VULNERABILITY FACTORS, ADJUSTMENT, AND OPIOID MISUSE IN CHRONIC NON-CANCER PAIN INDIVIDUALS.

There are several person variables that pre-date injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of two diathesis variables (impulsiveness and anxiety sensitivity) in the adjustment of individuals with chronic noncancer pain and in the opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modelling analyses. The results show a significant association between impulsiveness and anxiety sensitivity and all the maladjustment variables, and between impulsiveness and anxiety sensitivity and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the SEM analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and anxiety sensitivity are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including anxiety sensitivity and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and to opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.

ANF therapy® for pain management, feasibility, satisfaction, perceived symptom reduction and side effects: a real-world multisite observational study.

[Purpose] Non-invasive and drug-free interventions for pain are being developed. One of them is ANF (which stands for "Amino Neuro Frequency") Therapy®, which consists in the application of carbonized metal devices on a patient's skin. We aimed to: 1) test perceived changes in pain intensity after ANF application, 2) record frequency and severity of side effects, 3) assess clinician and patient satisfaction, 4) explore effects on swelling and range of motion (ROM). [Participants and Methods] In this real-world multisite observational study, N=113 physical therapists in 45 countries, applied ANF to N=1,054 patients (Mage=45.2, 56.2% female) with pain complaints. Demographic data, pain intensity (NRS-11), effects of ANF on swelling and ROM, clinician and patient satisfaction and side effects were collected. [Results] Main pain locations were: low back (14.9%), knee (12.4%), neck (10%), and shoulder (9.6%). Pre-treatment pain intensity was high (Mean=7.6, SD=1.9). It significantly decreased post-treatment (Mean=3.1, SD=2.0), t(1053)=7.25, with a large effect size (Cohen's d=2.2). Swelling decreased and ROM increased. Average satisfaction with ANF was 92/100. Patients often experienced mild side effects (42.3%): dry mouth, headache and fatigue. [Conclusion] Results show large effect sizes, high satisfaction, and mild and short-term side effects. This is very promising but should be interpreted with caution considering the study limitations.

Protocol for a multi-phase, multi-center, real-world, hybrid effectiveness-implementation study of a digital intervention for pediatric chronic pain co-designed with patients (Digital SPA).

Background: Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain. Methods: (Phase 1) Focus groups with patients, parents, and clinicians (n = 5-6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness-implementation trial. Participants (n = 195) will be adolescents aged 12-17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation. Discussion: This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation. Trial registration number TRN and date of registration: ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful.In this study, we expect that assessing users' needs and co-designing an intervention with them will improve adherence.Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts.This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care.

Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain?

OBJECTIVE: 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 intciolerance 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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pain Interference, Resilience, and Perceived Well-Being During COVID-19: Differences Between Women With and Without Trauma Exposure Prior to the Pandemic.

Objectives: The aim of this study was to investigate the consequences of the COVID-19 pandemic in women with non-malignant chronic pain, and to determine whether women exposed to traumatic situations prior to the outbreak would be at a higher risk of negative health impacts. Methods: A total of 365 women were divided into three subgroups according to whether or not they had experienced a traumatic event prior to COVID-19. They completed an online survey. Results: Significant differences were found between groups during lockdown: 1) more psychological abuse was experienced by the group of women who had experienced an interpersonal traumatic event prior to the pandemic than in the other subgroups; 2) physical activity levels were higher and scores on pain interference were lower in women in the non-traumatized subgroup than in the other subgroups; 3) pain interference was predicted by pain intensity, decreased social support, and resilience, whereas perceived well-being was predicted by pain interference. Conclusion: Women who had experienced a traumatic event prior to the pandemic suffered worse consequences of the COVID-19 lockdown, particularly greater pain interference, although resilience was shown to both mitigate pain interference and enhance perceived well-being.

Diagnostic and Predictive Capacity of the Spanish Versions of the Opioid Risk Tool and the Screener and Opioid Assessment for Patients with Pain-Revised: A Preliminary Investigation in a Sample of People with Noncancer Chronic Pain.

INTRODUCTION: Accurate assessment of the risk of opioid abuse and misuse in people with noncancer chronic pain is crucial for their prevention. This study aimed to provide preliminary evidence of the diagnostic and predictive capacity of the Spanish versions of the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). METHODS: We used the Current Opioid Misuse Measure (COMM) as criterion measure to assess the capacity of each tool to identify patients misusing opioids at the time of the assessment. Eighteen months later, we used the COMM and the Drug Abuse Screening Test-10 (DAST-10) to assess their predictive capacity. In total, 147 people with noncancer chronic pain participated in the diagnostic study, and 42 in the predictive study. RESULTS: Receiver operating curve analysis showed that the SOAPP-R had an excellent capacity to identify participants who were misusing opioids at the time of assessment (area under the curve [AUC] = 0.827). The diagnostic capacity of the ORT was close to acceptable (AUC = 0.649-0.669), whereas its predictive capacity was poor (AUC = 0.522-0.554). The predictive capacity of the SOAPP-R was close to acceptable regarding misuse (AUC = 0.672) and poor regarding abuse (AUC = 0.423). CONCLUSION: In the setting of Spanish-speaking communities, clinicians should be cautious when using these instruments to make decisions on opioid administration. Further research is needed on the diagnostic and predictive capacity of the Spanish versions of both instruments.

Intolerance of Uncertainty Moderates the Relationship between Catastrophizing, Anxiety, and Perceived Pain in People with Chronic Nononcological Pain.

OBJECTIVE: Substantial empirical evidence has shown that intolerance of uncertainty is a central transdiagnostic feature in psychopathology and it has been suggested to be a pain-related psychological factor contributing to the experience of chronic pain. However, research in this area is virtually nonexistent. The objective of this study was to investigate associations between pain severity, catastrophizing, and anxiety in people with chronic nononcological pain, while assuming that intolerance of uncertainty moderates these relationships. METHODS: A convenience sample of 188 individuals with nononcological chronic pain (157 women and 32 men) participated in the study. We investigated the moderated mediation of intolerance of uncertainty between anxiety and catastrophizing and between catastrophizing and pain intensity. RESULTS: The full moderated mediation model accounted for significant variance in pain intensity (R2 = 0.148, P< .001). Intolerance of uncertainty significantly moderated the interaction between anxiety and catastrophizing (B = 0.039, SE = 0.012, 95% CI [0.015, 0.063]) and between catastrophizing and pain intensity (B = -0.034, SE = 0.010, 95% CI [-0.054, -0.014]). Anxiety and intolerance of uncertainty did not interact in predicting catastrophizing, although an interaction effect was found between intolerance of uncertainty and catastrophizing in predicting pain intensity. CONCLUSION: This study is the first to address the interrelationship of intolerance of uncertainty, catastrophizing, and anxiety in relation to perceived pain intensity. The current findings support intolerance of uncertainty as a relevant psychological variable that is distinct from other relevant constructs in the setting of pain research and treatment.

Psychometric Properties of the Spanish Version of the Pain Anxiety Symptoms Scale-20 (PASS-20-SV).

BACKGROUND: The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations. METHODS: Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23 men). The dimensionality of the PASS-20-SV items was evaluated using Exploratory Factor Analysis and an optimal implementation of Parallel Analysis (robust maximum likelihood). Data from sample 1 was used to analyse internal consistency and convergent validity. Estimated test-retest stability and predictive validity were based on data from the sample 2 participants, who completed the first administration (T1) and a second administration (T2, 6 months later). RESULTS: The PASS-20-SV comprises two factors: pain-related anxiety and apprehension, and pain-related fear and avoidance. It has good to excellent reliability and adequate test-retest stability. The results support its convergent and predictive validity. CONCLUSIONS: The Spanish Version of the PASS-20 is a valid, reliable measure of pain-related anxiety and pain-related fear in Spanish-speaking patients.

The relevance of psychological strength for physical and psychological well-being in trauma-exposed women.

Traumatic experiences have consistently been linked to poor health and well-being, particularly in women. Psychological factors have been theorized to directly affect the reporting of physical symptoms and perceptions of general health. Posttraumatic stress disorder (PTSD) has been proposed as a major pathway through which trauma affects health and emotion dysregulation. Trauma is considered to be a key psychological variable in the pathogenesis of PTSD. Fortunately, not all women who have experienced trauma manifest adverse effects. Resilience acts as a psychological protective variable following trauma. The present study tested a hypothetical model of the contribution of resilience, emotional dysregulation, and PTSD symptoms to physical and psychological well-being in a large sample of trauma-exposed women. A transversal study with 753 female participants is used. Structural modeling was used to test linear associations between variables. After experiencing trauma, resilience was negatively and significantly associated with emotional dysregulation, which, in turn, was positively associated with PTSD symptoms. Both resilience and PTSD symptoms were associated with physical and psychological well-being. The results suggest that resilience and emotional dysregulation are relevant to the health and well-being of women with PTSD symptoms and may help guide the development of psychological treatment in this group. Therefore, these findings may be relevant in promoting health and well-being in such women, and may help to identify individuals who would receive the most benefit from interventions addressing emotional regulation and psychological resilience.

The Relationship Between Experiential Avoidance and Posttraumatic Stress Symptoms: A Moderated Mediation Model Involving Dissociation, Guilt, and Gender.

Experiential avoidance, dissociation, and guilt have been shown to be associated with trauma exposure and to play an important role in explaining the development and maintenance of posttraumatic stress symptoms. However, there is a lack of studies that simultaneously address the relationship between these variables, which has never been studied within the framework of emotional processing theory. Furthermore, gender differences in traumatic victimization, posttraumatic stress symptoms, experiential avoidance, dissociation, and guilt have also been reported. Therefore, this study had a double aim: a) to assess the mediating roles of dissociation and guilt in the relationship between experiential avoidance and posttraumatic stress symptoms; and b) to investigate whether gender moderates any such relationship. The final sample comprised 683 undergraduate students (150 men and 533 women) with a history of exposure to traumatic events and with posttraumatic stress symptoms. Mediation and moderated mediation analyses were conducted. Dissociation and guilt independently mediated the association between experiential avoidance and posttraumatic stress symptoms: however, this mediation effect was not moderated by gender. The findings suggest that interventions aimed at controlling psychological variables linked to PTSD (i.e. experiential avoidance, dissociation, and guilt) may be of help to both men and women.

Chronic pain in the time of COVID-19: Stress aftermath and central sensitization.

OBJECTIVES: The COVID-19 crisis is a significant stressor worldwide. The physical and emotional condition of individuals with pain sensitization syndromes who are experiencing the pandemic may worsen. This study investigated the contribution of life changes due to the coronavirus to emotional distress in individuals with a diagnosis of chronic central sensitization pain and tested whether the associations between level of pain and sensitization were independent of or mediated by emotional distress. METHODS: Spanish individuals with chronic pain (N = 362) completed an online survey on direct or indirect exposure to the consequences of COVID-19, pain intensity, and emotional distress. They also completed central sensitization questionnaires. RESULTS: An association was found between changes in daily routines and pain intensity, emotional distress, and sensitization scores. Correlations were found between emotional distress, sensitization, and pain intensity. Significant predictors of emotional distress were age, difficulty in receiving medical care, changes in daily routines, and diminished social support. Emotional distress did not mediate the association between sensitization and pain intensity. CONCLUSION: Due to the COVID-19 situation, individuals with central sensitization pain syndromes may be at higher risk of developing psychological distress. Interdisciplinary interventions involving psychologists are urgently needed to provide this population with appropriate health care.

Psychometric Properties of the Spanish Version of the Pain Anxiety Symptoms Scale-20 (PASS-20-SV) / Propiedades Psicométricas de la Versión Española de la Pain Anxiety Symptoms Scale-20 (PASS-20-SV)

Background: The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations. Methods: Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23 men). The dimensionality of the PASS-20-SV items was evaluated using Exploratory Factor Analysis and an optimal implementation of Parallel Analysis (robust maximum likelihood). Data from sample 1 was used to analyse internal consistency and convergent validity. Estimated test-retest stability and predictive validity were based on data from the sample 2 participants, who completed the first administration (T1) and a second administration (T2, 6 months later). Results: The PASS-20-SV comprises two factors: pain-related anxiety and apprehension, and pain-related fear and avoidance. It has good to excellent reliability and adequate test-retest stability. The results support its convergent and predictive validity. Conclusions: The Spanish Version of the PASS-20 is a valid, reliable measure of pain-related anxiety and pain-related fear in Spanish-speaking patients. (AU)

Antecedentes: el PASS-20 es una medida general de la ansiedad y el miedo relacionados con el dolor. El objetivo del presente estudio fue adaptar el cuestionario para su uso en población española. Método: la muestra 1 incluyó 216 personas con dolor crónico de espalda (114 mujeres y 102 hombres); la muestra 2 comprendió 85 personas con dolor agudo de espalda (62 mujeres y 23 hombres). La estructura factorial del PASS-20-SV se evaluó mediante un análisis factorial exploratorio y un análisis paralelo (máxima verosimilitud). Los datos de la muestra 1 se utilizaron para analizar la fiabilidad y la validez convergente. La estabilidad estimada de la prueba y la validez predictiva se basaron en los datos de los participantes de la muestra 2, que completaron el instrumento en dos momentos (T1 y T2, 6 meses después). Resultados: la versión española del PASS-20 se compone de dos factores: ansiedad y aprehensión al dolor, y miedo y evitación del dolor, con buena consistencia interna y adecuada estabilidad. Los resultados apoyan la validez convergente y predictiva del instrumento. Conclusiones: la versión española del PASS-20 es una medida válida y fiable para evaluar la ansiedad y el miedo al dolor. (AU)

Psychometric characteristics and factorial structures of the Defensive Pessimism Questionnaire-Spanish Version (DPQ-SV).

The aim of this study was to validate the Spanish version of the Defensive Pessimism Questionnaire. A sample of undergraduate students (N = 539) was measured on defensive pessimism using the Defensive Pessimism Questionnaire (DPQ), optimism and pessimism using the Life Orientation Test (LOT), positive and negative affect using the Positive and Negative Affect Schedule, and anxiety using the trait subscale of the State and Trait Anxiety Inventory. A Spanish version of the DPQ (DPQ-SV) is presented. Exploratory and Robust Confirmatory Factor Analysis had a bi-dimensional structure (Reflectivity and Negative Expectation). Omega coefficient showed a high internal consistency and the temporal stability was high in each dimension. Both DPQ-SV subscales (Negative Expectation and Reflectivity) showed adequate convergence with LOT-optimism and LOT-pessimism. Reflectivity showed adequate criterion validity with trait-anxiety and negative affect, but inadequate criterion validity with positive affect. Negative Expectation showed excellent criterion validity with trait-anxiety and negative affect and good criterion validity with positive affect. Finally, mediation analysis showed that Negative Expectation had a significant indirect mediating effect between trait-anxiety and negative affect. Reflectivity had a significant indirect mediating effect between trait-anxiety and negative and positive affect. Analysis of the psychometric properties of the DPQ-SV subscale scores showed that it is a two factor adequate measurement tool for its use in this type of samples.

Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain.

PURPOSE: The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily functioning, pain-related impairment, and psychological well-being). METHODS: The sample comprised 258 individuals with chronic musculoskeletal pain who completed a series of questionnaires and vignettes. The vignettes presented a short description of a situation in which a person with chronic pain experienced a threat to a valued domain-specific goal and had to choose a possible goal management solution (i.e., goal persistence, flexibility reengagement, and disengagement). Hierarchical regression analyses were used to predict chronic pain adaptation using the selected vignette strategies as predictors. RESULTS: After controlling for age, sex, pain intensity, and the responses to the dispositional goal management scales, persistence, reengagement, and disengagement goal strategies presented in the case scenarios predicted daily functioning (p < .001). Persistence, flexibility, disengagement (p < .001), and reengagement (p < .05) predicted pain-related impairment. Persistence, disengagement (p < .001), and flexibility (p < .05) predicted psychological well-being scores. CONCLUSION: The use of vignettes could be useful to assess goal adjustment because this methodology enables respondents to provide more context-specific responses. The results of this approach could be used to improve clinical practice aimed at helping people with chronic musculoskeletal pain to better cope with this health condition.

Goal Adjustment and Well-Being: The Role of Optimism in Patients with Chronic Pain.

BACKGROUND: Chronic pain directly or indirectly interferes with valued personal goals. Goal adjustment plays a central role in patients' adaptation. Studies on the relationship between optimism and goal regulation have shown that people with high dispositional optimism adjust their goals in a flexible way, and that flexible goal adjustment promotes quality of life. PURPOSE: The aim of this study was to analyze the relationship among optimism, goal adjustment, and adaptation in patients with chronic pain. METHODS: A sample of 258 patients with chronic musculoskeletal pain completed questionnaires on optimism, reengagement, disengagement, flexibility, tenacity, rumination, purpose in life, well-being, pain intensity, daily functioning, and impairment. RESULTS: Structural equation modeling analysis showed that optimism had a positive association with reengagement, flexibility, and tenacity, and a negative association with disengagement. Disengagement was positively associated with rumination, whereas reengagement, flexibility, and tenacity were associated with higher levels of purpose in life, which were strongly associated with adaptation in patients with chronic pain. CONCLUSIONS: This study supports the conclusions of previous research on the role of goal adjustment as a mediator variable between optimism and well-being.

Pesimismo defensivo, optimismo y adaptación al dolor crónico / Defensive pessimism, optimism and adaptation to chronic pain

El objetivo principal de este estudio fue contrastar empíricamente si el pesimismo defensivo en interacción con la ansiedad rasgo se asociaba con una mejor adaptación al dolor crónico (operacionalizada como mayor bienestar), mejor nivel de funcionamiento cotidiano y menor deterioro en 258 pacientes con dolor crónica musculoesqueletico. Se realizaron tres análisis de regresión jerárquica por pasos. Los resultados mostraron que el pesimismo defensivo en interacción con la ansiedad rasgo presentaba una asociación estadísticamente significativa con el bienestar. Por otra parte, se observó que el optimismo disposiciones se asociaba significativamente con un mejor funcionamiento y mayor bienestar. Se discute el papel fundamental que juega el optimismo disposicional en la adaptación al dolor crónico y se plantea como el pesimismo defensivo y el optimismo podrían convivir en un mismo individuo, entendiendo el pesimismo defensivo como una estrategia cognitiva para enfrentar una tarea concreta y el optimismo disposicional como expectativas positivas generalizadas. Se reflexiona sobre las implicaciones clínicas de estos hallazgo

The main aim of this study was to investigate whether defensive pessimism in interaction with trait anxiety was associated with better adaptation to chronic pain operationalized as greater well-being, a higher level of daily functioning, and less disability. The sample comprised 276 patients with chronic musculoskeletal pain. Three hierarchical stepwise regression analyses were performed. Statistically significant associations were found between defensive pessimism in interaction with trait anxiety and well-being, and between dispositional optimism and better functioning and greater well-being. The central role of dispositional optimism in adaptation to chronic pain is discussed. We speculate that defensive pessimism and optimism could coexist in the same individual, understanding defensive pessimism as a cognitive strategy aimed at managing a specific task, and dispositional optimism as generalized positive expectations. The clinical implications of these findings are discussed

Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain.

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ2/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.

Optimism, Positive and Negative Affect, and Goal Adjustment Strategies: Their Relationship to Activity Patterns in Patients with Chronic Musculoskeletal Pain.

Objective: Activity patterns are the product of pain and of the self-regulation of current goals in the context of pain. The aim of this study was to investigate the association between goal management strategies and activity patterns while taking into account the role of optimism/pessimism and positive/negative affect. Methods: Two hundred and thirty-seven patients with chronic musculoskeletal pain filled out questionnaires on optimism, positive and negative affect, pain intensity, and the activity patterns they employed in dealing with their pain. Questionnaires were also administered to assess their general goal management strategies: goal persistence, flexible goal adjustment, and disengagement and reengagement with goals. Results: Structural equation modelling showed that higher levels of optimism were related to persistence, flexible goal management, and commitment to new goals. These strategies were associated with higher positive affect, persistence in finishing tasks despite pain, and infrequent avoidance behaviour in the presence or anticipation of pain. Conclusions: The strategies used by the patients with chronic musculoskeletal pain to manage their life goals are related to their activity patterns.

Validation of the child ptsd symptom scale (cpss) in spanish adolescents / Validación española de la Child PTSD Symptom Scale (CPSS) en adolescentes

Background: One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. Objective: To provide data on the psychometric properties of the CPSS in a sample of Spanish adolescents, to establish the internal consistency of the measure, and to examine its criterion validity. Method: The participants were 339 adolescents (172 boys and 167 girls, mean age 13.95) exposed to peer violence during the previous year. Results: Confirmatory factor analysis demonstrated a good fit to the four-factor dysphoria model. The alpha reliabilities for the overall measure and its subscales were suitable. Discussion: The Spanish version of the scale has sound psychometric properties with good reliability and validity. Moreover, it integrates the four-factor structure corresponding to the dimensions of PTSD described in the DSM-V (AU)

Antecedentes: la Child PTSD Symptom Scale es uno de los cuestionarios más utilizados para evaluar el estrés postraumático en niños y adolescentes. Sin embargo, es escasa la investigación acerca de la validez de constructo de la versión en español de este instrumento, a pesar de tratarse de uno de los idiomas más hablados en el mundo. Objetivo: validar la versión española de esta escala en una muestra de adolescentes. Método: los participantes fueron 339 adolescentes (172 varones y 167 mujeres, con una media de edad de 13,95 años) que cumplían los criterios de haber sufrido violencia por parte de sus iguales durante el año previo al estudio. Resultados: el análisis confirmatorio mostró un buen ajuste del modelo de cuatro factores de disforia. Los coeficientes de fiabilidad para la medida global y sus subescalas fueron adecuados. Discusión: la versión española la escala presenta buenas propiedades psicométricas y una estructura factorial que se corresponde a los criterios para el trastorno de estrés postraumático del DSM-V (AU)

Validation of the Child PTSD Symptom Scale (CPSS) in Spanish adolescents.

BACKGROUND: One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. OBJECTIVE: To provide data on the psychometric properties of the CPSS in a sample of Spanish adolescents, to establish the internal consistency of the measure, and to examine its criterion validity. METHOD: The participants were 339 adolescents (172 boys and 167 girls, mean age 13.95) exposed to peer violence during the previous year. RESULTS: Confirmatory factor analysis demonstrated a good fit to the four-factor dysphoria model. The alpha reliabilities for the overall measure and its subscales were suitable. DISCUSSION: The Spanish version of the scale has sound psychometric properties with good reliability and validity. Moreover, it integrates the four-factor structure corresponding to the dimensions of PTSD described in the DSM-V.