Edmund Keogh

Sex differences in adolescent chronic pain and pain-related coping.

Abstract Sex differences exist in pain and the strategies used to cope with pain. Although it is has been proposed that such differences become apparent around puberty, somewhat surprisingly very little research has specifically investigated sex as a moderator of pain within adolescents. The primary aim of the current study was to investigate sex differences in pain and coping within a group of 46 male and 115 female adolescent chronic pain sufferers. All were aged between 11 and 19 years and had been referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases, United Kingdom. Patients completed a battery of measures including pain experiences and a pain coping questionnaire. No sex differences were found in pain chronicity, although males and females did differ in self‐reported pain experiences (females reported higher pain). Sex differences were also found in coping behaviours. Females used more social support, positive statements and internalizing/catastrophizing, whereas males reported engaging in more behavioural distraction. Of these strategies internalizing/catastrophizing was found to mediate the relationship between sex and pain. This suggests that not only do sex differences exist in the pain experiences and pain‐coping strategies of adolescents with chronic pain, but that internalizing/catastrophizing may be an important mechanism in understanding such differences. More research examining potential sex differences in children and adolescents is recommended.

Do men and women differ in their response to interdisciplinary chronic pain management

&NA; Women report more pain than men. It also seems that gender may moderate responses to pharmacological agents used to combat pain, suggesting that men and women differ in treatment efficacy. Recent research suggests that gender differences may also exist in response to interdisciplinary pain management interventions. We, therefore, report data from a treatment‐outcome program at a UK Pain Management Unit. The sample consisted of 98 chronic pain patients (33 males; 65 females) who completed a series of measures relating to pain and distress at three different time points: immediately prior, on completion, and 3 months following an interdisciplinary pain management intervention. The pain management intervention consisted of a 3‐ or 4‐week residential program that aimed to enhance daily functioning, and which involved physiotherapists, occupational therapists, a nurse, physicians, and clinical psychologists. Analyses revealed that the pain management intervention produced improvements in a range of domains of outcome for both men and women, and that such effects were sustained at 3 months following treatment. However, although both men and women exhibited significant post‐treatment reduction in measures of current pain intensity and with one measure of pain‐related distress, at 3 months following treatment men showed similar reductions as at post‐treatment, whereas for women there were no significant differences from pre‐treatment scores. This suggests that gender may play a role in reports of pain and distress following interdisciplinary chronic pain management. However, the current results are different from those previously reported. We discuss potential reasons for such differences.

Does Anxiety Sensitivity Predict Post-Traumatic Stress Symptoms Following Childbirth? A Preliminary Report

The aim of the current study was to investigate whether prenatal levels of anxiety sensitivity would predict post-traumatic stress disorder symptoms following childbirth. A total of 40 women completed a series of self-report measures, including the Anxiety Sensitivity Index and the General Health Questionnaire at 36 weeks gestation. The women were followed-up 2 weeks postpartum with self-report measures of post-traumatic stress disorder, mood and birth experiences. Correlational analysis revealed that a combination of pre- and postnatal psychological factors as well as obstetric events was related to post-traumatic stress disorder symptoms. Regression analysis revealed that prenatal anxiety sensitivity predicted post-traumatic stress disorder symptoms, suggesting that anxiety sensitivity may act as an important vulnerability factor in psychopathological responses to childbirth. Further investigation into this construct seems warranted.

Investigating the effect of anxiety sensitivity, gender and negative interpretative bias on the perception of chest pain

Abstract Research suggests that anxiety sensitivity may be an important component in the negative response to pain sensations, especially those with cardiopulmonary origin. Furthermore, there is experimental evidence to suggest that such effects may be stronger in women than men. The primary aim of the current investigation was to determine the relative roles that anxiety sensitivity and gender have on the pain reports of patients referred to a hospital clinic with chest pain. A total of 78 female and 76 male adults were recruited on entry to a Rapid Access Medical Clinic. All patients had been referred with chest pain, and were administered a range of pain and anxiety measures prior to diagnosis. Results indicate that males were more likely to receive a diagnosis of cardiac chest pain, whereas females were more likely to receive a diagnosis of non‐cardiac chest pain. Additionally, anxiety sensitivity was related to pain in women but not men. Finally, evidence was found for the mediating effect of negative interpretative bias on the relationship between anxiety sensitivity and pain. However, this mediating effect was only found in women. These results not only confirm that anxiety sensitivity is related to greater negative pain responses in women, but that this may be due to an increased tendency to negatively interpret sensations.

Anxiety sensitivity and pain: Generalisability across noxious stimuli

&NA; Anxiety sensitivity, a fear of anxiety‐related symptoms, has been associated with a heightened experience of pain, especially within women. The majority of experimental studies investigating this association have relied heavily on the cold pressor technique as a means of pain induction, limiting the generalisability of results. The aim of the current study was to extend previous research by using two types of pain stimuli (cold and heat) to determine whether the link between anxiety sensitivity and pain generalises beyond cold pressor pain. The pain experience of 125 participants in response to these stimuli was assessed using threshold and tolerance readings, as well as subjective pain ratings. Results indicated a positive association between anxiety sensitivity and subjective pain, with this association observed primarily in females. Although analysis also indicated a basic generalisability of results across pain stimuli, anxiety sensitivity effects appeared to be especially pronounced during heat stimulation. These findings suggest that those high in anxiety sensitivity may respond more negatively to specific types of pain. Possible implications along with suggestions for future research are discussed.

The interruptive effect of pain on attention

Pain is known to disrupt attentional performance in both healthy adults and patients with chronic pain. Exactly which aspects of attentional function are affected are, however, still to be determined. The primary aim of this investigation was to systematically examine the effects of experimentally induced pain on a range of attentional performance tasks. Following a review of tests of attentional disruption, seven best candidate tasks were selected and examined across seven experiments. The tasks were: continuous performance, flanker, endogenous precueing, n-back, inhibition, attentional switching, and divided attention. Healthy adult participants performed each of these tasks under three different conditions: a painful heat sensation, a warm heat sensation, and a nonheat control. Pain differentially affected attentional performance across these tasks; pain-related attentional impairment was found on the n-back, attentional switching, and divided attention tasks, but not on the other tasks. This finding suggests that the aspects of attention most affected by pain are those essential for the completion of complex tasks that require the processing of multiple cues and control over attentional deployment. These results are discussed in the context of an emerging view of pain as a demand for executive control and the development of measures that could be used to examine attentional disruption in the context of pain.

Test anxiety, susceptibility to distraction and examination performance

Examination stress is thought to prevent some individuals from reaching their academic potential. Explanations of this relationship include a proneness to ruminate and worry about examinations, as well as a tendency to be more susceptible to distraction. We therefore examined the relative roles that worry and distraction, assessed three months prior to examinations, have in predicting the academic grades of undergraduate students. Test–anxious worry was related to susceptibility to distraction, but not exactly as predicted. However, both worry and a proneness to be distracted by non-threatening, examination-irrelevant material were found to predict academic performance. These results are discussed in light of theories of test anxiety, as well as the potential for further research and interventions to manage examination stress.

Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness

A systematic review was conducted to investigate the use of technology in achieving behaviour change in chronic illness. The areas reviewed were: (1) methods employed to adapt traditional therapy from a face-to-face medium to a computer-assisted platform; (2) targets of behaviour change; and (3) level of human (e.g. therapist) involvement. The initial literature search produced 2032 articles. A total of 45 articles reporting 33 separate interventions met the inclusion/exclusion criteria and were reviewed in detail. The majority of interventions reported a theoretical basis, with many arising from a cognitive-behavioural framework. There was a wide range of therapy content. Therapist involvement was reported in 73% of the interventions. A common problem was high participant attrition, which may have been related to reduced levels of human interaction. Instigating successful behaviour change through technological interventions poses many difficulties. However, there are potential benefits of delivering therapy in this way. For people with long-term health conditions, technological self-management systems could provide a practical method of understanding and monitoring their condition, as well as therapeutic guidance to alter maladaptive behaviour.

e-Health and chronic pain management: current status and developments.

There are significant geographic, economic, and educational barriers for patients with chronic pain accessing evidence-based treatments. Recent developments in computing and sensing technologies have led to applications facilitating the management of other long-term health conditions such as diabetes, stroke, heart failure, and depression. Technology could also offer promising solutions to the management of chronic pain conditions and the current barriers of access. A number of technologies are being explored worldwide with a variety of goals. In what follows we focus largely on electronicbased innovations offered as part of a solution for the management of chronic pain. For ease of narration we adopt the term ‘e-health’ to encompass developments labelled variously as ‘telemedicine’, ‘telehealth’, ‘telecare’, ‘assistive technology’, ‘cybertherapy’. We aim to (i) introduce and scope the developing field, (ii) review the extant projects in pain, drawing on basic science, clinical case studies and where available treatment intervention trials, (iii) summarize e-health advances being explored with chronic conditions other than pain that may provide opportunities for developments in chronic pain management, (iv) critically appraise current technological developments as they might apply to pain, and (v) discuss challenges to further development.

A principal components analysis of negative affect-related constructs relevant to pain: evidence for a three component structure

UNLABELLED A number of negative affect-related constructs are important in pain. Some are general, such as anxiety, depression and negative affectivity, whereas others are more specifically pain-related (eg, fear of pain, pain anxiety, and pain catastrophizing). In addition, some more specific fear-related constructs, such as anxiety sensitivity, illness/injury sensitivity, and fear of negative evaluation have emerged as important to pain. Although these various constructs are considered conceptually separate, there is likely to be overlap between them. Since the extent of this overlap is unknown, the aim of the current study was to investigate these constructs in 1 sample in order to identify their common and unique features. Frequently used psychological measures were completed by 508 pain-free participants. Principal components analysis resulted in the extraction of three components: 1) General distress; 2) Fear of pain from injury/insult; and 3) Cognitive intrusion of pain. The results presented here suggest that there is indeed commonality between constructs, which may be due to either an overlap between items within measures or to close conceptual relatedness. The implications of these core dimensions are discussed with reference to future research and theory. PERSPECTIVE This article explores the relationships between various negative-affect pain-related measures and discusses the results from a principal components analysis. The findings show that some questionnaires may measure the same latent construct. A measure could be developed to measure these 3 core components more concisely for both clinical and research purposes.