Emelien Lauwerier

The Construct Validity of the Illness Cognition Questionnaire: The Robustness of the Three-factor Structure Across Patients with Chronic Pain and Chronic Fatigue

BackgroundThe Illness Cognition Questionnaire (ICQ; Evers et al., J Consult Clin Psychol, 69:1026-1036, 2001) assesses three ways of cognitively evaluating the stressful and aversive character of a chronic illness: helplessness, acceptance, and perceived benefits.PurposeThe purpose of this study was to evaluate the construct validity of the ICQ in individuals with chronic pain and patients with chronic fatigue.MethodThe ICQ was administered to 821 individuals with chronic pain and 295 patients with chronic fatigue. Confirmatory factor analyses were performed to assess the hypothesized three-factor structure, containing the factors “helplessness,” “acceptance,” and “perceived benefits.” A multigroup analysis was performed to investigate the stability of the factor structure in both groups.ResultsResults confirmed the three-factor structure in the two samples. The factor structure was invariant across individuals with chronic pain and chronic fatigue.ConclusionAs the three-factor structure provided a good fit in both groups, we confirm the usefulness of the subscale scores in research and clinical practice.

Medication use in patients with migraine and medication-overuse headache: the role of problem-solving and attitudes about pain medication.

&NA; Excessive medication intake is a risk factor for the development of medication‐overuse headache (MOH), a condition characterized by an increase of headache frequency to a daily or near‐daily pattern. As yet, it is largely unknown why some patients overuse medication. In this study, we examined to what extent attitudes about pain medication, especially perceived need and concerns, and problem‐solving are related to MOH. Patients with migraine (n = 133) and MOH with a history of migraine (n = 42) were recruited from a tertiary headache referral center and completed questionnaires measuring problem‐solving and attitudes about pain medication. A problem‐solving mode aimed at solving pain was associated with a higher need for and concerns about medication intake. Interestingly, in a model accounting for demographic factors and pain intensity, attempts to control pain, need for medication, and concerns about scrutiny by others because of medication intake all had a unique value in accounting for MOH. Results are discussed in terms of how repeated attempts to solve pain may trigger overuse of medication, even in the presence of clear negative consequences. Repeated attempts at solving pain may increase the need for analgesic medication, despite obvious costs. This mechanism might contribute to the problem of medication‐overuse headache.

Acceptance: What's in a Name? A Content Analysis of Acceptance Instruments in Individuals With Chronic Pain

UNLABELLED Instruments to assess chronic pain acceptance have been developed and used. However, whether and to what extent the content of the items reflects acceptance remain uninvestigated. A content analysis of 13 instruments that aim to measure acceptance of chronic pain was performed. A coding scheme was used that consisted of 3 categories representing the key components of acceptance, that is, disengagement from pain control, pain willingness, and engagement in activities other than pain control. The coding scheme consisted of 5 additional categories in order to code items that do not represent acceptance, that is, controlling pain, pain costs, pain benefits, unclear, and no fit. Two coders rated to what extent the items of acceptance instruments belonged to one or more of these categories. Results indicated that acceptance categories were not equally represented in the acceptance instruments. Of note, some instruments had many items in the category controlling pain. Further analyses revealed that the meaning of acceptance differs among different instruments and among different versions of the same instrument. This study illustrates the importance of content validity when developing and evaluating self-report instruments. PERSPECTIVE This article investigated the content validity of questionnaires designed to measure acceptance in individuals with chronic pain. Knowledge about the content of the instruments will provide further insight into the features of acceptance and how to measure them.

To control or not? A motivational perspective on coping with pain

Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists.

Goal Pursuit in Individuals with Chronic Pain: A Personal Project Analysis

Objectives: In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., “to control my pain”) and non-pain goals (e.g., “to go to work”). Design and Methods: “Personal Project Analysis” was used in 73 ICPs (48 females; 25 males; Mage = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed. Results: Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly, ICP’s with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing. Discussion: An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental.

Goal conflict in chronic pain : day reconstruction method

Background When suffering from chronic pain, attempts to control or avoid pain often compete with other daily activities. Engaging in one activity excludes engaging in another, equally valued activity, which is referred to as “goal conflict.” As yet, the presence and effects of goal conflicts in patients with chronic pain remain poorly understood. Methods This study systematically mapped the presence and experience of goal conflicts in patients with fibromyalgia compared to healthy controls. A total of 40 patients and 37 controls completed a semi-structured interview in which they first reconstructed the previous day, identified conflicts experienced during that day, and classified each of the conflicting goals in one of nine goal categories. Additionally, they assessed how they experienced the previous day and the reported conflicts. Results Results showed that patients did not experience more goal conflicts than healthy controls, but that they did differ in the type of conflicts experienced. Compared to controls, patients reported more conflicts related to pain, and fewer conflicts involving work-related, social or pleasure-related goals. Moreover, patients experienced conflicts as more aversive and more difficult to resolve than control participants. Discussion This study provides more insight in the dynamics of goal conflict in daily life, and indicates that patients experience conflict as more aversive than controls, and that conflict between pain control (and avoidance) and other valued activities is part of the life of patients.

Reorganisatie van de eerstelijnszorg in Vlaanderen : aandachtspunten op weg naar meer patiëntgerichte zorg

SamenvattingEen grijze epidemie dreigt voor België en de meeste andere westerse landen. In 2012 stond de teller op 1,92 miljoen personen die 65 jaar of ouder waren, waarbij 0,57 miljoen personen 80 jaar of ouder waren.

Van pijn lijden naar het leiden van pijn: een praktische handleiding in het omgaan met pijn

SamenvattingSommigen schrijven een vernuftig informatief werkstuk, anderen zetten een kraakhelder en toegankelijk praktijkboek op papier en een uniekeling schrijft ‘Managing pain before it manages you’.

966 DOES PERSISTENCE IN SEEKING PAIN RELIEF PREDICT GREATER WILLINGNESS TO TAKE RISKS? A VIGNETTE STUDY IN CHRONIC PAIN PATIENTS

Introduction: Pain patients and pain anxious individuals are found to be characterized by a pain-directed interpretation bias (IB), which means that they are inclined to negatively interpret pain-related ambiguity. However, because interpretations were often measured at a direct level (questionnaires, paper and pencil ambiguous word tasks), former studies do not provide insight in the spontaneous automatic interpretations that are made immediately upon confrontation with ambiguity. Using an automatized homograph priming paradigm, the current study aimed to examine spontaneous IB in function of pain-related anxiety. Furthermore, this study aims to test the predictive role of IB for pain responsivity. Method: Healthy volunteers completed measures of pain-related anxiety and IB, and underwent a pain induction procedure. Paindirected IB is derived from performance (rt and accuracy) on a computerized homograph priming task, in which lexical decision responses are made to targets that follow pain-related ambiguous primes. Furthermore, pain threshold, pain tolerance, and subjective sensory pain are assessed in response to experimentally induced pressure pain. Results: Results demonstrated a positive correlation between pain anxiety levels and pain-directed IB. Pain anxiety furthermore correlated with pain responsivity. The correlation between pain responsivity and the IB was not significant. Discussion: Elevated levels of pain-anxiety are accompanied by an automatic pain directed IB in healthy individuals. Although the present study does not confirm the predictive value of IB for pain responsivity, further research is necessary to deepen our insight in (automatic) interpretations of pain and their contribution to the pain problem.

967 CONSTRUCT VALIDITY OF THE ILLNESS COGNITION QUESTIONNAIRE: ROBUSTNESS OF THREE-FACTOR STRUCTURE ACROSS PATIENTS WITH CHRONIC PAIN AND CHRONIC FATIGUE

Introduction: Pain patients and pain anxious individuals are found to be characterized by a pain-directed interpretation bias (IB), which means that they are inclined to negatively interpret pain-related ambiguity. However, because interpretations were often measured at a direct level (questionnaires, paper and pencil ambiguous word tasks), former studies do not provide insight in the spontaneous automatic interpretations that are made immediately upon confrontation with ambiguity. Using an automatized homograph priming paradigm, the current study aimed to examine spontaneous IB in function of pain-related anxiety. Furthermore, this study aims to test the predictive role of IB for pain responsivity. Method: Healthy volunteers completed measures of pain-related anxiety and IB, and underwent a pain induction procedure. Paindirected IB is derived from performance (rt and accuracy) on a computerized homograph priming task, in which lexical decision responses are made to targets that follow pain-related ambiguous primes. Furthermore, pain threshold, pain tolerance, and subjective sensory pain are assessed in response to experimentally induced pressure pain. Results: Results demonstrated a positive correlation between pain anxiety levels and pain-directed IB. Pain anxiety furthermore correlated with pain responsivity. The correlation between pain responsivity and the IB was not significant. Discussion: Elevated levels of pain-anxiety are accompanied by an automatic pain directed IB in healthy individuals. Although the present study does not confirm the predictive value of IB for pain responsivity, further research is necessary to deepen our insight in (automatic) interpretations of pain and their contribution to the pain problem.