Travis L. Osborne

The scope and nature of pain in persons with multiple sclerosis

Much remains unknown about the scope, nature, and impact of pain on the lives of persons with multiple sclerosis (MS). In the present study, 180 community dwelling adults with MS completed a postal survey that included demographic measures, MS disease measures, and several standardized measures of pain, including pain intensity, variability, location, and pain-related interference. Some 66% of the sample reported pain, 25% of whom reported severe pain. Persons with pain reported an average of 6.6 distinct pain sites. Using the Brief Pain Inventory Interference Scale, the average level of overall pain interference was 3.33 (0- 10 scale) in the group reporting pain. The highest levels of pain interference were reported for sleep, recreational activities, and work in and outside the home. Persons with pain were more likely to report greater MS disease severity, poorer psychological functioning, and poorer health than persons with MS but not pain. Persons with pain were also less likely to be employed. These findings are consistent with previous research that shows that pain is common in MS, that it is severe in a substantial subset of these individuals and has the potential to negatively impact physical and psychosocial functioning over and above the effects of MS itself.

Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain

Abstract Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain‐related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease‐related factors. Participants were 125 community‐dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease‐related variables (p < .001). These variables explained an additional 22% of the variance in pain‐related interference (p < .001) and 43% of the variance in psychological functioning (p < .001), after adjusting for demographic and MS‐related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.

Effects of Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons with Spinal-Cord Injury

Abstract Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.

A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients With Multiple Sclerosis and Chronic Pain

Abstract Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.

Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation.

Objectives:The current study examined the relationship between preoperative anxiety and acute postoperative phantom limb pain (PLP), residual limb pain (RLP), and analgesic medication use in a sample of persons undergoing lower limb amputation. Materials and Methods:Participants included 69 adults admitted to a large level 1 trauma hospital for lower limb amputation. Participants’ average pain and anxiety during the previous week were assessed before amputation surgery. RLP, PLP, and analgesic medication use were measured on each of the 5 days following amputation surgery. Results:Results of partial-order correlations indicated that greater preoperative anxiety was significantly associated with greater ratings of average PLP for each of the 5 days following amputation surgery, after controlling for preoperative pain ratings and daily postoperative analgesic medication use. Partial correlation values ranged from 0.30 to 0.62, indicating medium to large effects. Preoperative anxiety was also significantly associated with ratings of average RLP only on postoperative day 1, after controlling for preoperative pain ratings and daily postoperative analgesic medication use (r=0.34, P<0.05). Correlations between preoperative anxiety and daily postoperative analgesic medication dose became nonsignificant when controlling for preamputation and postamputation pain ratings. Discussion:These findings suggest that anxiety may be a risk factor for acute postamputation PLP and RLP, and indicate that further research to examine these associations is warranted. If replicated, the findings would support research to examine the extent to which modifying preoperative anxiety yields a reduction in postoperative acute PLP and RLP.

Cross-sectional examination of the associations between symptoms, community integration, and mental health in multiple sclerosis

OBJECTIVE To determine the frequency and severity of 8 symptoms in persons with multiple sclerosis (MS) and to examine the association between these symptoms and community integration and mental health. DESIGN Cross-sectional survey that assessed 8 symptoms (pain, fatigue, imbalance, numbness, weakness, shortness of breath, vision loss, and memory loss), disease progression (self-report version of the Expanded Disability Status Scale), community integration, and mental health. SETTING Community. PARTICIPANTS Adults with self-reported MS who responded to a mailed survey (N=180). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence and intensity of symptoms were measured with a symptoms checklist. Community integration was assessed with the Community Integration Questionnaire, and mental health was measured by the Mental Health Index of the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS The average number of symptoms reported was 5.07±2.18. The most common symptoms (fatigue, weakness, and imbalance) were also rated as the most severe. Not all symptoms were associated with level of disease progression or with MS subtype. Symptoms related to mobility were more likely to be associated with these variables. The 8 symptoms as a whole accounted for significant amounts of variance (range, 13%-21%) in measures of community integration and mental health, with specific symptoms making differential independent contributions to these measures. CONCLUSIONS This study demonstrates that most individuals with MS report a number of bothersome symptoms. Type of MS or level of progression does not tell the whole story regarding the impact of symptoms.

Psychometric evaluation of the Overall Anxiety Severity And Impairment Scale (OASIS) in individuals seeking outpatient specialty treatment for anxiety-related disorders

BACKGROUND Comorbidity among anxiety-related diagnoses is common, highlighting the need for brief, meaningful measures of anxiety that cut across diagnoses. METHODS The current study examined the psychometric properties of one such measure, the Overall Anxiety Severity and Impairment Scale (OASIS) (Norman et al., 2006), in a naturalistic sample of individuals seeking treatment at an outpatient anxiety treatment center. We examined the measure׳s structure, convergent validity, and potential effects of respondent gender. Using ROC analysis, we estimated an optimal cut-score for determining presence of an anxiety disorder in this sample. Finally, we examined the responsiveness of the OASIS to clinical change and calculated a reliable change index. RESULTS We found strong psychometric properties of the OASIS. A unitary factor structure with correlated residuals on the first two items provided the best fit to the data. A cut-score of eight best distinguished the presence of an anxiety-related diagnosis. In measurement invariance analyses, we found evidence that men and women respond similarly to the measure. In addition, we found that change in the OASIS was correlated with change in other measures, and we estimated that a four-point change in the OASIS can be considered clinically reliable. LIMITATIONS Sample characteristics may limit generalizability. Diagnoses were established by clinicians using a semi-structured interview that, while based upon DSM-IV diagnostic criteria, has not been psychometrically evaluated. CONCLUSION The results provide support for the use of the OASIS in specialty treatment for anxiety-related diagnoses and further highlight the strengths of this measure in clinical practice and research settings.

Psychosocial Factors in Chronic Pain in the Dysvascular and Diabetic Patient

Dysvascular and diabetic patients are faced with high rates of chronic pain as a consequence of numerous secondary sequelae, including diabetic neuropathy and limb loss. Researchers and scientists have put forth a tremendous amount of effort to understand the complex nature of pain in this population of individuals, as well as others with chronic pain secondary to illness and injury. The emergent understanding of anatomy and sensory physiology within the past century has fueled an initial focus of understanding pain from a purely neurologic and biochemical perspective. Over the past few decades, the field has moved toward an understanding of pain as a process involving the dynamic interaction of biologic, psychological, behavioral, and social variables. This article provides a brief overview of several psychosocial processes, cognitive, affective, and behavioral, that have emerged as influential to the experience, impact, and treatment of pain.