Hanne P.J. Kindermans

Do depression and pain intensity interfere with physical activity in daily life in patients with Chronic Low Back Pain

&NA; Patients with chronic pain may have difficulties estimating their own physical activity level in daily life. Pain‐related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and/or report more pain indeed have a lower objectively assessed daily life activity level or whether they only perceive their activity level as lower. Patients with CLBP were included in a cross‐sectional study. During 14 days physical activity in daily life was measured, with both an electronic diary and an accelerometer. Multilevel analyses were performed to evaluate whether a higher level of depression and/or pain intensity was associated with a lower objectively assessed activity level or the discrepancy between the self‐reported and objectively assessed daily life activity levels. Results, based on 66 patients with CLBP (mean RDQ score 11.8), showed that the objectively assessed daily life activity level is not associated with depression or pain intensity. There was a moderate association between the self‐reported and objectively assessed activity levels (&bgr; = 0.39, p < 0.01). The discrepancy between the two was significantly and negatively related to depression (&bgr; = −0.19, p = 0.01), indicating that patients who had higher levels of depression judged their own activity level to be relatively low compared to their objectively assessed activity level. Pain intensity was not associated with the perception of a patients activity level (&bgr; = 0.12, ns).

Differences in activity-related behaviour among patients with chronic low back pain

The aim of the present study was to compare the subjectively reported and objectively assessed activity‐related characteristics of patients with Chronic Low Back Pain (CLBP) who were classified according to their scores on the Patterns of Activity Measure‐Pain (POAM‐P) into avoiders, persisters, mixed performers (i.e. high scores on both avoidance and persistence behaviour) or functional performers (i.e. low scores on avoidance and persistence behaviour).The aim of the present study was to compare the subjectively reported and objectively assessed activity-related characteristics of patients with Chronic Low Back Pain (CLBP) who were classified according to their scores on the Patterns of Activity Measure-Pain (POAM-P) into avoiders, persisters, mixed performers (i.e. high scores on both avoidance and persistence behaviour) or functional performers (i.e. low scores on avoidance and persistence behaviour). Patients carried an electronic diary during 14 days to assess the self-reported activity and pain intensity levels in daily life. An accelerometer was used to objectively assess their activity level during the same time period. Results were available for 79 patients. Avoiders, persisters and mixed performers showed a higher level of self-reported disability than functional performers. Avoiders were characterized by a low level of self-reported habitual activities and persisters by long objectively measured daily uptime. The objectively assessed level of physical activity did not differ between the four groups. A further analysis tested the association between pain intensity levels and self-reported and objectively assessed daily life activity levels in avoiders and persisters. In persisters, a higher level of self-reported activities in daily life was related to increased pain. The objectively assessed activity level was not associated with pain intensity.

Activity Patterns in Chronic Pain: Underlying Dimensions and Associations With Disability and Depressed Mood

UNLABELLED Activity patterns are believed to play an important role in the development and perpetuation of chronic pain. So far, 3 important activity patterns have been studied: avoidance behavior, persistence behavior, and pacing behavior. Yet, empirical evidence is limited and inconclusive about the relationships between these activity patterns and important outcomes. Therefore, the present study was aimed at identifying activity patterns by means of factor analyses and determining their relationship with disability and depressive symptomatology in participants with chronic pain (N = 132). Items across different measurement instruments pertaining to 1 particular activity pattern were aggregated, and submitted to factor analysis. Results from 3 separate factor analyses revealed 6 distinct activity patterns: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. In line with our hypotheses, pain and activity avoidance, and excessive persistence, were related to higher levels of disability and depressive symptomatology. In contrast to hypotheses, pacing was associated with worse outcomes as well. Interestingly, task-contingent persistence was related to lower levels of disability and depressive symptomatology. When controlling for pain and the other activity patterns, excessive persistence and activity avoidance were the most detrimental in terms of relations with depressed mood or disability. Task-contingent persistence appeared to be the least detrimental. PERSPECTIVE Our findings suggest the existence of several activity patterns, which are differentially related to disability and depressive symptomatology, in participants with chronic pain. The present results are discussed in the light of previous findings, and may provide a new impetus for future studies on activity patterns in chronic pain research.

Being in pain: the role of self-discrepancies in the emotional experience and activity patterns of patients with chronic low back pain

&NA; Chronic pain not only interferes with daily activities, it may also have a negative impact on the perceived integrity of one’s self through self‐discrepancies. Self‐discrepancies are experienced distances between the actual self and self‐guides that can exist from 2 perspectives (ie, own and other). Self‐discrepancies are associated with negative mood states and incite self‐regulatory behavior in order to reduce these discrepancies. The present study was aimed at replicating the emotional consequences of self‐discrepancies in patients with chronic low back pain, and extending current knowledge of the behavioral consequences of self‐discrepancies (ie, behavioral activity patterns such as avoidance and persistence). A cross‐sectional design was employed with 83 patients who completed a number of self‐report measures. We hypothesized that ideal and ought discrepancies, as well as feared congruencies were associated with depressed and anxious mood. On the behavioral level, a U‐shaped relationship was hypothesized between ideal and ought self‐discrepancies and persistence behavior, whereas feared self‐discrepancies were hypothesized to be related to avoidance behavior. Results were partially in line with the hypotheses. With respect to the emotional consequences, feared (own and other) self‐discrepancies were predictive of depressive and anxious mood. With regard to activity patterns, results showed a U‐shaped relationship between ideal‐other self‐discrepancies and persistence behavior and a positive relationship between feared‐own self‐discrepancies and avoidance behavior. In contrast to expectations, none of the other self‐discrepancies was related to activity patterns. Of interest was that avoidance, but not persistence behavior, was predictive of higher levels of disability and lower levels of quality of life. Support is provided for the role of self‐discrepancies in the emotional well‐being and behavioural patterns of patients with chronic low back pain.

Effects of self-discrepancies on activity-related behaviour: explaining disability and quality of life in patients with chronic low back pain.

Summary The self‐discrepancy model is applied to chronic low back pain to explain persistence and avoidance behaviour. Whether both styles are related to disability and quality of life is evaluated. ABSTRACT In chronic low back pain (CLBP) research, the self‐discrepancy model has been applied to explain dysfunctional avoidance and persistence behaviour. The main aim of this study was to evaluate whether specific self‐discrepancies in patients with CLBP are associated with the abovementioned types of activity‐related behaviour and whether changes in self‐discrepancies over time are associated with changes in activity‐related behaviour. Furthermore, the aim was to evaluate whether avoidance and persistence behaviour are associated with a higher level of disability and a diminished quality of life and whether changes over time in avoidance and persistence behaviour result in changes in disability and quality of life. A longitudinal cohort study in a sample of patients with CLBP (N = 116), in which self‐discrepancies, disability, quality of life, and objectively registered characteristics of activity‐related behaviour were measured, was performed to evaluate the pathways in the aforementioned self‐discrepancy model. Results indicate that patients with CLBP who feel closer to their ideal‐other show more characteristics of persistence behaviour. Patients who move further away from their ideal‐own also show more characteristics of persistence behaviour. Furthermore, in patients characterized as avoider, a decrease in a patient’s daily uptime was associated with a decrease of mental health‐related quality of life.

A Self-Regulation Perspective on Avoidance and Persistence Behavior in Chronic Pain New Theories, New Challenges?

Objective:Behavioral factors such as avoidance and persistence have received massive theoretical and empirical attention in the attempts to explain chronic pain and disability. The determinants of these pain behaviors remain, however, poorly understood. We propose a self-regulation perspective to increase our understanding of pain-related avoidance and persistence. Methods:A narrative review. Results:We identified several theoretical views that may help explaining avoidance and persistence behavior, and organized these views around 4 concepts central in self-regulation theories: (1) identity, (2) affective-motivational orientation, (3) goal cognitions, and (4) coping. The review shows that each of these self-regulation perspectives allows for a broadened view in which pain behaviors are not simply considered passive consequences of fear, but proactive strategies to regulate the self when challenged by pain. Discussion:Several implications and challenges arising from this review are discussed. In particular, a self-regulation perspective does not consider avoidance and persistence behavior to be intrinsically adaptive or maladaptive, but argues that their effects on disability and well-being rather depend on the goals underlying these behaviors. Such view would require a shift in how avoidance and persistence behavior are assessed and approached in clinical interventions.

Self‐discrepancies in work‐related upper extremity pain: Relation to emotions and flexible‐goal adjustment

Recurrent pain not only has an impact on disability, but on the long term it may become a threat to ones sense of self. This paper presents a cross‐sectional study of patients with work‐related upper extremity pain and focuses on: (1) the role of self‐discrepancies in this group, (2) the associations between self‐discrepancies, pain, emotions and (3) the interaction between self‐discrepancies and flexible‐goal adjustment. Eighty‐nine participants completed standardized self‐report measures of pain intensity, pain duration, anxiety, depression and flexible‐goal adjustment. A Selves Questionnaire was used to generate self‐discrepancies. A series of hierarchical regression analyses showed relationships between actual–ought other, actual–ought self, actual–feared self‐discrepancies and depression as well as a significant association between actual–ought other self‐discrepancy and anxiety. Furthermore, significant interactions were found between actual–ought other self‐discrepancies and flexibility, indicating that less flexible participants with large self‐discrepancies score higher on depression.

A content analysis of ideal, ought, and feared selves in patients with chronic low back pain

Patients with chronic pain are not only faced with disabilities but are also challenged to maintain a valued sense of self. This sense of self is in part determined by the extent to which patients can accomplish their identity‐related goals. The present study explores the content of three domains of the self, namely the ideal, ought and feared self and examines how the content relates to disability and depression.

Perceived Physical Activity Decline as a Mediator in the Relationship Between Pain Catastrophizing, Disability, and Quality of Life in Patients with Painful Diabetic Neuropathy

To fully understand the burden of painful diabetic neuropathy (PDN), we investigated the relationship of pain catastrophizing with disability and quality of life in patients with PDN. Furthermore, we studied the mediating roles of physical activity and/or decline in physical activity.

772 MEASURING AVOIDANCE, OVERDOING, AND PACING IN PATIENTS WITH CHRONIC PAIN: PSYCHOMETRIC PROPERTIES OF THE PATTERNS OF ACTIVITY MEASURE-PAIN

The aim of this study was to evaluate the quality of life in patients with Obstructive Peripheral Arterial Disease (OPAD) who complain of chronic pain. We identified patients with non-diabetic OPAD by means of medical record analysis, and we interviewed these patients in a University Hospital in Brazil. We applied a socio-demographic and economic questionnaire and the instrument WHOQOL-bref validated in Brazil. Each domain of the instrument WHOQOL-bref was analyzed and the higher scores correspond to better quality of life. 87 patients were interviewed and they presented the following characteristics: mean age of 66.15 years, 64.3% were male, 49.4% were married, 78% were catholic, 56.3% had primary school, 63.2% were retired, 41.3% had a minimum wage monthly income. We calculated the scores of four specific domains and the general domain of the WHOQOL-bref for each participant, and the average score for all participants. The minimum and maximum scores for four specific domains of the WHOQOLbref for each participant were: physical domain 5.14 and 19.42; psychological domain 4.66 and 19.33; social domain 6.66 and 20 and environmental domain 7 and 18, and general 6 and 20. The general average score for the physical domain was 11.12±2.70, psychological 12.70±2.60, social 14.95±3.62, environmental 12.68±2.19 and overall ±3.53 and 12.11. The lower quality of life is related to the physical domain, followed environmental, psychological and social domains. These results lead us to infer that intermittent claudication affects the quality of life of patients.