Shane MacDonald

The role of depression and catastrophizing in musculoskeletal pain.

Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built-in replication from two clinical samples of patients with sub-acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross-sectionally and at follow-up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect.

Development of a short form of the Örebro Musculoskeletal Pain Screening Questionnaire.

Study Design. A longitudinal design where the questionnaire was completed at a pretest and predictive ability evaluated with a 1-year follow-up. A second sample was employed to provide a replication. Objective. The aim of the study was to validate a short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMSPQ). Summary of Background Data. Several studies demonstrate the research and clinical utility of the ÖMSPQ. Calls have been made for a shorter form that requires less time in administering. Methods. The short version was constructed by taking two items from each of the five factors shown to have predictive power. It was then tested against the long form in two samples of people with musculoskeletal pain where one reflects an occupational health care population (N = 324) and the other a primary care population (N = 183) thus providing a built-in replication. All participants completed the ÖMSPQ and were then followed over the course of a year to evaluate disability as measured by sick leave. Results. The correlation between the short and long forms was 0.91. The receiver operating characteristic curve was nearly identical for the long and short versions of the questionnaire (e.g., primary care sample: 0.84 vs. 0.81; occupational sample: 0.72 vs. 0.70). Of those who developed disability, a cutoff of 50 on the short version identified 85% in the occupational and 83% in the primary care samples which was nearly as good as the full version. Conclusion. The short form of the ÖMSPQ is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version.

Avoidant Safety Behaviors and Catastrophizing: Shared Cognitive-Behavioral Processes and Consequences in Co-Morbid Pain and Sleep Disorders

Background: Research and theory suggest that the symptom pair of chronic pain and insomnia may be maintained by shared cognitive-behavioral processes and consequences. Purpose: This investigation describes the psychometric properties of an instrument designed to assess the way people think about symptoms of pain and poor sleep. Method: A pool of 12 items was generated from existing and validated measures. Exploratory factor analysis (EFA) was conducted on item responses from a community sample of respondents who reported having had a problem with pain or sleep (n = 1702) during the three months previous to the survey. Multinomial regression analyses (MRA) were used to describe derived subscale responses for distinct groups reporting different degrees of perceived symptom severity and overlap. Results: EFA suggested the existence of three distinct dimensions: safety behaviors of behavioral orientation, safety behaviors of cognitive orientation, and catastrophizing. MRA analyses indicated that catastrophizing appears to be a shared psychological process and that both types of safety behaviors may be enhanced in co-morbid problems with persistent pain and insomnia. Conclusion: Cognitions pertaining to avoidant safety behaviors and catastrophizing are associated with symptom severity and overlap in co-morbid pain and sleep disorders. More research is needed to explore the importance of shared psychological processes and consequences when studying and treating ill health.

Cognitive vulnerability in the development of concomitant pain and sleep disturbances.

OBJECTIVES The present study uses a cognitive behavioural framework to explore the idea that people with pain and sleep disturbances share a common cognitive vulnerability. DESIGN A longitudinal classification of people (N=592) in a community sample reporting on symptoms of pain and sleep at baseline, 3 and 12 months after the initial survey. METHOD Cluster analysis was used to classify people reporting different degrees of symptoms, and their endorsement of cognitive behavioural processes, and consequences at each time point. Groups in similar clusters were linked at adjacent time points to document patterns of stability and change. The clusters are described at baseline on a range of indices not used to form them (problem duration, problem frequency, anxiety, and depression). Reliable change in reports of symptom-related interference was cross tabulated with reliable change in cognitive behavioural processes and consequences. RESULTS Cluster analyses resulted in six homogenous and distinct profiles at each time point. Linking the clusters over time showed partial individual stability in cluster membership at adjacent time points. Reliable change in symptom-related interference was associated with reliable change in endorsement of cognitive behavioural processes and consequences on the short term. CONCLUSION The character and partial individual stability of symptom cluster membership suggests that problems with pain and sleep may share mutually maintaining cognitive behavioural processes and consequences. Future research should examine the utility of identifying mutually maintaining factors in the treatment of concomitant pain and sleep disturbances.

The affective personality, sleep, and autobiographical memories

Patterns of affect, sleep, and autobiographical memories seem related but there are no studies we know of to verify the notion. The purpose of this research is to investigate interrelationships’ between profiles of affect, sleep, and autobiographical memories. A cross-sectional design is employed. Three hundred and thirteen adult students participated. The data generated are viewed from two complementary perspectives. Our cluster analyses identified a group of individual states whose lives appear to be arousing and stressful (high positive and negative affect) yet they slept significantly better than self-destructive states (high on negative affect and low on positive affect). Our regressions imply that negative autobiographical memories are involved in a relationship with sleep independently of fairly stable patterns of affect, biological sex, and age. We finish by noting that apart from investigating these relationships longitudinally, cultural differences in patterns of affect and their health correlates should be explored.

Understanding catastrophizing from a misdirected problem-solving perspective

OBJECTIVES The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004). DESIGN In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. METHODS Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. RESULTS The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour. CONCLUSION These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.

Exploratory factor analysis of the Modified Somatic Perception Questionnaire on a sample with insomnia symptoms

Objectives: The purpose of this study was to examine the factorial solution of the Modified Somatic Perception Questionnaire (MSPQ) among individuals with insomnia symptoms in the general population. Design: A cross-sectional study with a randomly selected sample from the general population (N = 3600; 20–60 year old) was used. In total, 251 of the 2179 respondents fulfilled the criteria for insomnia symptoms and filled out a survey on demographic parameters, the MSPQ, the Hospital Anxiety and Depression Scale, sleep medication use and health care consumption. Methods: Exploratory factor analysis and correlations were used. Results: The results showed that a two-factor solution, accounting for 47.31% of the variance, was extracted from the 13 items of the MSPQ. Although one factor consisting of 10 items determined general symptoms of somatic arousal (α = 0.83), the other factor with three items assessed stomach symptoms and nausea (α = 0.78). The two factors were significantly inter-correlated (r = 0.54) and significantly associated with the total MSPQ (r = 0.96, r = 0.74). The two factors also showed discriminant validity with anxiety and depression and predictive validity with retrospective reports of sleep medication use and health care consumption. A few significant interactions emerged the two MSPQ factors and degree of sleep complaints. Conclusions: Although it is often assumed that the MSPQ taps a single factor of somatic arousal, this study on individuals with insomnia symptoms suggests that a two-factor solution has the best fit. Further research on the factorial solution of the MSPQ is warranted.

Letter. IN RESPONSE : Re: Gabel et al. Commenting on Linton et al. Development of a Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire

Letter. IN RESPONSE : Re: Gabel et al. Commenting on Linton et al. Development of a Short Form of the Orebro Musculoskeletal Pain Screening Questionnaire

SHORT-TERM PARTIAL SLEEP DEPRIVATION: EFFECTS ON EMOTION REGULATION OF HEALTHY ADULTS

Introduction and Objectives: Previous research has shown that sleep deprivation has negative effects on memory, cognitive, and physiological function. Sleep-deprived people also often show signs of emotionality. This study investigated risk posed by short-term partial sleep deprivation on the emotional regulation of healthy adults. Materials and Methods: We randomized 80 adults, ages 18-68, into sleep deprivation (3-nights with 5-hours in bed) and a control group. We used experimental emotion elicitation to examine group differences dependent on sleep conditions. We elicited negative emotions with music (MCI), visualization, and pictures (IAPS). We measured emotion regulation by levels of positive and negative emotion and affect; scores on discrete emotions (PANAS-X); levels of arousal, pleasure, emotion dominance (SAM, Affect Grid). We assessed within and between group differences with MANOVA, and group differences on discrete emotions with t-tests. Results: Following sleep-deprivation, people scored significantly lower on arousal, positive emotionality and affect compared to controls. In addition, they exhibited a negativity bias on discrete emotions, scoring positive (e.g., delighted, joyful) and neutral items (e.g., concentrating, attentive) lower and negative items (e.g., irritable, hostile) higher than controls. After emotion elicitation, both groups significantly reported increased negative emotion, arousal, displeasure, emotion dominance, and reduced positive emotion. The only significant differences between groups were on discrete emotions. The sleep-deprived group reported feeling significantly less fearless, more sluggish, tired, sleepy, and drowsy. Conclusion: Sleep-deprivation appears to pose risk to emotion regulation through reductions in positive emotionality and affect. This study supports prior research showing a negativity bias following sleep deprivation with participants scoring lower on positive and neutral items and higher on negative items. The results of this study provide an analog for how people with long-term sleep problems may be at increased risk for mood related disorders. Acknowledgements: Funding provided in part by Lars Hiertas Memorial Fund.

459 THE RELATIONSHIP OF DEPRESSION AND CATASTROPHIZING TO MUSCULOSKELETAL PAIN A CROSS-SECTIONAL STUDY IN TWO INTERNATIONAL SAMPLES

Background and Aims: Evidence supporting the assumption that attentional biases have an impact on the development of chronic pain is mixed. The present study sought to replicate and extend findings obtained with the pictorial dot-probe task that indicate attentional biases in chronic low back pain (CLBP) patients. Methods: Performances of 24 CLBP patients were compared with those of 24 subjects with no or less pain on a visual dotprobe task with pain associated and pain neutral pictures. Three indices served as performance indicators: the bias index (BI), the congruency index (CI), and the incongruency index (ICI). Separate repeated-measures ANOVA were performed with the three indices. Furthermore, the relation between measures of general distress (anxiety, depression), fear-avoidance-cognitions (fear of movement, catastrophizing, fear-avoidance-beliefs) and endurance-related cognitions (minimization, thought suppression) were examined. Results: For all three indices the main effect of picture category was significant. Furthermore, for the CI the main effect of patient group was significant. Concerning ICI, there was a trend to an interaction between picture category and patient group. Bivariate correlations revealed a significant correlation between the BI and catastrophizing. CI and ICI were significantly related to general distress (state/trait anxiety, depression), and to fear-avoidance beliefs. No correlations were found between endurance-cognitions and indices. Conclusions: The results of the present investigation support the hypothesis that pain alone does not account for attentional biases in CLBP patients. However, self-report characteristics mediate selective attentional processing in CLBP patients.