John A. Sturgeon

Resilience: A New Paradigm for Adaptation to Chronic Pain

Chronic pain is an affliction that affects a large proportion of the general population and is often accompanied by a myriad of negative emotional, cognitive, and physical effects. However, current pain adaptation paradigms do not account for the many chronic pain patients who demonstrate little or no noticeable impairment due to the effects of chronic pain. This paper offers resilience as an integrative perspective that can illuminate the traits and mechanisms underlying the sustainability of a good life and recovery from distress for individuals with chronic pain.

Psychological Resilience, Pain Catastrophizing, and Positive Emotions: Perspectives on Comprehensive Modeling of Individual Pain Adaptation

Pain is a complex construct that contributes to profound physical and psychological dysfunction, particularly in individuals coping with chronic pain. The current paper builds upon previous research, describes a balanced conceptual model that integrates aspects of both psychological vulnerability and resilience to pain, and reviews protective and exacerbating psychosocial factors to the process of adaptation to chronic pain, including pain catastrophizing, pain acceptance, and positive psychological resources predictive of enhanced pain coping. The current paper identifies future directions for research that will further enrich the understanding of pain adaptation and espouses an approach that will enhance the ecological validity of psychological pain coping models, including introduction of advanced statistical and conceptual models that integrate behavioral, cognitive, information processing, motivational and affective theories of pain.

Independent Validation of the MMPI-2-RF Somatic/Cognitive and Validity Scales in TBI Litigants Tested for Effort

The MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is replacing the MMPI-2 as the most widely used personality test in neuropsychological assessment, but additional validation studies are needed. Our study examines MMPI-2-RF Validity scales and the newly created Somatic/Cognitive scales in a recently reported sample of 82 traumatic brain injury (TBI) litigants who either passed or failed effort tests (Thomas & Youngjohn, 2009). The restructured Validity scales FBS-r (restructured symptom validity), F-r (restructured infrequent responses), and the newly created Fs (infrequent somatic responses) were not significant predictors of TBI severity. FBS-r was significantly related to passing or failing effort tests, and Fs and F-r showed non-significant trends in the same direction. Elevations on the Somatic/Cognitive scales profile (MLS-malaise, GIC-gastrointestinal complaints, HPC-head pain complaints, NUC-neurological complaints, and COG-cognitive complaints) were significant predictors of effort test failure. Additionally, HPC had the anticipated paradoxical inverse relationship with head injury severity. The Somatic/Cognitive scales as a group were better predictors of effort test failure than the RF Validity scales, which was an unexpected finding. MLS arose as the single best predictor of effort test failure of all RF Validity and Somatic/Cognitive scales. Item overlap analysis revealed that all MLS items are included in the original MMPI-2 Hy scale, making MLS essentially a subscale of Hy. This study validates the MMPI-2-RF as an effective tool for use in neuropsychological assessment of TBI litigants.

A multilevel structural equation modeling analysis of vulnerabilities and resilience resources influencing affective adaptation to chronic pain

Summary Average pain catastrophizing and time‐varying levels of pain catastrophizing and positive interpersonal events mediate the relationships between daily pain intensity and positive and negative affect. ABSTRACT The processes of individual adaptation to chronic pain are complex and occur across multiple domains. We examined the social, cognitive, and affective context of daily pain adaptation in individuals with fibromyalgia and osteoarthritis. By using a sample of 260 women with fibromyalgia or osteoarthritis, we examined the contributions of pain catastrophizing, negative interpersonal events, and positive interpersonal events to daily negative and positive affect across 30 days of daily diary data. Individual differences and daily fluctuations in predictor variables were estimated simultaneously by utilizing multilevel structural equation modeling techniques. The relationships between pain and negative and positive affect were mediated by stable and day‐to‐day levels of pain catastrophizing as well as day‐to‐day positive interpersonal events, but not negative interpersonal events. There were significant and independent contributions of pain catastrophizing and positive interpersonal events to adaptation to pain and pain‐related affective dysregulation. These effects occur both between persons and within a persons everyday life

From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing

Background Pain catastrophizing (PC) – a pattern of negative cognitive-emotional responses to real or anticipated pain – maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled “From Catastrophizing to Recovery” [FCR]. Objectives To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC. Design and methods Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student’s t-test contrasts were used to compare scores across time points. Results All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen’s d=0.85 and d=1.15). Conclusion Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.

Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study.

UNLABELLED Fatigue is a multidimensional construct that has significant implications for physical function in chronic noncancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic. Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference. Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic noncancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain and may provide directions for future clinical and theoretical research in the area of chronic noncancer pain. PERSPECTIVE Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic noncancer pain.

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways

In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.

Contributions of Physical Function and Satisfaction with Social Roles to Emotional Distress in Chronic Pain: A Collaborative Health Outcomes Information Registry (CHOIR) Study

Abstract Individuals with chronic pain show greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The present study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford Universitys Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of Patient-Reported Outcomes Measurement Information Systems (PROMIS) Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress seems to be disruption of social relationships, than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

Social pain and physical pain: shared paths to resilience

Although clinical models have traditionally defined pain by its consequences for the behavior and internal states of the sufferer, recent evidence has highlighted the importance of examining pain in the context of the broader social environment. Neuroscience research has highlighted commonalities of neural pathways connecting the experience of physical and social pain, suggesting a substantial overlap between these phenomena. Further, interpersonal ties, support and aspects of the social environment can impair or promote effective adaptation to chronic pain through changes in pain perception, coping and emotional states. The current paper reviews the role of social factors in extant psychological interventions for chronic pain, and discusses how greater attention to these factors may inform future research and clinical care.

The Psychosocial Context of Financial Stress: Implications for Inflammation and Psychological Health.

Objective Psychological distress may contribute to chronic activation of acute-phase inflammation. The current study investigated how financial stressors influence psychosocial functioning and inflammation. This study examined a) the direct relations between financial stress and inflammation; b) whether the relationships between financial stress and inflammation are mediated in part by negative interpersonal events, psychological distress, and psychological well-being; and c) whether social standing in ones community moderates the relations between financial stress and psychological distress, psychological well-being, and markers of inflammation (interleukin-6 [IL-6] and C-reactive protein). Methods Stressful financial and interpersonal events over the previous year, perceived social status, indices of psychological well-being and distress, and levels of IL-6 and C-reactive protein were assessed in a community sample of 680 middle-aged adults (ages 40–65 years). Results Structural equation modeling analyses revealed significant relations among financial stress, interpersonal stress, and psychological distress and well-being, and complex relationships between these variables and inflammatory markers. Psychological well-being mediated the association between financial stress and IL-6 ([mediation] ab = 0.012, standard error [SE] = 0.006, p = .048). Furthermore, individuals with higher perceived social standing within their communities exhibited a stronger relation between negative financial events and both interpersonal stressors (interaction B = 0.067, SE = 0.017, p < .001) and C-reactive protein (interaction B = 0.051, SE = 0.026, p = .050). Conclusions Financial stress demonstrates complex relations with inflammation, due partly to psychological well-being and social perceptions. Findings are discussed with regard to the social context of stress and physiological factors pertinent to stress adaptation and inflammation.