Active avoidance but not activity pacing is associated with disability in fibromyalgia.

Activity pacing has been suggested as a behavioural strategy that may protect patients with fibromyalgia (FM) against activity dysregulation and disability. The aim of the present study was to empirically test whether the construct of activity pacing is distinct from other behavioural strategies assessed with the Chronic Pain Coping Inventory (CPCI), such as guarding, resting, asking for assistance, relaxation, task persistence, exercise/stretch, seeking social support, and coping self-statements. The second objective was to test whether pacing was associated with physical disability when controlling for pain catastrophizing, pain severity and the other behavioural strategies as measured with CPCI. A random sample of patients with FM (N = 409) completed the CPCI, the Pain Catastrophizing Scale (PCS), the Physical Index of the Fibromyalgia Impact Questionnaire (FIQ-PH) and the Pain Disability Index (PDI). The results demonstrated that the Dutch version of the CPCI including the pacing subscale has adequate internal consistency and construct validity. Moreover, guarding and asking for assistance, but not pacing, were associated with disability. These findings are in line with fear-avoidance models and suggest that specifically active avoidance behaviours are detrimental in FM. The authors recommend developing cognitive-behavioural and exposure-based interventions and challenge the idea that pacing as an intervention is essential in pain self-management programs

84 ACTIVE AVOIDANCE BUT NOT ACTIVITY PACING IS ASSOCIATED WITH DISABILITY IN FIBROMYALGIA

Activity pacing has been suggested as a behavioural strategy that may protect patients with fibromyalgia (FM) against activity dysregulation and disability. The aim of the present study was to empirically test whether the construct of activity pacing is distinct from other behavioural strategies assessed with the Chronic Pain Coping Inventory (CPCI), such as guarding, resting, asking for assistance, relaxation, task persistence, exercise/stretch, seeking social support, and coping self-statements. The second objective was to test whether pacing was associated with physical disability when controlling for pain catastrophizing, pain severity and the other behavioural strategies as measured with CPCI. A random sample of patients with FM (N = 409) completed the CPCI, the Pain Catastrophizing Scale (PCS), the Physical Index of the Fibromyalgia Impact Questionnaire (FIQ-PH) and the Pain Disability Index (PDI). The results demonstrated that the Dutch version of the CPCI including the pacing subscale has adequate internal consistency and construct validity. Moreover, guarding and asking for assistance, but not pacing, were associated with disability. These findings are in line with fear-avoidance models and suggest that specifically active avoidance behaviours are detrimental in FM. The authors recommend developing cognitive-behavioural and exposure-based interventions and challenge the idea that pacing as an intervention is essential in pain self-management programs

Mood, stop-rules and task persistence : no mood-as-input effects in the context of pain

BACKGROUND AND OBJECTIVES: Task persistence despite experiencing pain might be a risk factor for development and maintenance of chronic pain. The Mood-as-Input (MAI) model predicts that the impact of mood on individuals' motivation to persist in a task depends on the interpretation of current mood within a certain motivational context. The aim of the current study was to replicate the original MAI study (Martin, Ward, Achee, & Wyer, 1993), but in a context where the task is painful. METHODS: A 2 Mood (negative versus positive) x 2 Stop-Rule (achievement versus hedonic) between-subjects factorial design was used in which 120 healthy participants (97 women, mean age = 21.78 years, SD = 3.07) performed an impression-formation task while being exposed to mechanically induced pressure pain. RESULTS: The MAI interaction hypothesis was not confirmed. Instead, participants showed more task persistence when they used hedonic stop-rules as a ground to decide on task (dis)continuation than when they used an achievement-oriented stop-rule. Additionally, participants reporting less pain-related fear also spent more time on the painful impression-formation task. The current findings suggest that the MAI perspective might not apply to task persistence behavior in a pain context. LIMITATIONS: These findings may not generalize to task performance in patients with chronic pain

Attentional control and the competition between nonpain goals and the threat of pain

Background Fully understanding attention to pain requires taking into account the motivational context. Both pain‐ and (nonpain) goal‐related information attracts attention. An intriguing question is which attentional bias prevails when pain‐ and goal‐related information co‐occurs? Reduced attentional bias towards pain‐ and goal‐related information was predicted when the other competing information was presented simultaneously. Moreover, trait attentional control was predicted to be associated with stronger attentional bias towards goal‐related information particularly in the presence of pain‐related information. Methods Attentional competition between pain‐ and (nonpain) goal‐related information was measured in ninety participants using a dot‐probe task presenting two stimuli (pain‐related, goal‐related or neutral) simultaneously. Reaction time was the dependent variable. Dot‐probe trials alternated with goal trials to induce a temporary goal. Trait attentional control was measured with the attentional control scale. Results For pain‐related neutral stimulus pairs, participants responded fastest when probes appeared on the same, compared to the opposite, location as the pain‐related stimulus. For pain‐goal‐related stimulus pairs, responses were fastest when probes appeared on the same, compared to the opposite, location as the goal‐related stimulus. Higher trait attentional control was associated with faster responding when probes appeared on the same, compared to the opposite, location as the goal‐related stimulus. Unpredicted, this effect was irrespective of the co‐occurring stimulus (neutral vs. pain‐related). Conclusions The findings suggest that the unintentional allocation of attention towards events related to a temporary (nonpain) goal prevails over attentional bias to events predicting pain. Trait attentional control predicts stronger attentional allocation towards events related to a temporary goal. Significance These findings indicate that treatment interventions facilitating goal pursuit in patients with chronic pain are beneficial in reducing attentional biases towards pain‐related events