Distress intolerance and pain catastrophizing as mediating variables in PTSD and chronic noncancer pain comorbidity.

Objectives: Several studies have demonstrated posttraumatic stress disorder (PTSD) and chronic pain comorbidity. However, there is a lack of research on the psychological variables that might explain their co-occurrence. We investigated the mediating role of distress intolerance and pain catastrophizing in this relationship. Methods: A moderated mediation model was tested. The sample comprised 114 individuals with chronic noncancer pain (90 women and 24 men; mean age, of 60.04 years [SD=9.76]). Results: Catastrophizing had a significant effect on PTSD. Distress intolerance mediated catastrophizing and PTSD, and pain intensity moderated this relationship. Conclusions: New insights are provided into the psychological variables that may explain PTSD and chronic noncancer pain comorbidity

Does Pain Catastrophizing and Distress Intolerance Mediate the Relationship Between PTSD and Prescribed Opioid Misuse in People With Chronic Noncancer Pain?

Última versión de borrador en PDFObjective: There is an ongoing debate on the use of long-term high-dose medically prescribed opioid analgesics for patients with chronic noncancer pain. Such use is elevated when there is comorbid pain and PTSD, which is quite prevalent. Therefore, it is relevant to investigate the psychological variables that may explain opioid misuse in this population. The purpose of this study was to examine the interaction effect of PTSD severity, distress intolerance, and pain catastrophizing on prescribed opioid misuse in chronic noncancer pain patients. Method: A total of 168 participants (M age = 60 years, 74% women) were assessed regarding opioid medication, pain intensity, traumatic psychological events, PTSD, distress intolerance, pain catastrophizing, and current opioid misuse. Results: Groups were formed according to the level of PTSD severity (no symptoms, moderate symptoms, and severe symptoms). Significant differences were found between the groups in pain intensity, catastrophizing, distress intolerance, and opioid misuse. The severe-symptoms group had the highest scores on all variables. There were no between-group differences in the prescribed medication. Mediation analysis showed that the relationship between PTSD severity and opioid misuse was completely and independently mediated by distress intolerance and pain catastrophizing. Conclusions: Distress intolerance and pain catastrophizing may be theoretically and clinically relevant constructs in understanding the motivation for opioid misuse in people with concurrent chronic noncancer pain and PTSD

Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain

Background. The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal. Methods. The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal. Results. The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster. Conclusions. These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles...Funding for open access charge: Universidad de Málaga/CBUA. This research was supported by grants from the Spanish Ministry of Science and Innovation (PID2019-106086RB-I00), and the Regional Government of Andalusia (HUM-566; UMA20-FEDERJA-118). Rocío de la Vega's work is supported by the Spanish Ministry of Science and Innovation with a Ramon y Cajal contract (RYC2018-024722-I)

Measuring Pain-Related Behavioural Inhibition and Behavioural Activation System Responses: Further validity evidence for the Pain Responses Scale.

Política de acceso abierto tomada de: https://v2.sherpa.ac.uk/id/publication/8945The Pain Responses Scale and its short form (PRS-SF) were recently developed to assess the affective, behavioural, and cognitive responses to pain based on the Behavioural Inhibition and Behavioural Activation Systems (BIS-BAS) model of chronic pain. The purpose of this study was to provide additional tests of the psychometric properties of the PRS-SF in a new sample of individuals with chronic pain. Sample: 190 adults with chronic non-cancer pain from Spain completed a translated version of the PRS-SF and a battery of questionnaires measuring validity criteria hypothesized the be associated with BIS and BAS activation, including measures of sensitivity to punishment, sensitivity to reward, pain intensity, pain interference, catastrophizing, and pain acceptance. Confirmatory factor analysis supported a 4-factor structure for the PRS-SF assessing despondent, escape, approach, and relaxation responses with marginal internal consistency for one scale (Relaxation) and adequate to good internal consistency for the others. The pattern of associations found support the validity of the instrument. The results provide additional support for the validity of the four PRS-SF scale scores, and the reliability of three of the scales. The PRS-SF may be used to measure BIS and BAS responses to pain to (1) provide further tests of the BIS-BAS model of chronic pain and/or (2) understand the potential mediating effects of BIS and BAS responses on the effects of psychological pain treatments to help determine which specific responses are most responsible for the benefits of treatment, and therefore which responses should be specifically targeted to enhance treatment response.Ministerio de Ciencia e Innovación (Spain, Grant number: PID2019-106086RB-I00) and by the Conserjería de Economía y Conocimiento, Junta de Andalucía (UMA20-FEDERJA-118). In addition, this research was also supported by another grant from the Ministerio de Ciencia e Innovación (Spain, Programa de Formación de Profesorado Universitario, Grant number: FPU20/05484) to GST. RV’s work is supported by the Spanish Ministry of Science and Innovation with a Ramón y Cajal contract (RYC2018-024722-I)