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. SIGNIFICANCE: The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain.

PURPOSE: This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. METHOD: Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability. RESULTS: A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability. CONCLUSION: Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models.

BACKGROUND: The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models. METHODS: Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale. RESULTS: Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance. CONCLUSIONS: This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.

Empirical evidence of the validity of the Spanish version of the pain vigilance awareness questionnaire.

BACKGROUND: The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated. PURPOSE: The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity. METHOD: A sample of 468 chronic back pain patients completed a battery of instruments to assess fear-avoidance beliefs, pain anxiety, pain catastrophizing, pain vigilance and awareness, pain acceptance, depression, anxiety, disability, and pain intensity. RESULTS: Confirmatory factor analysis supported the validity of a nine-item version with two subscales: Active Vigilance and Passive Awareness. Both subscales and the total score were positively and significantly correlated with other fear-related constructs: fear-avoidance beliefs, pain anxiety, and pain catastrophizing. Regression analyses showed that Active Vigilance and the two subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with higher anxiety and that the Acceptance Activity Engagement subscale was significantly associated with lower anxiety. The Fear-Avoidance Beliefs Questionnaire-Physical subscale was associated with higher disability and the Acceptance Pain Willingness subscale was associated with lower disability. The Fear-Avoidance Beliefs Questionnaire-Work subscale was significantly associated with higher pain intensity and depression; the Acceptance Activity Engagement and Pain Willingness subscales were significantly associated with lower pain intensity and depression. CONCLUSION: The Spanish version of the Pain Vigilance and Awareness Questionnaire is a reliable and valid instrument. Pain Acceptance and Fear Avoidance beliefs are better predictors of adjustment to pain than pain hypervigilance.

Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain.

Anxiety sensitivity has been included in the fear-avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect-related regulatory process that involves unwillingness to endure private experiences. The role of these constructs as vulnerability variables has not been investigated in chronic pain patients. The aim of this study was to investigate the role of anxiety sensitivity and experiential avoidance as dispositional variables in pain fear-avoidance. Two alternative hypothetical models were tested: one in which anxiety sensitivity and experiential avoidance would be independently associated with pain fear-avoidance; and second, one in which experiential avoidance would mediate the relationship between anxiety sensitivity and pain fear-avoidance. The sample was composed of 299 patients with chronic back pain. The postulated relationships were tested using LISREL 8.20 software (Scientific Software International, Chicago, IL, USA) and the generally weighted least squares. The structural equation modelling analyses showed that experiential avoidance and anxiety sensitivity were independently associated with pain fear-avoidance and that anxiety sensitivity had a stronger association with pain fear-avoidance than experiential avoidance. The alternative model, in which experiential avoidance mediates the relationship between anxiety sensitivity and pain fear-avoidance, gave a much worse fit. These results highlight the importance of both anxiety sensitivity and experiential avoidance as variables which could explain individual differences in pain fear-avoidance. Thus, in terms of prevention, it should be a priority to identify patients with increased anxiety sensitivity and experiential avoidance during the first stages of the development of chronic pain conditions.

Diferencias en la percepción del dolor relacionadas con las variables sexo y edad / Differences in the perception of pain related to sex and age variables

Numerosos estudios indican que las características personales pueden actuar como variables diferenciales en la vivencia de la experiencia de dolor. Objetivo: En este sentido, el objetivo del presente estudio es analizar las diferencias entre sujetos en la percepción de dolor en función de las variables edad y sexo. Material y método: Para ello, contamos con una muestra compuesta por 165 hombres y 165 mujeres con dolor crónico, de edades comprendidas entre los 15 y los 92 años. El instrumento de evaluación utilizado para medir el dolor es el Cuestionario McGill de Dolor (1) adaptado al español por Lázaro, Bosch, Torfubia y Baños (2). Las hipótesis establecen relaciones positivas entre la edad y las diferentes dimensiones del dolor: dimensión sensorial, afectiva y evaluativa. De igual forma se espera encontrar diferencias significativas en dichas dimensiones en función del sexo, obteniendo las mujeres puntuaciones medias más altas que los hombres. Se aplicó MANOVA para analizar las diferencias entre los diferentes grupos de edad y sexo en las dimensiones de dolor. Resultados y conclusiones: Los resultados muestran que las mujeres presentan medias superiores a los hombres en las tres dimensiones, así como en la puntuación total. Por otro lado, sólo se encuentran diferencias en las dimensiones afectiva y sensorial en función de la edad. Los pacientes con mayor edad (mayores de 65 años) obtienen puntuaciones medias significativamente más elevadas en la dimensión afectiva, mientras que en la dimensión sensorial las puntuaciones más altas las obtienen los sujetos de menor edad (AU)

Alteraciones de la memoria en pacientes con dolor crónico / Memory disorders in patients with chronic pain

Es muy frecuente que los pacientes con dolor crónico p resenten problemas de memoria y concentración. A pesar de ello, la investigación empírica al respecto es muy escasa y concretamente, en lengua castellana no existe ninguna publicación al respecto. El presente trabajo revisa sistemáticamente los estudios realizados hasta el momento agrupándolos en torno a las principales hipótesis que se han formulado para explicar el fenómeno: a) las alteraciones de memoria como efecto secundario de la medicación dirigida al control del dolor y de otra medicación coadyuvante; b) las alteraciones de memoria como un síntoma más del estado depresivo que es frecuente en los pacientes con dolor crónico; c) los problemas de memoria como parte de problemas generales de procesamiento de la información y, d) los problemas de memoria como consecuencia de alteraciones en el mecanismo atencional. La evidencia disponible indica que los déficits de memoria interfieren en el normal funcionamiento de los pacientes con dolor crónico y que son una fuente importante de malestar. De la revisión de estos estudios se concluye que las alteraciones de memoria parece que se asocian a un cambio general en el modo de procesamiento de la información que se deriva de la condición de padecer dolor de forma crónica. Aunque todavía los resultados de la investigación no sean absolutamente concluyentes, no parece que la medicación contra el dolor, ni las alteraciones en el estado de ánimo den cuenta de los déficits de memoria. Los sesgos atencionales presentes en los pacientes con dolor crónico sí parecen ser más bien una consecuencia de alteraciones en el estado de ánimo que del dolor mismo, concretamente los pensamientos catastróficos parecen jugar un papel importante.Finalmente, se destaca la necesidad de que los programas de intervención psicológica incorporen medidas terapéuticas dirigidas a influir sobre las alteraciones de memoria en los pacientes con dolor crónico y se presentan las líneas generales de un entrenamiento que está siendo aplicado actualmente de forma piloto en pacientes con dolor crónico (AU)