The development and assessment of the Worry About Pain Questionnaire.

BACKGROUND: Worry can be conceptualized as a cognitive-affective automatic process initiated in order to address uncertainty and potential personal inadequacies that could result in negative outcomes. The purpose of the current study was to develop a measure of pain-specific worry - the Worry About Pain Questionnaire (WAPQ). METHOD: In study 1, responses of 335 pain-free participants were used to complete an item analysis and exploratory factors analysis to develop and assess the internal structure of the WAPQ. Study 2 included 224 pain-free participants who completed the WAPQ in order to confirm its factor structure, and to examine its relation to the experience of acute experimental pain. In study 3, 137 individuals with persistent pain were asked to complete the WAPQ as well as measures of pain and depressive symptoms. RESULTS: The resulting 15-item measure assesses uncertainties and potential negative outcomes related to the experience of pain. The results of the exploratory and confirmatory factor analyses showed a two-factor structure. Across all studies, the WAPQ was found to be related to measures of pain in clinical and non-clinical samples, acute experimental pain stimuli, as well as pain anxiety, pain catastrophizing, fear of pain, rumination and depressive symptomatology. CONCLUSIONS: The results suggest that the WAPQ is a reliable and valid measure for the assessment of worry about pain that can be used to understand how pain-specific worries are related to the experience and impact of pain across different populations. SIGNIFICANCE: Worry has been assessed in pain populations using measures that assess worry in general. The current study shows a relationship between pain-specific worry and the experience of pain. Further, worry about pain is related to but not synonymous with pain catastrophizing.

Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review.

STUDY DESIGN: Scoping review. OBJECTIVES: To gain a better understanding of the prevalence, course and association with age of secondary health conditions in individuals with spinal cord injury (SCI). SETTING: Seattle, Washington, USA. METHODS: We performed searches of electronic databases for studies published from 1986-2011 that provided information regarding the prevalence, course or associations with age and duration of secondary health conditions in individuals with SCI. RESULTS: Ninety-two studies were included. The findings indicate that: (1) individuals with SCI experience a number of secondary health conditions, many of which occur at a higher rate in those with SCI than the normative population; (2) the most common conditions or symptoms are pain, bowel and bladder regulation problems, muscle spasms, fatigue, esophageal symptom and osteoporosis; (3) a number of conditions, including cardiovascular disease, diabetes, bone mineral density loss, fatigue and respiratory complications or infections, occur with higher frequency in older individuals or those with longer SCI duration, relative to younger individuals or those with shorter SCI duration; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in individuals aging with SCI. CONCLUSIONS: The findings support the conclusion that individuals with SCI show signs of 'premature aging' in different organ systems. Longitudinal research is needed to understand when problems are most likely to emerge, and to develop and test the efficacy of interventions to prevent these health conditions and their negative impact.

Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches.

STUDY DESIGN: Literature review. OBJECTIVES: Utilizing individuals with spinal cord injury (SCI) as a representative population for physical disability, this paper: (1) reviews the history of the concept of secondary conditions as it applies to the health of individuals aging with long-term disabilities; (2) proposes a definition of secondary health conditions (SHCs) and a conceptual model for understanding the factors that are related to SHCs as individuals age with a disability; and (3) discusses the implications of the model for the assessment of SHCs and for developing interventions that minimize their frequency, severity and negative effects on the quality of life of individuals aging with SCI and other disabilities. METHODS: Key findings from research articles, reviews and book chapters addressing the concept of SHCs in individuals with SCI and other disabilities were summarized to inform the development of a conceptual approach for measuring SCI-related SHCs. CONCLUSIONS: Terms used to describe health conditions secondary to SCI and other physical disabilities are used inconsistently throughout the literature. This inconsistency represents a barrier to improvement, measurement and for the development of effective interventions to reduce or prevent these health conditions and mitigate their effects on participation and quality of life. A working definition of the term SHCs is proposed for use in research with individuals aging with SCI, with the goal of facilitating stronger evidence and increased knowledge upon which policy and practice can improve the health and well-being of individuals aging with a disability.