The journal of pain : official journal of the American Pain Society
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More than a third of breast cancer patients undergoing aromatase inhibitor (AI) treatment report joint pain. We conducted a longitudinal study to characterize the course of AI-induced joint pain and other symptoms and to identify potential predictors for developing these symptoms. Patients were recruited before AI initiation. The Brief Pain Inventory, M. D. Anderson Symptom Inventory, and a joint-pain questionnaire were administered at baseline and then biweekly for 1 year. Analysis included logistic regression, Cox models, and mixed-effects models. Of 47 patients assessed, 16 (34%) reported joint pain at least once. Median time to first report of joint pain was 7 weeks (range, 1-38). Baseline pain was the only predictor for both incidence of joint pain and time to first event. In the first 6 weeks, emergence of joint pain was associated with increase in general pain, fatigue, disturbed sleep, hot flashes, vaginal dryness, and decreased sexual activity. After week 6, having joint pain was associated with increase in general pain and with persistently high fatigue. Having AI-associated joint pain correlated with increase in or persistence of other symptoms likely related to AI therapy. Further research is needed to validate predictors of AI-associated symptoms. ⋯ We demonstrate for the first time that AI-induced joint pain associates with development of other symptoms and that pretreatment pain level is a potential, measurable predictor of symptom development during treatment. Because baseline pain is easily assessed with a brief questionnaire, it can be applied clinically with minimal patient burden.
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The way in which individuals attend to pain-related stimuli is thought to affect their pain experience. Early and late stages of processing, with shifts from attentional engagement to disengagement (avoidance), have been identified, but rarely investigated in the same protocol. Therefore, the present study aimed to consider 2 time frames that might be indicative of attentional engagement and disengagement. One hundred pain-free individuals performed a modified dot-probe task with pictorial stimuli displaying affective facial expressions (ie, pain, anger, joy, neutral face), presented either for 100 ms or for 500 ms. Because fear of pain has been found to moderate attentional processing of pain stimuli, the Fear of Pain Questionnaire (FPQ III) was also administered. Results indicated both early attentional engagement and later disengagement (avoidance) for negative facial expressions (anger, pain). This pattern was most prominent for pain faces and among those participants high in pain-related fear. Taken together, these findings provide evidence that the dot-probe task is suitable to investigate different stages of attentional processing for pain-related stimuli. In accordance with the vigilance-avoidance hypothesis, pain-related stimuli seem to attract attention quickly, but attentional avoidance may occur shortly after. ⋯ We focused on different stages of attentional processing of pain faces in pain-free individuals. Results highlight the importance of distinguishing between early (engagement) and later (disengagement) components of attention, as well as considering the role that fear of pain has in understanding the nature of these effects.
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The verbal numerical rating scale (vNRS-11) is one of the most widely used scales for assessing pediatric pain intensity. The literature shows that it is a valid instrument for assessing pain intensity in children above 8 years of age. The aim of this work was to study whether the vNRS-11 is also a valid instrument when it is used with Catalan-speaking children between 6 and 8 years old. A total of 126 schoolchildren (mean age, 6.87; SD, .68) were interviewed individually. Participants reported the maximum intensity of the most frequent pain they had experienced in the previous 3 months, and the intensity they would experience in 3 circumstances, using the vNRS-11 and other widely used scales: the Faces Pain Scale-Revised (FPS-R), the mechanical visual analog scale (VAS), and the colored analog scale (CAS). They rated their affective state in relation to the pain experience and reported their pain-related disability. Participants also indicated which of the 4 scales they preferred. The vNRS-11 showed a high convergent construct validity (r = .73-.86), adequate discriminant validity (z = 2.05-5.55), and adequate criterion-related validity (r = .45-.70). The vNRS-11 was the second most preferred scale. ⋯ This study contributes to the increasing literature that supports the use of the vNRS-11 to assess pain intensity in children. Specifically, it shows that it can be used in children as young as 6 years of age.
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An 8-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8) has recently been proposed and validated. The aims of this study were to further investigate the reliability and validity of the CPAQ-8 in a new sample. Questionnaires were completed by 550 people with chronic pain (478 online survey, 72 paper survey). A demographic and pain history questionnaire was administered along with the CPAQ-8 and measures of pain self-efficacy, pain catastrophizing, psychological flexibility in pain, anxiety, and mood. In addition, 105 respondents completed the CPAQ-8 within 6 weeks to provide test-retest reliability data. The 2-factor structure of the CPAQ-8 (Activity Engagement [AE] and Pain Willingness [PW]) was confirmed and had reasonable-to-good scale score reliability and test-retest reliability. Pain acceptance as measured by the CPAQ-8 was associated with less depression, anxiety, pain interference, fear of reinjury, pain catastrophizing, and psychological inflexibility in pain, and higher levels of satisfaction with life, pain self-efficacy, and general acceptance. Furthermore, pain acceptance fully mediated the relationship between reported pain severity and emotional distress (anxiety and depression) and partially mediated the relationship between pain severity and pain interference in a structural equation model. The test-retest reliability after 4 to 6 weeks ranged from .68 for PW to .86 for AE; the overall score correlation was .81. We conclude that the CPAQ-8 is a reliable and valid measure of pain acceptance and that the 2 subscales of the measure each make an individual contribution to the prediction of adjustment in people with chronic pain. ⋯ The present study provides further evidence for the reliability and validity of the CPAQ-8. Support was found for the 2 related subscales, PW and AE, which appear to work in synergy to influence levels of pain interference and emotional distress in people living with chronic pain.
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Little is known about treatment mechanisms underlying acceptance strategies. Acceptance is a strategy that is expected to increase pain tolerance more than distraction, while distraction should lead to lower pain intensity. The effect of cognitive restructuring on experimental pain has not yet been investigated. The present study aimed to explore differential short-term effects of acceptance, distraction, and cognitive restructuring on pain tolerance and intensity. Pain was induced in a sample of 109 female students using a thermode. We conducted analyses of covariance with instruction as the independent variable and posttest scores on pain variables as dependent variables, covarying for pretest scores. In addition, adherence to instructions and credibility of instructions were included as covariates. Acceptance led to a higher increase in pain tolerance than did cognitive restructuring of pain-related thoughts. No differences were detected between either acceptance and distraction or distraction and cognitive restructuring with respect to pain tolerance. Distraction led to lower pain intensity compared to acceptance. Cognitive restructuring did not differ from either acceptance or distraction with respect to pain intensity. As a short-term strategy, cognitive restructuring was not as useful as acceptance in increasing pain tolerance. Further studies should evaluate the preconditions under which different strategies are most effective. ⋯ This study demonstrated that acceptance was superior to cognitive restructuring in increasing tolerance for experimentally induced pain, but was inferior to distraction with respect to decreasing pain intensity. Knowledge about the types of strategies that are useful in targeting diverse pain-related outcome measures is important for efforts to refine the treatment of chronic pain.