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Understanding Comorbid Pain and Emotions: A transdiagnostic approach
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0002-3887-6281
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Experiencing pain, including an emotional reaction, is part of being hu­man. Emotional comorbidity is common in pain patients, and corre­lated to higher symptomatology and worse treatment outcome. The shared vulnerability model suggests that many vulnerability and main­taining factors may be involved in both pain and emotional problems. Hence, they may be transdiagnostic. Since our knowledge about these shared factors is lacking, potential targets for risk assessment, preven­tion, and treatment are likely underutilized. The overarching aim of this dissertation was to further our understanding of comorbid musculo­skeletal pain and emotional problems by investigating the role of trans­diagnostic factors. Specifically, it was studied if levels of shared vulner­abilities (negative affect and anxiety sensitivity) and symptomatology covary in pain patients depending on the occurrence of comorbid social anxiety symptoms (Study I); if peer-related stress predicts musculoskel­etal pain problems over time in adolescents, and if this is mediated by worry and moderated by gender (Study II); and if symptomatology can be decreased in pain patients with comorbid emotional problems by using an internet delivered unified protocol for emotional disorders (Study III). Results show that vulnerabilities covaried with comorbid pain and social anxiety. Also, peer-related stress predicted musculoskel­etal pain problems in adolescents and was mediated by worry for girls. However, the internet-delivered unified protocol did not unequivocally decrease symptomatology. In sum, the studies in this dissertation pro­vide partial support for the role of transdiagnostic factors in comorbid musculoskeletal pain and emotional problems. A transdiagnostic ap­proach may offer a parsimonious understanding of the  development and maintenance of this comorbid symptomatology.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 98
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 40
Keywords [en]
Transdiagnostic approach, musculoskeletal pain, emotions, comorbidity, shared vulnerability model, social factors, gender
National Category
Psychology (excluding Applied Psychology)
Identifiers
URN: urn:nbn:se:oru:diva-66696ISBN: 978-91-7529-250-2 (print)OAI: oai:DiVA.org:oru-66696DiVA, id: diva2:1199836
Public defence
2018-06-08, Örebro universitet, Långhuset, Hörsal L2, Fakultetsgatan 1, Örebro, 09:15 (English)
Opponent
Supervisors
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-06-08Bibliographically approved
List of papers
1. Characteristics and consequences of the co-occurence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment
Open this publication in new window or tab >>Characteristics and consequences of the co-occurence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment
2016 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 12, p. 45-52Article in journal (Refereed) Published
Abstract [en]

Background and aims: Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerabil-ity factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occur-rence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear.

Methods: 180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxi-ety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy).

Results: Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment.

Conclusions: A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability.

Implications: These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2016
Keywords
Social anxiety, pain related fear, chronic pain, comorbidity, treatment outcome, vulnerability factors
National Category
Psychology Neurology
Research subject
Psychology; Neurology
Identifiers
urn:nbn:se:oru:diva-51689 (URN)10.1016/j.sjpain.2016.03.006 (DOI)000383375000009 ()2-s2.0-84962840819 (Scopus ID)
Note

Funding Agency:

Regional Research Council (Regionala Forskningsrådet, RFR)

Available from: 2016-08-17 Created: 2016-08-17 Last updated: 2018-05-16Bibliographically approved
2. Musculoskeletal pain in adolescents: Prevalence, and the role of peer-related stress, worry, and gender in the development of pain problems over time
Open this publication in new window or tab >>Musculoskeletal pain in adolescents: Prevalence, and the role of peer-related stress, worry, and gender in the development of pain problems over time
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:oru:diva-66950 (URN)
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-06-18Bibliographically approved
3. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study
Open this publication in new window or tab >>Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study
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2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 54-64Article in journal (Refereed) Published
Abstract [en]

In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Internet delivered treatment; pain; transdiagnostic; emotional comorbidity; single case
National Category
Other Medical Sciences not elsewhere specified
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-62356 (URN)10.1016/j.invent.2017.10.004 (DOI)2-s2.0-85032807121 (Scopus ID)
Projects
SÅS
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2018-08-10Bibliographically approved

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