Heather Adams

Catastrophizing and Perceived Injustice Risk Factors for the Transition to Chronicity After Whiplash Injury

Study Design. The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. Objective. This article focuses on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. Summary of Background Data. Research has shown that psychological variables play a role in determining the trajectory of recovery after whiplash injury. Methods. This article will focus on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. Results. Several investigations have shown that measures of catastrophizing and perceived injustice prospectively predict problematic trajectories of recovery after whiplash injury. Basic research points to the potential roles of expectancies, attention, coping and endogenous opioid dysregulation as possible avenues through which catastrophizing might heighten the probability of the persistence of pain after whiplash injury. Although research has yet to systematically address the mechanisms by which perceived injustice might contribute to prolonged disability in individuals with whiplash injuries, there are grounds for suggesting the potential contributions of catastrophizing, pain behavior and anger. Conclusion. A challenge for future research will be the development and evaluation of risk factor–targeted interventions aimed at reducing catastrophizing and perceived injustice to improve recovery trajectories after whiplash injury.

Investigating risk factors for chronicity: the importance of distinguishing between return-to-work status and self-report measures of disability.

Objective: The objective of this study was to examine whether the outcome of psychosocial risk factor analyses varied as a function of whether the outcome variable was return-to-work status or self-reported functional disability. Methods: Participants were 255 workers who sustained a soft tissue injury to the back and participated in a community-based secondary prevention program. Assessment of psychologic risk factors (pain severity, pain catastrophizing, fear of movement/reinjury, depression) was conducted at pretreatment. Results: Logistic regression revealed that pain catastrophizing (odds ratio [OR], 0.53; 95% confidence interval [CI] = 0.32–0.88) and pain severity (OR, 0.65; 95% CI = 0.45–0.94) were significant predictors of return to work. However, when change in self-reported disability was used as the outcome variable, none of the psychosocial risk factors emerged as significant predictors. Conclusions: Given the important theoretical, clinical, and policy implications of the outcome of risk factor research, more research is needed to further clarify the respective advantages and limitations to using self-reported versus return to work-based measures of disability.

Stage of Chronicity and Cognitive Correlates of Pain-Related Disability

The present research examined the functional relations between the different dimensions of catastrophic thinking and pain-related disability, as a function of stage of chronicity. In the present study, 150 patients with chronic pain were grouped to form 3 different levels of chronicity: Group A (6 months to 2 years, n = 44); Group B (2-4 years, n = 55); and Group C (more than 4 years, n = 51). The 3 subscales of the Pain Catastrophizing Scale (Rumination, Magnification, Helplessness) were used as predictors of disability. Disability was assessed with the Pain Disability Index and pain was assessed with the McGill Pain Questionnaire. For Group A, regression analysis revealed that none of the PCS subscales predicted disability beyond the variance accounted for by sex, age and pain. Rumination was a significant predictor of disability in Group B, and both rumination and helplessness predicted disability in Group C. These findings provide preliminary evidence that stage of chronicity is an important moderator of psychological vulnerability for pain-related disability. Discussion addresses how the impact of pain management programs might be increased by tailoring interventions to specific patient needs.

Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain

PURPOSE The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression. METHODS The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention. RESULTS At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes. CONCLUSIONS The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.

Perceived cognitive deficits, emotional distress and disability following whiplash injury.

OBJECTIVES To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury. PARTICIPANTS A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work-related soft-tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups. METHODS Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain-related disability. RESULTS Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain-related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits. DISCUSSION The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.

Targeting Catastrophic Thinking to Promote Return to Work in Individuals with Fibromyalgia

In this study, a sample of 30 individuals with fibromyalgia (FM) were enrolled in a 10-week risk factor targeted intervention designed to promote return to work. Participants completed measures of pain severity, pain catastrophizing, fear of movement, depression, and self-reported disability at three points in time through the course of the intervention. Results showed that most individuals with FM were agreeable to participate in the return-to-work intervention. Treatment response of individuals with FM was compared to a matched sample of individuals with chronic low back pain (CLBP). Analysis of variance (ANOVA) revealed that both groups showed comparable reductions in pain catastrophizing, depression, and fear of movement through the course of treatment. Individuals with FM were less likely than individuals with CLBP to show clinically meaningful reductions in pain severity and self-reported disability. Patients with FM were less likely to return to work (23%) than participants with CLBP (50%). The findings suggest that although individuals with FM are more treatment resistant than individuals with CLBP, a significant proportion can still benefit from participation in a rehabilitation intervention with a stated objective of return to work. Implications of the findings for the structure and content of rehabilitation interventions for FM are discussed.

Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury.

Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program

Abstract The present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men) with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.

Assessing catastrophic thinking associated with debilitating mental health conditions

Abstract Purpose: The present study examined the psychometric properties of the Symptom Catastrophizing Scale (SCS). The SCS items were drawn from the Pain Catastrophizing Scale but were modified to make them better suited to the context of debilitating mental health conditions that are not necessarily associated with pain. The number of items was reduced from 13 to 7, and the response scale was simplified. Methods: The SCS was administered to individuals diagnosed with Major Depressive Disorder (MDD) (N = 79) or with a chronic musculoskeletal (MSK) condition (N = 88). Results: Exploratory factor analyzes revealed single factor solutions of the SCS for both the MSK and MDD samples. The internal consistency of the SCS was good. The SCS was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the SCS than individuals with MSK. The SCS was shown to be sensitive to treatment-related reductions in catastrophic thinking. Conclusions: Preliminary analyzes suggest that the SCS is a reliable and valid measure of symptom-related catastrophic thinking associated with debilitating mental health conditions. Implications for Rehabilitation Although catastrophic thinking has been identified as a risk factor for disability, current assessment tools are not well suited for individuals with debilitating mental health conditions. This paper describes a brief assessment instrument that can be used to assess catastrophic thinking in individuals with debilitating mental health conditions. The results of this study suggest that targeting catastrophic thinking might yield reductions in symptom severity and disability in work-disabled individuals with major depressive disorder.

Return to work helps maintain treatment gains in the rehabilitation of whiplash injury.

Abstract This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), &khgr;2 = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (&bgr; = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed.