Pascal Thibault

Fear of movement and (re)injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples

Abstract The aims of the current study were twofold. First, the factor structure, reliability (i.e., internal consistency), and validity (i.e., concurrent criterion validity) of the Tampa Scale for Kinesiophobia (TSK), a measure of fear of movement and (re)injury, were investigated in a Dutch sample of patients with work‐related upper extremity disorders (study 1). More specifically, examination of the factor structure involved a test of three competitive models: the one‐factor model of all 17 TSK items, a one‐factor model of the TSK (Woby SR, Roach NK, Urmston M, Watson P. Psychometric properties of the TSK‐11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005;117:137–44.), and a two‐factor model of the TSK‐11. Second, invariance of the aforementioned TSK models was examined in patients with chronic musculoskeletal pain conditions (i.e., work‐related upper extremity disorders, chronic low back pain, fibromyalgia, osteoarthritis) from The Netherlands, Sweden, and Canada was assessed (study 2). Results from study 1 showed that the two‐factor model of the TSK‐11 consisting of ‘somatic focus’ (TSK‐SF) and ‘activity avoidance’ (TSK‐AA) had the best fit. The TSK factors showed reasonable internal consistency, and were modestly but significantly related to disability, supporting the concurrent criterion validity of the TSK scales. Results from study 2 showed that the two‐factor model of the TSK‐11 was invariant across pain diagnoses and Dutch, Swedish, and Canadian samples. Altogether, we consider the TSK‐11 and its two subscales a psychometrically sound instrument of fear of movement and (re)injury and recommend to use this measure in future research as well as in clinical settings.

Psychological predictors of pain expression and activity intolerance in chronic pain patients

Abstract Recent research suggests that communicative and protective pain behaviors represent functionally distinct subsystems of behavior associated with pain. The present research examined whether components of pain experience such as pain severity, catastrophizing and fear of pain were differentially associated with communicative and protective pain behaviors. It was predicted that pain severity would be associated with decreased physical tolerance and heightened expression of pain behavior. It was also predicted that pain catastrophizing would be preferentially associated with communicative pain behaviors, and fear of pain would be preferentially associated with protective pain behaviors and decreased physical tolerance. To test these predictions, work‐disabled patients with musculoskeletal pain conditions (N = 72) were filmed as they participated in a simulated occupational lifting task. Multiple regressions revealed that pain severity was uniquely associated with decreased physical tolerance and increased expression of protective pain behaviors. Pain catastrophizing was uniquely associated with the expression of both communicative and protective pain behaviors. Fear of pain was associated with physical tolerance and protective pain behaviors but not when controlling for pain severity. This study provides additional evidence for the functional distinctiveness of different types of pain expression and provides preliminary evidence for the functional distinctiveness of pain expression and activity intolerance. Discussion addresses the processes by which psychological factors might influence the display of different types of pain behaviors. Discussion also addresses how different types of interventions might be required to specifically target the sensory and behavioral dimensions of the pain system.

Darwin and emotion expression.

In his book The Expression of the Emotions in Man and Animals, Charles Darwin (1872/1965) defended the argument that emotion expressions are evolved and adaptive (at least at some point in the past) and serve an important communicative function. The ideas he developed in his book had an important impact on the field and spawned rich domains of inquiry. This article presents Darwins three principles in this area and then discusses some of the research topics that developed out of his theoretical vision. In particular, the focus is on five issues--(a) the question of what emotion expressions express, (b) the notion of basic emotions, (c) the universality of emotion expressions, (d) the question of emotion prototypes, and (e) the issue of animal emotions--all of which trace their roots to Darwins discussion of his first two principles.

The influence of communication goals and physical demands on different dimensions of pain behavior

&NA; The purpose of the present research was to examine the influence of communication goals and physical demands on the expression of communicative (e.g., facial grimaces) and protective (e.g., guarding) pain behaviors. Participants with musculoskeletal conditions (N = 50) were asked to lift a series of weights under two communication goal conditions. In one condition, participants were asked to estimate the weight of the object they lifted. In a second condition, participants were asked to rate their pain while lifting the same objects. The display of communicative pain behaviors varied as a function of the communication goal manipulation; participants displayed more communicative pain behavior when asked to rate their pain while lifting objects than when they estimated the weight of the object. Protective pain behaviors varied with the physical demands of the task, but not as a function of the communication goals manipulation. Pain ratings and self‐reported disability were significantly correlated with protective pain behaviors but not with communicative pain behaviors. The results of this study support the functional distinctiveness of different forms of pain behavior. Findings are discussed in terms of evolutionary and learning theory models of pain behavior. Clinical implications of the findings are addressed.

Initial Depression Severity and the Trajectory of Recovery Following Cognitive-Behavioral Intervention for Work Disability

Introduction: The present study examined the recovery trajectories of a group of mildly depressed and moderately-severely depressed injured workers enrolled in a 10-week community-based rehabilitation program. Methods: A sample of 168 individuals (75 women, 93 men) with a disabling musculoskeletal pain condition participated in the research. On the basis of BDI-II (1) scores at pre-treatment assessment, patients were classified as either mildly (BDI-II =9–16; N=68) or moderately-severely depressed (BDI-II >16; N: 100). Results: Both groups showed significant reductions in depression, but individuals in the (initially) moderately-severely depressed group were more likely to score in the depressed range of the BDI-II at post-treatment than individuals who were initially mildly depressed. For the mildly depressed group, early treatment reductions in pain catastrophizing, and perceived disability predicted improvement in depression scores. For the moderately-severely depressed group, none of the early treatment changes predicted improvement in depression; only late treatment reductions in pain catastrophizing and fear of movement/re-injury predicted improvement in depression. Chi-square analysis revealed that patients who were no longer depressed at post-treatment had the highest probability of returning to work (91%), followed by (post-treatment) mildly depressed patients (60%), and finally (post-treatment) moderately-severely depressed patients (26%), χ2=38.9, p < 0.001. Conclusion: In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.

Children’s and adolescents’ perception of the authenticity of smiles☆

Recently, Thibault and colleagues described the Duchenne marker as a cultural dialect for the perception of smile authenticity. The current study had the goal to follow up on this finding and to investigate the cues that French Canadian children use to evaluate the authenticity of smiles from members of three ethnic groups. The authenticity of six smiles differing in intensity and presence of orbicularis oculi (Duchenne marker) was rated by 1206 children from 4 to 17 years of age. No differences were found as a function of encoder group. All children perceived medium Duchenne smiles as more authentic than equally intense medium non-Duchenne smiles. Furthermore, results suggest a decrease in the reliance on intensity across the age span. Younger children use the intensity marker along the whole continuum to infer authenticity. In contrast, older children (14- to 17-year-olds) rated all smiles that did not contain the Duchenne marker as roughly equally low in authenticity.

Depression augments activity-related pain in women but not in men with chronic musculoskeletal conditions

OBJECTIVESnThe primary objective of the present study was to examine the role of sex as a moderator of the relation between depression and activity-related pain.nnnMETHODSnThe study sample consisted of 83 participants (42 women, 41 men) with musculoskeletal conditions. Participants were asked to lift a series of 18 canisters that varied in weight (2.9 kg, 3.4 kg and 3.9 kg) and distance from the body. Participants were asked to rate their pain while they lifted each canister and estimate the weight of the canisters.nnnRESULTSnConsistent with previous research, the relations among depression, pain intensity and disability were stronger for women than for men. ANOVA revealed that depression was associated with more intense activity-related pain in women only. For both women and men, the intensity of pain increased with each trial, although the weight of the objects lifted remained constant. Neither sex nor depression had an effect on participants weight estimates.nnnCONCLUSIONSnThe present discussion addresses the mechanisms through which depression may differentially affect pain in women and men. It also addresses the potential clinical implications of pain-augmenting effects of depression in women.