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Clinical and Health Psychology in Chronic Pain Management

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 24855

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Special Issue Editors

Dr. Albert Feliu-Soler

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Guest Editor

1. Faculty of Psychology, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
2. Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950. Esplugues de Llobregat, Spain.
Interests: chronic pain; fibromyalgia; mindfulness; acceptance; cognitive behavioural therapy; health psychology; biological psychology; randomized controlled trials; clinical effectiveness; cost-utility; psychometrics

Dr. Juan V. Luciano

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Guest Editor

1. Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
2. Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
Interests: effectiveness; cost-effectiveness; cost utility; randomized controlled trials; psychological treatment; biopsychosocial approach; psychometrics; patient-reported outcome measures
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Dr. Adrian Perez-Aranda

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Guest Editor

1. Faculty of Psychology, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
2. Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950. Esplugues de Llobregat, Spain.3. Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain
Interests: fibromyalgia; chronic pain; effectiveness; cost utility; randomized controlled trials; third-wave psychotherapy; mediation analysis

Special Issue Information

Dear Colleagues,

Chronic pain has a high prevalence in the general population worldwide and is associated with severe functional impairment, poor quality of life, and elevated health care and societal costs. It represents a great challenge for health professionals due to the scarcity of treatment options that provide improvements of relevant clinical significance. To date, the effectiveness of pharmacological interventions has been generally limited, and more ubiquitous effects have been found for nonpharmacological treatments such as different cognitive-behavioral approaches. For this Special Issue on “Chronic pain and Health Psychology”, cutting-edge research on the following topics is welcome: the effectiveness, cost-effectiveness, and neurobiological underpinnings of psychological therapies in individuals experiencing chronic pain. Given that multicomponent approaches are common (and even recommended) in chronic pain, Randomized Controlled Trials (RCTs) evaluating psychotherapy as a stand-alone intervention or in the context of multicomponent approaches to chronic pain will be considered. RCTs including mediation analyses for a deeper understanding of the psychobiological mechanisms behind therapeutic effects will be particularly welcome. Furthermore, studies exploring potential moderators/predictors of clinical response are needed in order to change the paradigm from one-size-fits-all to personalized care. For comparability purposes, studies adopting the Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations will also be strongly appreciated. Since the start of the SARS-CoV-2 pandemic, health systems have faced new difficulties in the delivery of interventions (e.g., limited access to standard face-to-face therapies), studies evaluating “pandemic-resistant” approaches for chronic pain (e.g., online interventions) are especially welcome. Although this Special Issue will focus on RCTs, it is also open to high-quality systematic reviews and meta-analyses on the effectiveness, cost-effectiveness, and neurobiological underpinnings of psychotherapies in chronic pain.

Dr. Albert Feliu-Soler
Dr. Juan V. Luciano
Dr. Adrian Perez-Aranda
Guest Editors

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Keywords

effectiveness
chronic pain
Cognitive Behavioral Therapy
psychotherapy
cost-effectiveness
biomarkers
mediation analysis
personalized care

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Published Papers (7 papers)

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Research

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12 pages, 690 KiB

Open AccessArticle

Does Pain Acceptance Contribute to Improved Functionality through Walking in Women with Fibromyalgia? Looking at Depressive Comorbidity

by Cecilia Peñacoba, Carmen Ecija, Lorena Gutiérrez and Patricia Catalá

Int. J. Environ. Res. Public Health 2023, 20(6), 5005; https://doi.org/10.3390/ijerph20065005 - 12 Mar 2023

Cited by 1 | Viewed by 1757

Abstract

In the last decade, research has pointed to physical exercise as an effective treatment in fibromyalgia patients. Some studies have highlighted the role of acceptance and commitment therapy in optimizing the benefits of exercise in patients. However, given the high comorbidity in fibromyalgia, it is necessary to value its possible influence on the effect of certain variables, such as acceptance, on the benefits of treatments, such as physical exercise. Our aim is to test the role of acceptance in the benefits of walking over functional limitation, further assessing whether this model is equally valid, considering depressive symptomatology as an additional differential diagnosis. A cross-sectional study with a convenience sample through contacting Spanish fibromyalgia associations was carried out. A total of 231 women with fibromyalgia (mean age 56.91 years) participated in the study. Data were analyzed with the Process program (Model 4, Model 58, Model 7). The results highlight the role of acceptance as a mediator between walking and functional limitation (B = −1.86, SE = 0.93, 95% CI = [−3.83, −0.15]). This model, when depression is incorporated as a moderator, is significant only in patients without depression, revealing the need for personalized treatments in fibromyalgia, considering their most prevalent comorbidity. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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13 pages, 1060 KiB

Open AccessArticle

Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study

by Marina Lopez-Ruiz, Andrea Doreste Soler, Jesus Pujol, Josep-Maria Losilla, Fabiola Ojeda, Laura Blanco-Hinojo, Gerard Martínez-Vilavella, Teresa Gutiérrez-Rosado, Jordi Monfort and Joan Deus

Int. J. Environ. Res. Public Health 2023, 20(4), 2935; https://doi.org/10.3390/ijerph20042935 - 8 Feb 2023

Cited by 4 | Viewed by 2135

Abstract

Background: Personality traits are relevant for pain perception in persistent pain disorders, although they have not been studied in depth in sensitized and nonsensitized patients with knee osteoarthritis (OA). Objective: To explain and compare the personality profile of patients with OA, with and without central sensitization (CS), and fibromyalgia (FM). Setting: Participants were selected at the Rheumatology Department in two major hospitals in Spain. Participants: Case-control study where the sample consists of 15 patients with OA and CS (OA-CS), 31 OA without CS (OA-noCS), 47 FM, and 22 controls. We used a rigorous and systematic process that ensured the sample strictly fulfilled all the inclusion/exclusion criteria, so the sample is very well delimited. Primary outcome measures: Personality was assessed by the Temperament and Character Inventory of Cloninger. Results: The percentile in harm-avoidance dimension for the FM group is higher compared to OA groups and controls. The most frequent temperamental profiles in patients are cautious, methodical, and explosive. Patients with FM are more likely to report larger scores in harm-avoidance, with an increase in logistic regression adjusted odds ratio (OR_adj) between 4.2% and 70.2%. Conclusions: Harm-avoidance seems to be the most important dimension in personality patients with chronic pain, as previously found. We found no differences between OA groups and between sensitized groups, but there are differences between FM and OA-noCS, so harm-avoidance might be the key to describe personality in patients with CS rather than the presence of prolonged pain, as found in the literature before. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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16 pages, 643 KiB

Open AccessArticle

Efficacy of the FIBROWALK Multicomponent Program Moved to a Virtual Setting for Patients with Fibromyalgia during the COVID-19 Pandemic: A Proof-of-Concept RCT Performed Alongside the State of Alarm in Spain

by Mayte Serrat, Mireia Coll-Omaña, Klara Albajes, Sílvia Solé, Miriam Almirall, Juan V. Luciano and Albert Feliu-Soler

Int. J. Environ. Res. Public Health 2021, 18(19), 10300; https://doi.org/10.3390/ijerph181910300 - 30 Sep 2021

Cited by 19 | Viewed by 5325

Abstract

FIBROWALK is a multicomponent program including pain neuroscience education, therapeutic exercise, cognitive behavioral therapy and mindfulness training that has recently been found to be effective in patients with fibromyalgia (FM). This RCT started before the COVID-19 pandemic and was moved to a virtual format (i.e., online videos) when the lockdown was declared in Spain. This study is aimed to evaluate the efficacy of a virtual FIBROWALK compared to Treatment-As-Usual (TAU) in patients with FM during the first state of alarm in Spain. A total of 151 patients with FM were randomized into two study arms: FIBROWALK plus TAU vs. TAU alone. The primary outcome was functional impairment. Secondary outcomes were kinesiophobia, anxiety and depressive symptomatology, and physical functioning. Differences between groups at post-treatment assessment were analyzed using Intention-To-Treat (ITT) and completer approaches. Baseline differences between clinical responders and non-responders were also explored. Statistically significant improvements with small-to-moderate effect sizes were observed in FIBROWALK+TAU vs. TAU regarding functional impairment and most secondary outcomes. In our study, the NNT was 5, which was, albeit modestly, indicative of an efficacious intervention. The results of this proof-of-concept RCT preliminarily support the efficacy of virtual FIBROWALK in patients with FM during the Spanish COVID-19 lockdown. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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11 pages, 601 KiB

Open AccessArticle

Effects of Mindfulness-Based Cognitive Therapy for Chronic Pain: A Multicenter Study

by Estela María Pardos-Gascón, Lucas Narambuena, César Leal-Costa, Antonio Jesús Ramos-Morcillo, María Ruzafa-Martínez and Carlos J. van-der Hofstadt Román

Int. J. Environ. Res. Public Health 2021, 18(13), 6951; https://doi.org/10.3390/ijerph18136951 - 29 Jun 2021

Cited by 8 | Viewed by 4198

Abstract

The prevalence of chronic pain in Spain is 15%. The objective of this study was to evaluate the efficacy of mindfulness-based cognitive therapy on patients with chronic pain. A quasi-experimental design of repeated measures pre- and post-test (N = 57) was carried out at three hospitals from the province of Alicante. Self-reported assessment measurements of pain intensity, anxiety-depression symptoms, perception of health status, interference of pain on sleep, self-efficacy in pain, acceptance, and mindfulness attitude were included. The T-test indicates significant differences in intensity of present pain, mental quality of life, and depression (medium effect sizes), as well as in self-efficacy: total score, symptom management and pain control (medium effect sizes), sleep disturbances and quantity of sleep (large effect sizes). MBCT is effective in reducing many symptoms in patients with chronic pain, although its maintenance needs to be further investigated. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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13 pages, 358 KiB

Open AccessArticle

Assessing the Functional Status of Patients with Chronic Pain—Cross Cultural Adaptation and Psychometric Properties of the Serbian Version of the Pain Disability Questionnaire

by Aleksandar Knežević, Petar Čolović, Milica Jeremić-Knežević, Čila Demeši-Drljan, Dušica Simić-Panić and Randy Neblett

Int. J. Environ. Res. Public Health 2021, 18(13), 6911; https://doi.org/10.3390/ijerph18136911 - 28 Jun 2021

Cited by 4 | Viewed by 2841

Abstract

The Pain Disability Questionnaire (PDQ) has established itself as a leading patient-reported outcome measure for assessing both mental and physical components of pain-related disability. The current study aimed to translate the PDQ into Serbian and validate its psychometric properties. Following a standard translation process, a total of 554 chronic pain patients (average age 55.37 ± 12.72 years; 375 (67.5%) females) completed the PDQ-Serb, Oswestry Disability Index (ODI), Short Form-36 (SF-36), pain intensity rating and a six-minute walk test (6MWT). Responsiveness was examined in a subsample of 141 patients who completed an inpatient rehabilitation program. The internal consistency of the PDQ-Serb was excellent (Cronbach α = 0.92) and test-retest reliability was favorable (ICC = 0.87). Factor analyses found a bifactor model to be the best fit (CFI = 0.97: TLI = 0.96: RMSEA = 0.05; SRMR = 0.03). Statistically significant Pearson’s coefficient correlations (p < 0.001) were found between the PDQ-Serb and ODI (r = 0.786), SF-36 Physical Components summary (r = −0.659), SF-36 Mental Components summary (r = −0.493), pain intensity rating (r = 0.572), and 6MWT (r = −0.571). Significant post-treatment improvements following inpatient rehabilitation were found with the PDQ-Serb (p < 0.001; effect size 0.431) and other clinical variables (p < 0.001; effect sizes from 0.367 to 0.536). The PDQ-Serb was shown to be a reliable and valid self-report instrument for the evaluation of pain-related disability. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

11 pages, 531 KiB

Open AccessArticle

Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised

by Adrián Pérez-Aranda, Albert Feliu-Soler, Scott D. Mist, Kim D. Jones, Yolanda López-Del-Hoyo, Rebeca Oliván-Arévalo, Anna Kratz, David A. Williams and Juan V. Luciano

Int. J. Environ. Res. Public Health 2021, 18(1), 247; https://doi.org/10.3390/ijerph18010247 - 31 Dec 2020

Cited by 9 | Viewed by 3694

Abstract

Fibromyalgia (FM) is a heterogeneous and complex syndrome; different studies have tried to describe subgroups of FM patients, and a 4-cluster classification based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) has been recently validated. This study aims to cross-validate this classification in a large US sample of FM patients. A pooled sample of 6280 patients was used. First, we computed a hierarchical cluster analysis (HCA) using FIQR scores at item level. Then, a latent profile analysis (LPA) served to confirm the accuracy of the taxonomy. Additionally, a cluster calculator was developed to estimate the predicted subgroup using an ordinal regression analysis. Self-reported clinical measures were used to examine the external validity of the subgroups in part of the sample. The HCA yielded a 4-subgroup distribution, which was confirmed by the LPA. Each cluster represented a different level of severity: “Mild–moderate”, “moderate”, “moderate–severe”, and “severe”. Significant differences between clusters were observed in most of the clinical measures (e.g., fatigue, sleep problems, anxiety). Interestingly, lower levels of education were associated with higher FM severity. This study corroborates a 4-cluster distribution based on FIQR scores to classify US adults with FM. The classification may have relevant clinical implications for diagnosis and treatment response. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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19 pages, 670 KiB

Open AccessSystematic Review

A Systematic Review of the Adherence to Home-Practice Meditation Exercises in Patients with Chronic Pain

by Alberto Barceló-Soler, Héctor Morillo-Sarto, Selene Fernández-Martínez, Alicia Monreal-Bartolomé, Maria José Chambel, Paula Gardiner, Yolanda López-del-Hoyo, Javier García-Campayo and Adrián Pérez-Aranda

Int. J. Environ. Res. Public Health 2023, 20(5), 4438; https://doi.org/10.3390/ijerph20054438 - 2 Mar 2023

Cited by 6 | Viewed by 3516

Abstract

Mindfulness-, compassion-, and acceptance-based (i.e., “third wave”) psychotherapies are effective for treating chronic pain conditions. Many of these programs require that patients engage in the systematic home practice of meditation experiences so they can develop meditation skills. This systematic review aimed at evaluating the frequency, duration, and effects of home practice in patients with chronic pain undergoing a “third wave” psychotherapy. A comprehensive database search for quantitative studies was conducted in PubMed, Embase, and Web of Sciences Core Collection; 31 studies fulfilled the inclusion criteria. The reviewed studies tended to indicate a pattern of moderately frequent practice (around four days/week), with very high variability in terms of time invested; most studies observed significant associations between the amount of practice and positive health outcomes. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy were the most common interventions and presented low levels of adherence to home practice (39.6% of the recommended time). Some studies were conducted on samples of adolescents, who practiced very few minutes, and a few tested eHealth interventions with heterogeneous adherence levels. In conclusion, some adaptations may be required so that patients with chronic pain can engage more easily and, thus, effectively in home meditation practices. Full article

(This article belongs to the Special Issue Clinical and Health Psychology in Chronic Pain Management)

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