Kim E. Dixon

Psychological interventions for arthritis pain management in adults: a meta-analysis

CONTEXT The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. OBJECTIVE This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. DATA SOURCES Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. STUDY SELECTION Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. DATA EXTRACTION Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. DATA SYNTHESIS An overall effect size of 0.177 (95% CI=0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p=.01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. CONCLUSIONS These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found.

An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description

Abstract A cold pressor task (CPT) was used with 203 college students (112 women and 91 men) in a study of sex differences in pain response. Physiological measures were taken before and after pain induction, and sex‐differentiating personality traits were assessed with the Personal Attributes Questionnaire (PAQ). The Pain Catastrophizing Scale (PCS) was given with standard instructions prior to the CPT, and it was re‐administered after the CPT with modified instructions to assess catastrophic thinking during the CPT. Hypotheses were formulated into an explanatory model that was evaluated by path analysis. Pain induction elevated blood pressures and cortisol levels for both sexes, but systolic blood pressure reactivity and cortisol response were greater in men, even with sex differences in CPT tolerance times controlled statistically. Post‐CPT PCS scores were positively related to pain ratings and negatively related to tolerance, but baseline PCS scores did not predict tolerance or pain ratings. Pre‐PCS scores were not well correlated with post‐PCS scores (r=0.46) and underestimated post‐PCS scores, particularly for women. The Sex difference on the post‐CPT PCS was largely attributable to the PAQ personality trait of Emotional Vulnerability. The differential results obtained from assessing catastrophizing before and after the CPT emphasized the importance of specifying the context in which catastrophizing is assessed (both timing and instructions). Theoretical considerations in the construct of catastrophizing are also highlighted, including, but not limited to, the confounding of variables such as pain intensity and unpleasantness.

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study

Summary Combined training in pain and weight management in overweight and obese OA patients resulted in improved pain and other outcomes compared to either training alone. ABSTRACT Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long‐term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n = 232) were randomized to a 6‐month program of: 1) PCST + BWM; 2) PCST‐only; 3) BWM‐only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self‐efficacy, weight self‐efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST + BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self‐efficacy, and weight when compared to the other 3 conditions (Ps < 0.05). PCST + BWM also did significantly better than at least one of the other conditions (ie, PCST‐only, BWM‐only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self‐efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long‐term benefits.

Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain.

Objective:To examine the effects of personality and pain catastrophizing upon pain tolerance and pain ratings and to examine the impact of an experimental pain induction on subsequent ratings of catastrophizing. Method:Two hundred nineteen college students participated in a cold pressor task. Sex-differentiating personality constructs were measured by the Extended Personal Attributes Questionnaire. The Pain Catastrophizing Scale was given before and after the cold pressor task. Results:A path-analytic model fit the data well and permitted tests of explanatory relationships. Mediational analyses demonstrated that sex differences in catastrophizing were explained by the Personal Attributes Questionnaire Masculinity–Femininity and Verbal Passive-Aggressiveness scales. Pain tolerance and pain ratings differed significantly between men and women, but Masculinity–Femininity partially mediated those sex–pain relationships. Additionally, higher pain ratings and lower pain tolerance were independently associated with increased catastrophizing after the cold pressor task. Conclusions:The results suggest that sex differences in catastrophizing and pain responsivity are partially accounted for by the dispositional tendency to describe oneself as emotionally vulnerable. The findings also suggest that pain catastrophizing may be situational as well as dispositional.

Domain Specific Self-Efficacy Mediates the Impact of Pain Catastrophizing on Pain and Disability in Overweight and Obese Osteoarthritis Patients

UNLABELLED This study examined whether self-efficacy mediated the relationship between pain catastrophizing and pain and disability. Participants were 192 individuals diagnosed with osteoarthritis (OA) of the knees who were overweight or obese. Multiple mediator analyses were conducted to simultaneously test self-efficacy for pain control, physical function, and emotional symptoms as mediators while controlling for demographic and medical status variables. Higher pain catastrophizing was associated with lower self-efficacy in all 3 domains (Ps < .05). Self-efficacy for pain control fully mediated the relationship between pain catastrophizing and pain (beta = .08, Sobel test Z = 1.97, P < .05). The relationship between pain catastrophizing and physical disability was fully mediated by self-efficacy for physical function (beta = .06, Sobel test Z = 1.95, P = .05). Self-efficacy for emotional symptoms partially mediated the relationship between pain catastrophizing and psychological disability (beta = .12, Sobel test Z = 2.92, P < .05). These results indicate that higher pain catastrophizing contributed to greater pain and disability via lower domain-specific self-efficacy. Efforts to reduce pain and improve functioning in OA patients should consider addressing pain catastrophizing and domain specific self-efficacy. Pain catastrophizing may be addressed through cognitive therapy techniques and self-efficacy may be enhanced through practice of relevant skills and personal accomplishments. PERSPECTIVE This study found that higher pain catastrophizing contributed to greater pain and disability via domain specific self-efficacy. These results suggest that treatment efforts to reduce pain and improve functioning in OA patients who are overweight or obese should consider addressing both pain catastrophizing and self-efficacy.

Arthritis self-efficacy and self-efficacy for resisting eating: relationships to pain, disability, and eating behavior in overweight and obese individuals with osteoarthritic knee pain.

&NA; This study examined arthritis self‐efficacy and self‐efficacy for resisting eating as predictors of pain, disability, and eating behaviors in overweight or obese patients with osteoarthritis (OA) of the knee. Patients (N = 174) with a body mass index between 25 and 42 completed measures of arthritis‐related self‐efficacy, weight‐related self‐efficacy, pain, physical disability, psychological disability, overeating, and demographic and medical information. Hierarchical linear regression analyses were conducted to examine whether arthritis self‐efficacy (efficacy for pain control, physical function, and other symptoms) and self‐efficacy for resisting eating accounted for significant variance in pain, disability, and eating behaviors after controlling for demographic and medical characteristics. Analyses also tested whether the contributions of self‐efficacy were domain specific. Results showed that self‐efficacy for pain accounted for 14% (p = .01) of the variance in pain, compared to only 3% accounted for by self‐efficacy for physical function and other symptoms. Self‐efficacy for physical function accounted for 10% (p = .001) of the variance in physical disability, while self‐efficacy for pain and other symptoms accounted for 3%. Self‐efficacy for other (emotional) symptoms and resisting eating accounted for 21% (p < .05) of the variance in psychological disability, while self‐efficacy for pain control and physical function were not significant predictors. Self‐efficacy for resisting eating accounted for 28% (p = .001) of the variance in eating behaviors. Findings indicate that self‐efficacy is important in understanding pain and behavioral adjustment in overweight or obese OA patients. Moreover, the contributions of self‐efficacy were domain specific. Interventions targeting both arthritis self‐efficacy and self‐efficacy for resisting eating may be helpful in this population.

Measurement of agency, communion, and emotional vulnerability with the personal attributes questionnaire

Factor analytic studies of the 24-item Personal Attributes Questionnaire (Spence & Helmreich, 1978) have reported inconsistent results, and a previous confirmatory factor analysis (CFA) indicated inadequate fit for factors corresponding to Masculinity, Femininity, and Masculinity–Femininity scales. In this research, we used CFA in a college sample (N = 382) to evaluate the 3-factor model, and we revised scales by eliminating 6 misspecified items. The revised model fit well in another college sample (N = 230). We renamed the revised scales Agency, Communion, and Emotional Vulnerability. In relation to Five-factor theory, Emotional Vulnerability and Communion correlated well with Neuroticism and Agreeableness, respectively, and Agency had moderate correlations with Neuroticism, Extraversion, and Conscientiousness. Psychometric results in the context of current theory suggest that Agency (Masculinity) may not be a fully adequate measure of the agency construct.

Board Certification in Psychology: Insights from Medicine and Hospital Psychology

For physicians board certification is an accepted tradition that research suggests improves services and outcomes. In contrast, relatively few psychologists pursue board certification suggesting ambivalence or limited contingencies reinforcing it. The authors report on medical school and hospital-based psychologists’ attitudes toward board certification and current certification status. About one-fifth (21.7%) of the sample were certified by the American Board of Professional Psychology, a greater proportion than psychologists generally: Highest rates were seen in neuropsychology (7.5%), clinical psychology (6.4%), clinical child and adolescent psychology (3.2%) and clinical health psychology (2.8%). Few (<2%) reported their hospitals required board certification. Half recognized benefits to the profession for psychologists pursuing board certification, yet 70% opposed requiring it for their hospital-based practice. Forces seeking to promote healthcare quality ultimately may increase expectations for board certification. If consumers, employers, hospitals and managed care organizations demand board certification for health professionals, greater numbers of psychologists would likely seek it.

Hospital privileges for psychologists in the era of competencies and increased accountability

After campaigning to be granted hospital privileges decades ago, new issues are emerging that are affecting psychologists’ hospital privileges. Some of the forces shaping hospital privileges emanate from within the field of psychology, where there has been a movement to more closely examine psychologists’ competences. Other forces impinging on hospital privileges are external to psychology, most notably the Joint Commission, which has promulgated new standards for hospital-based practitioners across disciplines. This article discusses the effects of these new standards on the practice of psychology and describes the findings of a survey examining how privileges are currently obtained and maintained within hospitals.