War experiences and relationship problems predict pain sensitivity cross-sectionally among patients with chronic primary pain.

BACKGROUND Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain. OBJECTIVES We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0). METHODS A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity. RESULTS We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p < .001) and relationship problems (β = 0.096, p = .014) were associated with higher pain sensitivity. In addition, the control variables of age, sex, and pain intensity also showed a predictive value for higher pain sensitivity. Unlike Studer et al., we could not identify a certified inability to work as a predictor of higher pain sensitivity. CONCLUSIONS This study showed that beyond age, sex, and pain intensity, the psychosocial stressors of war experiences and relationship problems were associated with higher pain sensitivity

Being Trapped and Seeing No Way Out – Effects of Entrapment on Treatment Outcome in an Interdisciplinary Pain Treatment

Background: Entrapment describes a feeling of being stuck in an inescapable aversive situation. This feeling often arises in the context of uncontrollable and/or chronic stress and is associated with various psychopathologies. Objective: Owing to the nature of their disease, also chronic pain, patients might experience their situation as unremitting and inescapable. The aim of the present study was to examine the role of entrapment in patients with a chronic pain disorder and the association of entrapment with treatment outcome. Methods: A total of 189 patients with a chronic pain disorder where psychological factors play a decisive role in its severity, exacerbation, and maintenance (International Classification of Diseases, ICD-10: F45.41, "Chronic pain disorder with somatic and psychologic factors") receiving inpatient care completed a set of standardized self-report questionnaires at intake and discharge of an interdisciplinary pain treatment. To analyze the effects of entrapment on pain-related interference and psychologic distress, hierarchical linear models were used. Results: Over treatment, reduced levels of entrapment were observed, which were associated with decreases in psychologic distress and pain-related interference at discharge. Conclusion: Results support the relevance of entrapment in chronic pain and its treatment. To further improve interdisciplinary pain treatments, entrapment should be assessed and targeted by according interventions

Motive Satisfaction Among Patients with Chronic Primary Pain: A Replication.

We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychological distress (Vincent et al., Journal of Clinical Psychology in Medical Settings 28:331-343, 2021). 475 Patients with chronic primary pain completed standardized self-reported questionnaires assessing motivational incongruence, psychological distress, pain intensity, and pain interference at intake and discharge from a tertiary psychosomatic university clinic. We used hierarchical linear models to analyze motivational incongruence's effects on psychological distress. We partially replicated Vincent et al.'s findings. Significant reductions in pain, psychological distress, and motivational incongruence after treatment were found. Reductions in motivational incongruence were associated with reductions in psychological distress. Similarly, a better motive satisfaction mediated the relationship between pain interference and psychological distress. Our findings show that reducing motivational incongruence may be a key component of treating chronic primary pain; we recommend to assess and target motivational incongruence to improve interdisciplinary multimodal pain treatment