Ester Solé

The Pittsburgh Sleep Quality Index: Validity and factor structure in young people.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality in adolescents, but information regarding its psychometric strengths and weaknesses in this population is limited. In particular, questions remain regarding whether it measures one or two sleep quality domains. The aims of the present study were to (a) adapt the PSQI for use in adolescents and young adults, and (b) evaluate the psychometric properties of the adapted measure in this population. The PSQI was slightly modified to make it more appropriate for use in youth populations and was translated into Spanish for administration to the sample population available to the study investigators. It was then administered with validity criterion measures to a community-based sample of Spanish adolescents and young adults (AYA) between 14 and 24 years old (N = 216). The results indicated that the questionnaire (AYA-PSQI-S) assesses a single factor. The total score evidenced good convergent and divergent validity and moderate reliability (Cronbachs alpha = .72). The AYA-PSQI-S demonstrates adequate psychometric properties for use in clinical trials involving adolescents and young adults. Additional research to further evaluate the reliability and validity of the measure for use in clinical settings is warranted.

Validity of three rating scales for measuring pain intensity in youths with physical disabilities.

There is growing evidence confirming that youths with physical disabilities are at risk for chronic pain. Although many scales for assessing pain intensity exist, it is unclear whether they are all equally suitable for youths. The aim of this study was to address this knowledge gap by comparing the validity of the Numerical Rating Scale (NRS‐11), the Wong Baker FACES Pain Rating Scale (FACES), and a 6‐point categorical Verbal Rating Scale (VRS‐6) for assessing pain intensity among youths (aged 8–20) with physical disabilities.

Sex differences in psychological response to pain in patients with fibromyalgia syndrome.

Objectives:To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. Methods:A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ⩽0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. Results:Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. Discussion:The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.

Assessment of Pain Intensity in Clinical Trials: Individual Ratings vs Composite Scores

OBJECTIVES To evaluate the reliability of findings suggesting that composite scores made up of just two ratings of recalled pain may be adequately reliable and valid for assessing outcome in pain clinical trials. DESIGN Secondary analyses of data from a study where the responsivity of the outcome measures was a critical concern; that is, a study with few subjects testing the effects of a treatment that had only modest effects. Ten adults with spinal cord injury rated four domains of pain intensity (current pain and 24-hour recalled worst, least, and average pain) on four occasions before and after 12 sessions of neurofeedback treatment. We evaluated the reliability and validity of four single ratings and 16 different composite scores. RESULTS None of the single-item scales performed adequately. However, composite scores made up of two items or more yielded consistent effect size estimates. CONCLUSIONS The findings provide additional evidence that two-item composite scores may be adequate for assessing the primary outcome of pain intensity in chronic pain clinical trials. Additional research is needed to further establish the generalizability of these findings.

What Determines Whether a Pain is Rated as Mild, Moderate, or Severe? The Importance of Pain Beliefs and Pain Interference

Summary Reliable and valid measures of pain intensity are needed to accurately evaluate the efficacy of pain treatments. Perhaps with the exception of faces pain intensity scales, which are thought to reflect both pain intensity and pain affect, the other most commonly used pain intensity scales—Numerical Rating Scales (NRSs), Visual Analog Scales, and Verbal Rating Scales (VRSs)—are all thought to reflect primarily pain intensity or the magnitude of felt pain. However, to our knowledge, this assumption has not been directly tested for VRSs. Methods We evaluated whether VRS pain severity ratings are influenced by pain beliefs, catastrophizing, or pain interference over and above any effects of pain intensity, as measured by a NRS, in 4 samples of individuals with physical disabilities and chronic pain. Results As hypothesized, and while controlling for pain intensity as measured by a NRS, higher scores on factors representing pain interference with function, pain catastrophizing, and a number of pain-related beliefs were all associated with a tendency for the study participants to rate their pain as more severe on a VRS. Discussion These findings indicate VRSs of pain severity cannot necessarily be assumed to measure only pain intensity; they may also reflect patient perceptions about pain interference and beliefs about their pain. Clinicians and researchers should take these findings into account when selecting measures and when interpreting the results of studies using VRSs as outcome measures.

Cognitive Fusion and Pain Experience in Young People

Objectives:Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability. Methods:A community sample of 281 young people (11 to 20 y) completed measures assessing cognitive fusion, pain intensity, disability, and pain catastrophizing. Results:Cognitive fusion was positively related to pain intensity (r=0.24, P<0.01), disability (r=0.32, P<0.001), and pain catastrophizing (r=0.47, P<0.001). Moreover, cognitive fusion was found to mediate the association between pain catastrophizing and disability (&bgr;=0.01, 95% confidence interval=0.002-0.024, 5000 bootstrap resamples). Discussion:The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.

A Catalan adaptation and validation of the Pain Catastrophizing Scale for Children.

Pain catastrophizing is a key factor in modern conceptualizations of pain. The development of the Pain Catastrophizing Scale for Children (PCS-C) has greatly contributed to the interest shown by pediatric pain specialists. The purpose of this work was to study the factor structure of the Pain Catastrophizing Scale and analyze its reliability and convergent, discriminant, and criteria related validity. Three hundred sixteen adolescents (12-19 years) completed the Catalan version of the PCS-C and provided information about pain intensity. A subgroup of 136 participants also completed measures of disability, anxiety sensitivity and pain coping strategies. The results confirmed the 3-factor model solution for the PCS-C, and demonstrated good internal consistency for the total Catastrophizing Scale (0.89) and for the Rumination (0.80) and Helplessness (0.82) PCS-C subscales. Internal consistency for the Magnification subscale, however, was not quite as good (0.63). This 3-factor model could be improved by removing Item 8 and developing additional items for the Rumination PCS-C subscale. The results also provide evidence of the convergent, discriminant and criterion-related validity of the PCS-C scores when used with Catalan-speaking adolescents. Our data demonstrate that the Catalan version of the PCS-C is a psychometrically sound questionnaire that provides valid and reliable scores when used to assess pain catastrophizing in adolescents. (PsycINFO Database Record

Factors Associated with Suicidal Ideation in Patients with Chronic Non-Cancer Pain.

Objectives. This study’s aim was to identify the most important general and pain-related risk factors of suicidal ideation in a large sample of patients with chronic non-cancer pain. Methods. A total of 728 patients with chronic non-cancer pain were recruited from the waitlists of eight multidisciplinary pain clinics across Canada. Patients were assessed using self-administered questionnaires to measure demographic, pain-related (intensity, duration, interference, sleep problems), psychological (anxiety, anger, depressive symptoms including suicidal ideation), cognitive (catastrophizing, attitudes/beliefs), and health-related quality of life variables. A hierarchical logistic regression analysis was used to identify the factors that were associated with presence/absence of suicidal ideation while controlling for depressive symptoms. Results. The results showed that being a male, longer pain duration, higher anger levels, feelings of helplessness, greater pain magnification, and being more depressed were significant independent predictor factors of suicidal ideation, while better perceived mental health was related with a lesser likelihood of suicidal ideation. Moreover, being in a relationship and believing in a medical cure for pain might be protective of suicidal ideation while being anxious may be more associated with suicidal ideation. Conclusions. These results indicate that development of suicidal ideation is more closely related to pain chronicity and certain psychosocial factors than how severe or physically incapacitating the pain is. Many of these factors could potentially be modified by early identification of suicidal ideation and developing targeted cognitive interventions for suicidal at-risk patients. Research to examine the efficacy of these interventions for reducing suicidal ideation is warranted.

Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain

Abstract Background and aims Trait behavioral inhibition represents a tendency to react with negative emotions - primarily worry - to cues which signal potential threats. This tendency has been hypothesized by a two-factor model of chronic pain to have direct effects on psychological and physical function in individuals with chronic pain, as well as to influence the associations between pain-related maladaptive cognitions and function. Our aim was to test these hypothesized associations in a sample of individuals who were being screened for possible interdisciplinary chronic pain treatment. Methods Eighty-eight patients referred to an interdisciplinary chronic pain management program were administered measures of average pain intensity, trait behavioral inhibition, kinesiophobia, pain catastrophizing, depressive symptoms, and pain interference. We then performed two linear regression analyses to evaluate the direct effects of trait behavioral inhibition on depressive symptoms and pain interference and the extent to which behavioral inhibition moderated the associations between kinesiophobia and pain catastrophizing, and the criterion variables. Results In partial support of the study hypotheses, the results showed significant (and independent) direct effects of trait behavioral inhibition on depressive symptoms, and behavioral inhibition moderated the association between kinesiophobia and depression, such that there were stronger associations between kinesiophobia and depressive symptoms in those with higher dispositional sensitivity to fear-inducing stimuli. However, neither direct nor moderating effects of behavioral inhibition emerged in the prediction of pain interference. Conclusions If replicated in additional studies, the findings would indicate that chronic pain treatments which target both reductions in maladaptive cognitions (to decrease the direct negative effects of these on depressive symptoms) and the individual’s tendency to respond to pain with worry (as a way to buffer the potential effects of maladaptive cognitions on depressive symptoms) might be more effective than treatments that targeted only one of these factors. Implications Additional research is needed to further evaluate the direct and moderating effects of pain-related behavioral inhibition on function, as well as the extent to which treatments which target behavioral inhibition responses provide benefits to individuals with chronic pain.

Observational studyThe Survey of Pain Attitudes: A revised version of its pediatric form

Abstract Background and aims Valid and reliable measures of patients’ pain beliefs are needed by clinicians and researchers to better understand the efficacy and mechanisms of pain treatments. The objective of this work was to address this need by further developing the pediatric version of the Survey of Pain Attitudes (Peds-SOPA), one of the most commonly used measures of pain beliefs. Methods A convenience sample of three hundred and seven adolescents (mean age= 14.35; SD = 1.62; 59% girls) participated in the study. They rated the intensity of their worst pain experienced in the 3 months prior to the assessment and completed both the Functional Disability Inventory and a revised version of a pediatric version of the Survey of Pain Attitudes (Peds-SOPA-R). Results Factor analyses confirmed a seven-factor solution of the questionnaire, and the revised version demonstrated improvements in the internal consistency of several of the scales (values ranged between adequate and good: 0.71–0.87), except for the Medical Cure scale which showed an internal consistency value of 0.65. The results support the validity of the Peds-SOPA-R scale scores by showing, as predicted, positive relationships between beliefs thought to be maladaptive (e.g., the belief that one is unable to function because of pain) and pain intensity and disability, and negative relationships with beliefs thought to be adaptive (e.g., the belief that exercise is beneficial for pain management) and these criterion variables. Conclusions These findings will be helpful to researchers who wish to study the role that pain beliefs play in adjustment to pain in youth. Implications The results provide critical psychometric information about a revised version of one of the most used questionnaires to assess pain beliefs. The evidence presented will be helpful to researchers who want to study the role that pain beliefs play in adjustment to chronic pain in young people.