diminished QOL in patients with IC/PBS. However, the deleterious association between sexual dysfunction and QOL has not been investigated in more inclusive models that use validated measures. METHODS Women were recruited from 3 North American centers who agreed to the study and completed measures of QOL, pain severity, IC/PBS symptoms and bother (IC Symptom Index, IC Problem Index), pain catastrophizing, depression, and sexual dysfunction. Hierarchical multivariate regression was executed to test both unique and combined effects. RESULTS A total of 115 women, with a mean age of 50 years, participated in this study. Regression modeling showed that diminished QOL physical composite scores were predicted by a longer symptom duration (P = .013), unemployment (P = .017), and greater pain severity (P = .004). In regard to the diminished QOL mental composite scores, the lone predictors included age (P = .029) and pain catastrophizing (P = .002). CONCLUSIONS In disagreement with previous research, sexual functioning was not associated with diminished physical or mental composites of patient QOL. Furthermore, these data suggest that demographic factors and pain might be predictive of poorer QOL outcomes, and that anxious worry about pain (ie, catastrophizing) is a target for future research and clinical intervention.