The impact of chronic pain on patients and spouses: Consequences on occupational status, distribution of household chores and care‐giving burden.

Background: Informal care-giving by spouses has become frequent in chronic pain settings. However, the impact of pain on occupational, functional and health out-comes in spouses has not been systematically investigated.Aims: The goal of the present study was to examine the impact of pain on both pa-tient and spousal outcomes.Methods: In the present study, the impact of chronic pain on 114 heterosexual dyads was explored (patients: 59% females, average age=57.81years, SD=11.85; spouses: 41% females, average age=57.32years, SD=12.15).Results: Overall, both patients and spouses reported important consequences of pain on outcomes, including occupational status distribution of household chores and marital satisfaction). Almost 52% of spouses indicated a high-to-severe burden. A multivariate model with spouse and patient factors accounted for 37.8% of the vari-ance of this burden. In the model, patient disability (=0.36, p=.002), spouses’ change in occupational status (=0.26, p=.002) and spousal perception of marital adjustment (=−0.36, p<.001) were uniquely associated with burden.Conclusions: The results indicate that the impact of chronic pain should be evalu-ated both for patients and spouses and point to patient and spouse factors that might contribute to spousal burden, which might help guide family interventions in a more effective manner.Significance: Research has shown that chronic pain poses a significant burden on individuals, which increases their reliance on others for assistance. However, the bur-den of informal care-giving assumed by spouses of patients with chronic pain has not been systematically investigated. This study offers new insights into the impact of chronic pain on patients and their spouses, which might provide empirical foundation for the development of new avenues for intervention aimed at promoting adjustment in patients with chronic pain and spouses who act as informal caregivers

Cross-sectional and prospective correlates of recovery expectancies in the rehabilitation of whiplash injury

Investigations have shown that expectancies are significant prognostic indicators of recovery outcomes following whiplash injury. However, little is currently known about the determinants of recovery expectancies following whiplash injury. The purpose of the present study was to examine the cross-sectional and prospective correlates of recovery expectancies in individuals admitted to a rehabilitation program for whiplash injury.Participants (N=96) completed measures of recovery expectancies, psychosocial variables, symptom severity, symptom duration, and disability at time 0 (admission) and time 1 (discharge).Consistent with previous research, more positive recovery expectancies at time 0 were related to reductions in pain at time 1 (r=-0.33,

Psychological influences on return to work outcomes: the central role of recovery expectancies

Research suggests that pain-related psychological variables such as depression, pain catastrophizing, fear of movement and perceived injustice are associated with work disability following musculoskeletal injury. However, little is known about the mechanisms underlying the relationships between pain-related psychological variables and return-to-work (RTW) outcomes. Evidence from several lines of research suggests that recovery expectancies may be one of the final common pathways by which pain-related psychological variables impact on RTW outcomes. The purpose of this thesis was to examine whether recovery expectancies mediate the relationships between pain-related psychological variables and RTW outcomes following musculoskeletal injury.Study 1 examined the mediating role of recovery expectancies on the relationship between depressive symptoms and RTW outcomes. This prospective study reported on 109 individuals with work-related musculoskeletal injuries who participated in a 7-week physiotherapy rehabilitation program. Within one week of entering the program, participants reported on their recovery expectancies, depressive symptoms and pain intensity. At 1-year follow-up, participants provided details about their work status. Receiver Operating Characteristic curve analyses were used to identify the expectancy cut-score that best distinguished between individuals who returned to work and those who remained work-disabled at 1-year follow-up. The results revealed that recovery expectancies significantly mediated the relationship between depressive symptoms and RTW outcomes following work-related injury. Study 2 investigated the mediating role of recovery expectancies on the relationships between pain catastrophizing and RTW outcomes, and fear of movement and RTW outcomes. This prospective study reported on 154 individuals with whiplash-associated disorders who participated in a 7-week multidisciplinary rehabilitation program. At baseline, participants reported on their recovery expectancies, pain catastrophizing, fear of movement and pain intensity. At 1-year follow-up, participants provided details about their work status. Receiver Operating Characteristic curve analyses were used to identify the expectancy cut-score in relation to work status at 1-year follow-up. The results revealed that recovery expectancies partially mediated the relationship between pain catastrophizing and RTW outcomes, and fully mediated the relationship between fear of movement and RTW outcomes following whiplash injury. The goal of Study 3 was to extend these findings and to examine the mediating role of expectancies on the relationship between perceived injustice and RTW outcomes. Several investigations have shown that high levels of perceived injustice are associated with prolonged work disability following musculoskeletal injury. However, little is currently known about the processes by which perceived injustice impacts on RTW outcomes. Study 3 utilized the same sample of individuals with whiplash-associated disorders as in Study 2. The results revealed that recovery expectancies significantly mediated the relationship between perceived injustice and RTW outcomes following whiplash injury. Taken together, the findings provide evidence for the central role of recovery expectancies on the relationships between pain-related psychological variables and RTW outcomes. Our findings argue for greater attention to recovery expectancies as risk factors for work disability and as potential targets of intervention following musculoskeletal injury.La recherche démontre que les facteurs psychologiques liés à la douleur, tels que la dépression, la pensée catastrophique, la peur du mouvement et les sentiments d’injustice sont associés avec l’incapacité au travail suite à une blessure musculosquelettique (BMS). Cependant, nous en connaissons peu sur les mécanismes qui sous-tendent les relations entre les facteurs psychologiques et le retour au travail. La recherche suggère que les attentes envers le rétablissement pourraient représenter l’une des voies communes finales par laquelle les facteurs psychologiques influencent le retour au travail. Le but de cette thèse était d’examiner si les attentes envers le rétablissement jouent un rôle médiateur sur les relations entre les facteurs psychologiques et le retour au travail suivant une BMS. L’étude 1 a examiné le rôle médiateur des attentes envers le rétablissement sur la relation entre les symptômes de la dépression et le retour au travail. Cette étude prospective comprenait un échantillon de 109 individus ayant des BMS liées au travail ayant participé à un programme de physiothérapie d’une durée de 7 semaines. Durant la première semaine, les participants ont indiqué leurs attentes envers le rétablissement, de même que leurs symptômes de la dépression et leur intensité de douleur. Lors du suivi annuel, les participants ont fourni des détails sur leur statut de travail. Une analyse de la fonction d’efficacité du récepteur (courbe ROC) a été utilisée pour identifier le résultat des attentes envers le rétablissement qui permettait au mieux de distinguer les personnes qui ont retournées au travail et celles qui ont demeurées en arrêt de travail. Les résultats ont révélé que les attentes envers le rétablissement expliquent comment les symptômes de la dépression influencent le retour au travail. L’étude 2 a examiné le rôle médiateur des attentes envers le rétablissement sur la relation entre les pensées catastrophiques, la peur du mouvement et le retour au travail. Cette étude prospective comprenait un échantillon de 154 individus atteints de blessures cervicales qui participaient à un programme de réadaptation multidisciplinaire d’une durée de 7 semaines. Dès le début du programme, les participants ont indiqué leurs attentes envers le rétablissement, de même que leurs niveaux de pensées catastrophiques, de leur peur du mouvement et de leur intensité de douleur. Lors d'un suivi annuel, les participants ont fourni des détails sur leur statut au travail. Des analyses de la courbe ROC ont été utilisées pour identifier le score d’attentes envers le rétablissement en fonction du statut de travail. Les résultats ont révélé que les attentes envers le rétablissement influençaient partiellement la relation entre la pensée catastrophique et le retour au travail, et expliquaient entièrement la relation entre la peur du mouvement et le retour au travail. L’étude 3 visait à développer les recherches précédentes et à examiner le rôle médiateur des attentes envers le rétablissement sur la relation entre les sentiments d’injustice et le retour au travail. Plusieurs études ont démontré que les sentiments d’injustice sont associés avec une absence de travail prolongée. Cependant, nous en connaissons très peu sur les processus par lesquels les sentiments d’injustice influencent le retour au travail. L'étude 3 a utilisé le même échantillon d’individus que dans l'étude 2. Les résultats ont révélé que les attentes envers le rétablissement expliquent la relation entre les sentiments d’injustice et le retour au travail. Dans l’ensemble, les résultats obtenus dans cette thèse mettent en lumière le rôle central des attentes envers le rétablissement sur les relations entre les facteurs psychologiques et le retour au travail suivant une BMS. Les résultats soulignent l’importance de porter attention aux attentes envers le rétablissement comme étant des facteurs de risque pour l’incapacité au travail et comme étant des cibles d’intervention potentielles

Return to work helps maintain treatment gains in the rehabilitation of whiplash injury

This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), χ = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (β = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed

Pain behavior mediates the relationship between perceived injustice and opioid prescription for chronic pain: a collaborative health outcomes information registry study

Background and purpose: Perceived injustice has been defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame and a sense of unfairness. Recent findings have identified perceived injustice as an important risk factor for pain-related outcomes. Studies suggest that perceived injustice is associated with opioid prescription in patients with pain conditions. However, the mechanisms by which perceived injustice is linked to opioid prescription are not well understood. The primary objective of this study was to examine the potential mediating roles of pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription among patients with chronic pain. Methods: This cross-sectional study used a sample of 344 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of perceived injustice, pain intensity, depressive symptoms, pain behavior and opioid prescription. Bootstrapped multiple mediation analyses were used to examine the mediating role of patients’ pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription. Results: Consistent with previous research, we found a significant association between perceived injustice and opioid prescription. Interestingly, results revealed that pain behavior was the only variable that mediated the association between perceived injustice and opioid prescription. Conclusion: This study was the first to examine the mechanisms by which perceived injustice is associated with opioid prescription in patients with chronic pain. We found that pain behavior, rather than pain intensity and depressive symptoms, mediated the association between perceived injustice and opioid prescription. Future research in this area should employ a longitudinal research design in order to arrive at clearer causal conclusions about the relationships between pain behavior, perceived injustice and opioid prescription