A comprehensive model of adjustment to pain in the co-occurrence of PTSD and chronic musculoskeletal pain: vulnerability and protective pathways

There are a significant comorbidity between PTSD and chronic pain. Thus, studies clarifying the vulnerability and protective variables and mechanisms associated with PTSD and chronic pain are needed. The aim of this study was to examine the association between trauma, resilience, PTSD symptoms, and the variables included in the fear-avoidance models (anxiety sensitivity, catastrophizing, fear-avoidance beliefs, fear of pain, pain hypervigilance) as well as pain acceptance and experiential avoidance in explaining adjustment to chronic pain (pain intensity, pain-related disability and emotional distress). Method: the sample consisted of 229 patients with chronic musculoskeletal back pain. Results: Structural Equation Modelling was used. Statistical tests indicated that the hypothesized model adequately fitted the data (RMSEA = .07; CFI = .99; NNFI = .98; TLI = .96). The χ2 test was significant (χ2 (8) = 19.25, χ2 /dl = 2.40, p = .014). The results provided support for the hypothesized model. All the standardized path coefficients were significant (p < .05). Conclusions: This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain, and may provide support for the diathesis-stress model of pain. It is the first comprehensive model of adjustment to pain to consider vulnerability and protective adaptation mechanisms in patients who have undergone a traumatic event. The study highlights the importance of a comprehensive framework of reference to understand the comorbidity of PTSD and chronic musculoskeletal pain, and the need to provide well-designed treatment programs for the simultaneous treatment of these conditions.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Development of an Activity Patterns Scale (APS)

Six activity patterns were identified across various self-report measures in participants with chronic pain: Pain Avoidance, Activity Avoidance; Task Contingent Persistence; Excessive Persistence, Pain Contingent Persistence and Pacing (Kindermans et al., 2011). It was proposed that instruments assessing “pacing” should include items addressing one specific pacing behavior (breaking tasks into smaller pieces; taking frequent short rests and speeding up or slowing down) with a single goal (increasing activity level, conserve energy for valued activities and pain reduction) (Nielson et al., 2013). The aim of the present study was to develop an instrument to assess the activity patterns identified by Kindermans et al. (2011). The instrument also included three pacing scales one for each of the aforementioned goals. Methods A sample of 229 patients with fibromyalgia and 62 suffering other rheumatic diseases answered online the APS and the “Patterns of Activity Measure-Pain” (POAM-P) (Cane et al., 2007). Three alternative factor structures were tested by confirmatory factor analyses performed via structural equation modelling. . Results The structure with the best fit had 8 factors corresponding to the hypothesized scales: Pain Avoidance (α=.60), Activity Avoidance (α=.60); Task Contingent Persistence (α=.81); Excessive Persistence (α=.84), Pain Contingent Persistence (α=.70), Pacing for increasing activity (α=.76), Pacing for energy conservation (α=.72) and Pacing for pain reduction (α=.65). The correlations with the POAM-P scales were high and in the postulated direction. Conclusions The APS showed adequate reliability and structural validity. According to these results, Avoidance, Persistence and Pacing seem to be multidimensional constructs.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

A comprehensive model of adjustment to pain in the co-occurrence of PTSD and chronic musculoskeletal pain: vulnerability and protective pathways

There are a significant comorbidity between PTSD and chronic pain. Thus, studies clarifying the vulnerability and protective variables and mechanisms associated with PTSD and chronic pain are needed. The aim of this study was to examine the association between trauma, resilience, PTSD symptoms, and the variables included in the fear-avoidance models (anxiety sensitivity, catastrophizing, fear-avoidance beliefs, fear of pain, pain hypervigilance) as well as pain acceptance and experiential avoidance in explaining adjustment to chronic pain (pain intensity, pain-related disability and emotional distress). Method: the sample consisted of 229 patients with chronic musculoskeletal back pain. Results: Structural Equation Modelling was used. Statistical tests indicated that the hypothesized model adequately fitted the data (RMSEA = .07; CFI = .99; NNFI = .98; TLI = .96). The χ2 test was significant (χ2 (8) = 19.25, χ2 /dl = 2.40, p = .014). The results provided support for the hypothesized model. All the standardized path coefficients were significant (p < .05). Conclusions: This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain, and may provide support for the diathesis-stress model of pain. It is the first comprehensive model of adjustment to pain to consider vulnerability and protective adaptation mechanisms in patients who have undergone a traumatic event. The study highlights the importance of a comprehensive framework of reference to understand the comorbidity of PTSD and chronic musculoskeletal pain, and the need to provide well-designed treatment programs for the simultaneous treatment of these conditions.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Predicting long-term disability in a sample of patientes with back pain: A 2-year prospective follow-up study

The predictive power of the Fear-Avoidance Model is well established although further research is needed on the sequential interrelationships among its variables and the role of resilient factors. This paper presents a 2-year prospective follow-up study with the aim of investigating whether back-pain-related disability was predicted by the following variables which were measured when back pain was acute: the initial level of pain-related Disability; Perceived Pain Intensity; Depression; Fear-Avoidance Beliefs; Anxiety Sensitivity, Resilience and, Experiential Avoidance. With the same aim, two time-variant variables were measured when pain was chronic: Pain Fear-Avoidance and Chronic Pain Acceptance. Methods A sample of 95 patients treated in five primary care centres was assessed five times: when the patients were having an acute back pain episode and at 6, 12, 18 and 24 months. Multilevel regression models were performed via SAS. Results Pain-related Disability over 2 years was significantly predicted by the level of Disability and Fear-Avoidance Beliefs at pain onset, as well as by changes in Pain Fear-Avoidance at the time of the different measurements. Conclusions The results highlighted the predictive power of the Fear-Avoidance Model. According to the results, Pain Fear-Avoidance — composed of Pain Catastrophizing, Pain Vigilance, and Pain Anxiety — significantly predicted Disability over time. Also, initial functional disability played a more prominent role than pain intensity in the transition from acute to chronic pain. These results showed that non-psychopathological fear-avoidance beliefs grounded in the social health culture can account for disability across time.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech