ABSTRACT
Background: In Canada, one out of five people lives with chronic pain, a condition frequently co-occurring with other chronic illnesses. As with most chronic illnesses, successful engagement in symptom management is key. In the context of multiple illnesses, self-management involves daily prioritization of symptoms and conditions and decision-making, which can be challenging. Self-management of chronic illnesses can require more complex competence and tasks to address the different implications of each condition. Objective: Our research objective was to explore types and processes of self-management symptom prioritization among adults living with chronic pain and other chronic illnesses. Design: This research was carried out as part of a larger study that adopted an explanatory sequential mixed-methods design. This study focused more specifically on the qualitative part of the study. Settings: Participants recruited for the qualitative component took part in a semi-structured individual interview online or in-person at the center hospitalier de l'Université de Montréal. Participants: In total, 25 participants were interviewed, including 18 women and 7 men. Methods: To participate in the qualitative part of the study, participants were selected from the larger study and were eligible if they were 18 years old or older and experiencing pain for more than 3 months and had at least one other chronic illness for which they were receiving treatment or engaged in symptom management. Semi-structured interviews were conducted in-person or virtually and were transcribed verbatim. Reflexive thematic analysis was used to explore patients' narratives, and an open and iterative approach was adopted to code interviews and generate themes. Findings: The first theme, focus on symptom prioritization, showed different prioritization processes, including prioritizing a dominant illness, prioritizing multiple illnesses to avoid undesirable consequences, and finally absence of or automatic processes of prioritization. In the second theme, we identified several characteristics of an illness, in this case chronic pain that made it a self-management priority: uncontrollable and disabling nature, omnipresence, unpredictability, unpleasantness, and invisibility to others. In the last theme, we highlighted that some psychosocial factors influenced levels of engagement in self-management and prioritization processes, including social support and the patient-physician relationship. Conclusions: Chronic pain was the medical condition most often prioritized by participants in their self-management tasks. Because of its characteristics, it was the medical condition that had the most negative impact on day-to-day functioning.
ABSTRACT
Background: Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims: The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods: This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results: Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46-0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion: These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain.
Contexte: La douleur chronique a des répercussions importantes sur le fonctionnement physique et psychologique des personnes atteintes. Il est maintenant reconnu que la thérapie d'acceptation et d'engagement (ACT) est une intervention efficace pour la prise en charge de la douleur chronique; cependant, plusieurs barrières limitent son accessibilité.Objectifs: La présente étude avait pour but d'évaluer l'efficacité d'une intervention psychologique autoadministrée de huit semaines sous forme de bibliothérapie avec contact thérapeutique minimal, basée sur l'ACT dans la gestion de la douleur chronique.Méthodes: Cet essai contrôlé et randomisé comprenait trois temps de mesure (prétest, posttest et trois mois suivant l'intervention) (Code d'identification ClinicalTrials.gov :NCT03924687). Un total de 140 adultes souffrant de douleur chronique a été assigné aléatoirement dans une condition ACT de type self-help (bibliothérapie) et une condition liste d'attente.Résultats: Un modèle d'analyse de variance (ANOVA) à deux facteurs à mesures répétées a démontré des différences statistiquement significatives entre le prétest et le posttest sur l'incapacité liée à la douleur (variable principale), la dépression (variable secondaire), l'acceptation et l'inflexibilité psychologique associées à la douleur (d = 0,46 à 0,88) en faveur de la condition ACT de type self-help. Au suivi de trois mois, ces différences se sont maintenues et près de 54 % des participants ont rapporté une amélioration globale de leur santé physique et mentale.Conclusion: Ces résultats suggèrent qu'une intervention psychologique autoadministrée par le biais d'une bibliothérapie de type ACT, avec soutien thérapeutique minimal, peut améliorer le fonctionnement physique et émotionnel des adultes souffrant de douleur chronique en provenance de la communauté.
ABSTRACT
OBJECTIVE: Perceived injustice has been defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame, and a sense of unfairness. Recent findings suggest that perceived injustice is an important risk factor for elevated disability associated with chronic pain. However, the mechanisms by which this perception leads to disability are not well understood. Therefore, the current study aimed to examine the mediating role of pain acceptance on the relation between perceived injustice and chronic pain outcomes (pain intensity, pain-related disability, and psychological distress). METHOD: This cross-sectional study used a sample of 475 individuals from the community who report chronic pain. Participants completed the Injustice Experience Questionnaire, the Chronic Pain Acceptance Questionnaire, a pain rating intensity scale, the Modified Brief Pain Inventory, and the Hospital Anxiety and Depression Scale. RESULTS: Results revealed significant direct links from perceived injustice to pain intensity (c'=0.416, P<0.001), disability (c'=0.891, P<0.001), and distress (c'=0.261, P<0.001), as well as indirect links from perceived injustice through acceptance of pain to pain disability (ab=0.512, P<0.001, confidence interval, 0.390-0.635) and psychological distress (ab=0.106, P<0.001, confidence interval, 0.077-0.136). DISCUSSION: Clinical and theoretical implications are discussed along with future research directions.
