Rosa Esteve

Adjustment to chronic pain: The role of pain acceptance, coping strategies, and pain-related cognitions

Background: Previous research has found that acceptance of pain is more successful than coping variables in predicting adjustment to pain.Purpose: To compare the influence of acceptance, pain-related cognitions and coping in adjustment to chronic pain.Methods: One hundred seventeen chronic pain patients attending the Clinical Pain Unit were administered a battery of questionnaires assessing pain acceptance, active and passive coping, pain-related cognitions, and adjustment.Results: The influence of acceptance, coping, and cognition on all the adjustment variables was considered simultaneously via Structural Equation Modeling using LISREL 8.30 software. A multigroup analysis showed that the male and female samples did not significantly differ regarding path coefficients. The final model showed that acceptance of pain determined functional status and functional impairment. However, coping measures had a significant influence on measures of emotional distress. Catastrophizing self-statements significantly influenced reported pain intensity and anxiety; resourcefulness beliefs had a negative and significant influence on depression.Conclusions: These findings suggest that acceptance may play a critical role in the maintenance of functioning and, with this aim, acceptance-based treatments are promising to avoid the development of disability. They also lend support to the role of control beliefs and of active coping to maintain a positive mood. Acceptance and coping are presented as complementary approaches.

Cognitive appraisal and coping in chronic pain patients

Objectives: This study analyses the relationships between patients’ cognitive appraisals concerning their pain and the coping strategies they use. In addition, the way the coping strategy influences the intensity of perceived pain and impairment in these patients was studied.

The path to capacity: resilience and spinal chronic pain.

Study Design. A cross-sectional study. Objective. To analyze the relationship between resilience, acceptance, coping, and adjustment to spinal chronic pain. Summary of Background Data. Several studies have concluded that resilience is relevant in predicting pain and physical functioning among patients with chronic pain. Although resilience may have a role in preventing or living with chronic pain, there is little research on the effects of resilience on adjustment among patients with chronic pain. Methods. Multivariate multiple regression by structural equation modeling was performed to simultaneously determine the influence of all the predictor variables on all the dependent variables. The sample was composed of 299 patients (138 men and 161 women) suffering from chronic spinal pain. Results. Higher levels of resilience were associated with higher levels of pain acceptance and active coping strategies. Active coping and acceptance were associated with higher levels of adjustment to pain. Conclusion. Positive personality characteristics could play a crucial role in patient adjustment, and thus clinicians should take into account the positive path to capacity to better understand the chronic pain experience.

Some empirical evidence regarding the validity of the Spanish Version of the McGill Pain Questionnaire (MPQ-SV)

&NA; Despite the fact that the McGill Pain Questionnaire (MPQ) is a useful pain assessment tool with widespread acceptance, empirical analyses have questioned its validity because they have not consistently supported the three a priori factors that guided its construction. The Spanish version that has followed the most systematic and rigorous reconstruction process (Lázaro C, Bosch F, Torrubia R, Banos JE. The development of a Spanish Questionnaire for assessing pain: preliminary data concerning reliability and validity. Eur J Psychol Assess, 1994;10:145–151) lacks evidence to support its construct validity. In the present study, the internal structure of the Spanish version of the McGill Pain Questionnaire (Lázaro C, Bosch F, Torrubia R, Banos JE. The development of a Spanish Questionnaire for assessing pain: preliminary data concerning reliability and validity. Eur J Psychol Assess, 1994;10:145–151) was examined in a sample of 202 acute pain patients and 207 chronic pain patients. Confirmatory factor analyses were carried out to compare alternative models postulating different internal structures (one‐factor model, the classic three‐factor model, and the semantic model inspired by the alternative structure found by Donaldson in 1995 (Donaldson GW. The factorial structure and stability of the McGill Pain Questionnaire in patients experiencing oral mucositis following bone marrow transplantation. Pain 1995;62:101–109)). Results from the LISREL CFA analysis indicated that the semantic model fitted better than the other models. On the other hand, intercorrelations between scales were smaller than the reliability indexes. In relation to concurrent evidence, significant correlations (P>0.001) were found between each subscale and the criteria measurements of every pain dimension. Only the affective subscale presented discriminant validity. Evidence supports the validity of the affective and sensory subscales but not the evaluative scale.

The Role of Sex/Gender in the Experience of Pain: Resilience, Fear, and Acceptance as Central Variables in the Adjustment of Men and Women With Chronic Pain

UNLABELLED The aim of the present study was to analyze differences between men and women in the experience of chronic pain. Resilience, fear-avoidance of pain, and pain acceptance were included in a hypothetical model as variables involved in chronic pain adjustment. A sample of 400 chronic spinal pain patients (190 men and 210 women) attending primary care units participated in the study. Students t-test analyses showed that the womens scores were significantly higher than mens scores on pain intensity, pain anxiety, and current functioning. A LISREL multisample analysis of the theoretical model across genders was conducted. As expected, statistically significant associations were found between resilience and confrontation in both samples. Thus, resilient people will probably develop accepting behavior when faced with chronic pain. Confrontation yielded 3 statistically significant path coefficients: to pain intensity, functional status, and negative mood. Statistically significant associations were found between fear-avoidance and negative mood in both samples, but no association was found between fear-avoidance and functional status in either sample. Finally, fear-avoidance was associated with pain intensity in the sample of men alone. Despite this difference, the results suggest that the theoretical model had an adequate fit across both groups. PERSPECTIVE In the context of fear-avoidance models, this article analyzed differences between men and women with spinal pain in relation to the pain experience. The fear-avoidance model appeared to be a good theoretical reference model in both men and women.

New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain

OBJECTIVE The aims of this study were to examine the internal structure of the Spanish version of the Chronic Pain Acceptance Questionnaire and present new empirical evidence regarding its validity. DESIGN AND METHODS A sample of 315 chronic pain patients attending a pain clinic completed a battery of instruments to assess pain acceptance, general psychological acceptance, depression, anxiety, pain intensity, functional impairment, and current functioning. RESULTS Confirmatory factor analysis supported the validity of a 20-item version with two subscales corresponding to two independent factors: Activity Engagement and Pain Willingness. Structural Equation Modelling showed that the association between pain intensity and anxiety and depression was fully mediated by Activity Engagement which partially mediated the association between pain intensity and functioning. Pain Willingness partially mediated the influence of pain intensity on functional impairment. CONCLUSIONS These findings indicate the differential influence of both components on adjustment to chronic pain.

Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain

Anxiety sensitivity has been included in the fear‐avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect‐related regulatory process that involves unwillingness to endure private experiences. The role of these constructs as vulnerability variables has not been investigated in chronic pain patients. The aim of this study was to investigate the role of anxiety sensitivity and experiential avoidance as dispositional variables in pain fear‐avoidance. Two alternative hypothetical models were tested: one in which anxiety sensitivity and experiential avoidance would be independently associated with pain fear‐avoidance; and second, one in which experiential avoidance would mediate the relationship between anxiety sensitivity and pain fear‐avoidance.

Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain

BackgroundPrior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability.PurposeThe aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed.MethodsThe sample was composed of 686 patients with chronic spinal pain. Structural equation modelling analyses were used to test the hypothetical model.ResultsExperiential avoidance was associated with pain fear-avoidance, and resilience was strongly associated with pain acceptance. Pain acceptance was negatively associated with negative mood, functional impairment and pain intensity. However, pain fear-avoidance was positively and significantly associated with negative mood but had no association with pain intensity. There was a path from functional impairment to pain fear-avoidance.ConclusionsResilience and experiential avoidance appear as variables which could explain individual differences in pain experience.

Disposition and adjustment to chronic pain.

Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

An examination of the structural link between post‐traumatic stress symptoms and chronic pain in the framework of fear‐avoidance models

The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post‐traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re‐experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear‐avoidance models.