Michelle J. Verrier

Disruption of cognitive function in Fibromyalgia Syndrome

Abstract Accumulating evidence points to significant cognitive disruption in individuals with Fibromyalgia Syndrome (FMS). This study was carried out in order to examine specific cognitive mechanisms involved in this disruption. Standardized experimental paradigms were used to examine attentional function and working memory capacity in 30 women with FMS and 30 matched controls. Cognitive function was examined using performance on these tests and between group results were analysed in the context of important psychological and behavioural measures. Performance of standardized everyday attentional tasks was impaired in the FMS group compared to controls. Working memory was also found to be impaired in this group. Stimulus interference was found to be significantly worse in the FMS group as the demands of the tasks increased. These effects were found to exist independent of the measures of mood and sleep disruption. However, when pain levels were accounted for statistically, no differences existed between groups on cognitive measures. These findings point to disrupted working memory as a specific mechanism that is disrupted in this population. The results of this study suggest that pain in FMS may play an important role in cognitive disruption. It is likely that many factors, including disrupted cognition, play a role in the reduced quality of life reported by individuals with FMS.

A Critical Review of Neurobiological Factors Involved in the Interactions Between Chronic Pain, Depression, and Sleep Disruption.

Aims/Objectives/Background:A significant number of people who experience chronic pain also complain of depression and sleep problems. The comorbidities and bidirectional relationships that exist between these ailments are well recognized clinically. Further, all 3 disorders involve similar alterations in structural and functional neurobiology and share common pathophysiological mechanisms. We sought to comprehensively review the research literature regarding common neurobiological factors associated with these complex clinical disorders in order to better understand how they are related and provide further rationale for future clinical and research efforts to appropriately understand and manage them. Methods:A comprehensive review of the existing research literature was conducted in the domains of chronic pain, depression, and sleep. Results:Although the neurobiological underpinnings of these factors are complex and require further investigation, comparable changes are seen in levels of serotonin (5-hydroxytryptamine), proinflammatory cytokines, brain-derived neurotrophic factor, and other transmitters in these disorders. Conclusions:This review is unique as it attempts to cast a broader net over the common neurobiological correlates that exist across these 3 conditions. It highlights the complexity of the interrelationships between these disorders and the importance of increasing our understanding of neurobiological factors associated with them.

Symptom Burden, Medication Detriment, and Support for the Use of the 15D Health-Related Quality of Life Instrument in a Chronic Pain Clinic Population

Chronic noncancer pain is a prevalent problem associated with poor quality of life. While symptom burden is frequently mentioned in the literature and clinical settings, this research highlights the considerable negative impact of chronic pain on the individual. The 15D, a measure of health-related quality of life (HRQOL), is a user-friendly tool with good psychometric properties. Using a modified edmonton symptom assessment scale (ESAS), we examined whether demographics, medical history, and symptom burden reports from the ESAS would be related statistically to HRQOL measured with the 15D. Symptom burden, medication detriment scores, and number of medical comorbidities were significant negative predictors of 15D scores with ESAS symptom burden being the strongest predictor. Our findings highlight the tremendous symptom burden experienced in our sample. Our data suggest that heavier prescription medication treatment for chronic pain has the potential to negatively impact HRQOL. Much remains unknown regarding how to assess and improve HRQOL in this relatively heterogeneous clinical population.

A psychometric evaluation of the Pain Response Preference Questionnaire in a chronic pain patient sample.

OBJECTIVE The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytic study of the PRPQ conducted with a nonclinical sample identified scales labeled Solicitude, Management, Suppression, and Encouragement. The first aim of the current study was to evaluate whether these scales would be appropriate for use with chronic pain patients. The construct validity of the emerging scales and their relations to pain-related disability were also investigated. METHODS A large sample of chronic pain patients (N = 300) completed the PRPQ along with self-reports of personality constructs, coping styles, pain severity, and disability. RESULTS Factor analysis supported a three-factor solution. Two factors were similar to those obtained in its initial evaluation, and were given the identical labels of Solicitude and Suppression. The remaining factor was labeled Activity Direction and was comprised primarily of items that were part of the earlier Management and Encouragement scales. Internally consistent PRPQ scales based on these factors were created. Correlation analyses involving the personality and coping measures provided support for the construct validity of these PRPQ scales. Supportive of their clinical utility, multiple regression analyses indicated that, after adjusting for pain severity, the PRPQ scales accounted for significant variance in disability ratings. CONCLUSIONS Additional factor analytic research aimed at identifying the most appropriate set of PRPQ scales is warranted. The present findings indicate that the PRPQ scales used in the current study have strong psychometric properties and hold promise as research and clinical tools.

Exploring attentional disruption in fibromyalgia using the attentional blink

Disrupted attentional function in individuals with fibromyalgia syndrome (FMS) has been noted in a number of previous studies. The cognitive mechanisms related to this disruption are not well-understood. This study sought to identify whether differences exist in early attentional processing and attentional capacity in individuals with FMS measuring the attentional blink (AB). Early attentional function was assessed in 16 females with FMS and compared with 16 healthy age-matched females without FMS. Simple early visual stimulus target detection accuracy was not significantly different between groups. However, as target detection difficulty increased, individuals in the FMS group showed significantly poorer performance compared to healthy participants. Our findings suggest that attentional disruption in individuals with FMS is associated with deficits in the early allocation of attentional resources during the completion of tasks with higher attentional demand.

A longitudinal investigation of pain-related social support preferences in a chronic pain treatment sample.

Objectives:Chronic pain patients’ pain-related social support preferences have received little clinical or research attention. However, recent research utilizing the Pain Response Preference Questionnaire (PRPQ) has indicated that such preferences are related to pain-related disability. This study investigated whether pain-related social support preferences: (1) were related to disability levels, (2) predicted changes in pain and disability following a group-based treatment program, and (3) changed from pretreatment to posttreatment. Methods:At pretreatment and posttreatment, chronic pain patients (N=45) participating in a self-management psychoeducation program completed the PRPQ and measures of pain severity and disability. Results:A multiple regression analysis indicated that at pretreatment the Solicitude scale of the PRPQ was positively associated with disability, and that this association was moderated by the other 2 PRPQ scales (Activity Direction and Suppression). The PRPQ scales did not predict changes in pain or disability and there were no significant changes in the PRPQ scale scores. However, participants did not respond to the Solicitude scale in a consistent manner from pretreatment to posttreatment (51.1% decreased, 35.5% increased, and 13.3% remained the same). These changes were unrelated to changes in pain or disability. Discussion:Additional research aimed at identifying the processes underlying the association between pain-related support preferences and disability is warranted. Given the potentially important role that a desire for solicitous support may play in shaping the social context of pain, understanding the unexpected changes in Solicitude scale scores found in the present study may be particularly important for improving self-management treatments for chronic pain.

EHMTI-0340. Distance treatment programs for individuals with complex chronic headaches living far from the hospital: the Canadian experience

Individuals far from treatment centres are at increased risk of unmet needs. Given the high prevalence of headache, this is a great concern. With increased communication technology advancements including telehealth comes the opportunity to treat remote patients with limited or no access.

Do Pain-Related Support Preferences Moderate Relationships Between Chronic Pain Patients’ Reports of Support Received and Psychosocial Functioning?

Objective The operant theory of chronic pain and related research suggest pain-related solicitous support promotes disability. The current study investigated the hypotheses that solicitous support is positively associated with both disability and relationship satisfaction and that these relationships are moderated by the level of desire for this type of support. Methods Patients with chronic pain (N = 147) and in a relationship were recruited from a multidisciplinary pain treatment center. They provided self-reports of the amount of three types of pain-related support wanted and received (i.e., solicitous, encouragement, and suppression), disability, and relationship satisfaction. Results A hierarchical regression analysis indicated that solicitous support received was not significantly associated with disability. However, a moderation effect was found regarding encouragement. Encouragement received was negatively associated with disability, and this relationship was strongest at lower levels of interest in encouragement. Solicitous support received had a large positive association with relationship satisfaction. Conclusions The findings suggest the influence of pain-related support is more complex than suggested by the operant conditioning model of chronic pain, which emphasizes the possible detrimental impact of solicitous support. Further research is warranted regarding the potential relationship enhancing effects of solicitous support and the influence of encouragement on disability experienced by those with chronic pain.

A Brief Cognitive-Behavioral Intervention for Sleep in Individuals With Chronic Noncancer Pain: A Randomized Controlled Trial

PURPOSE/OBJECTIVE Chronic pain has a significant negative impact on the quality of life, including sleep disruption. There is compelling evidence that cognitive-behavioral therapy can be effective in treating sleep disorders. To our knowledge, no research has been carried out on brief cognitive-behavioral educational interventions in individuals with chronic pain. This study was conducted to determine whether a brief education session that incorporates sleep hygiene and cognitive-behavioral strategies would help improve the sleep of individuals with chronic pain. RESEARCH METHOD/DESIGN Eighty-five patients from a tertiary care Multidisciplinary Pain Centre completed all aspects of the study. This sample was randomized into 2 groups: a treatment group who received a brief cognitive-behavioral educational session, and a control group who did not. All participants completed a daily sleep diary for 28 days. Measures on sleep quality, beliefs and attitudes about sleep, pain, disability, and mood were recorded at baseline. RESULTS No significant differences were found between groups on demographic, pain, disability, mood measures, or sleep quality at baseline. Overall, 42% of the individuals who completed this study had depression scores above the clinical cutoff. This sample reported a high level of pain-related disability. Individuals in the treatment group had significantly reduced sleep onset latency compared to controls. No significant differences between groups on the number of times waking or hours slept. CONCLUSIONS/IMPLICATIONS Our findings suggest that there is potential for a brief educational intervention to have a positive impact on some aspects of sleep in the chronic pain population.

Pain Assessment in Children Undergoing Regional Anesthesia

Accurate and reliable assessment of pain in children is critical since a large portion of this population cannot verbally communicate and describe any pain they are experiencing. However, the inability of many young children to adequately report pain or discomfort makes pain assessment in pediatric patients difficult. A variety of different pain scales and reporting tools have been developed to facilitate pain assessment for each pediatric age group, from neonates to adolescents. Additionally, specialized pain reporting scales have been developed to allow pain assessment in critically ill children and children with developmental delays. This chapter outlines the principles and concepts underlying pain assessment and reporting in children and discusses some of the factors that influence pain assessment in the pediatric population. Examples of currently available pain assessment tools are also provided, and their uses, advantages, and disadvantages are discussed.