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  • 1.
    Bergström, Gunnar
    et al.
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Cecilia
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients: Is sick leave outcome dependent on psychologically derived patient groups?2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, p. 426-433Article in journal (Refereed)
    Abstract [en]

    A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.

  • 2.
    Carstens-Söderstrand, Johan K. P.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Shaw, W. S.
    Liberty Mutual Research institute for Safety, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Reme, S. E.
    Uni Research Health, Bergen, Norway; Harvard School of Public Health, Boston, USA.
    Pransky, G.
    Liberty Mutual Research institute for Safety, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Linton, Steven J.
    When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain2014In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, no 2, p. 269-278Article in journal (Refereed)
    Abstract [en]

    Background Expectations for recovery are a known predictor for returning to work. Most studies seem to conclude that the higher the expectancy the better the outcome. However, the development of expectations over time is rarely researched and experimental studies show that realistic expectations rather than high expectancies are the most adaptive. This study aims to explore patterns of stability and change in expectations for recovery during the first weeks of a back-pain episode and how these patterns relate to other psychological variables and outcome.

    Methods The study included 496 volunteer patients seeking treatment for work-related, acute back pain. The participants were measured with self-report scales of depression, fear of pain, life impact of pain, catastrophizing and expectations for recovery at two time points. A follow-up focusing on recovery and return to work was conducted 3 months later. A cluster analysis was conducted, categorizing the data on the trajectories of recovery expectations.

    Results Cluster analysis revealed four clusters regarding the development of expectations for recovery during a 2-week period after pain onset. Three out of four clusters showed stability in their expectations as well as corresponding levels of proximal psychological factors. The fourth cluster showed increases in distress and a decrease in expectations for recovery. This cluster also has poor odds ratios for returning to work and recovery. Conclusion Decreases in expectancies for recovery seem as important as baseline values in terms of outcome, which has clinical and theoretical implications.

  • 3.
    Engman, Linnea
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Ekdahl, J.
    Department of Psychology, Mid Sweden University, Östersund, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 8, p. 1388-1398Article in journal (Refereed)
    Abstract [en]

    Background: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

    Methods: One hundred and seventeen women, 18-35years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

    Results: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

    Conclusions: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

    Significance: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

  • 4.
    Flink, Ida K.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 8, p. 887-892Article in journal (Refereed)
    Abstract [en]

    This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain-related fear. The study was based on data from a randomized-controlled trial for patients with non-specific spinal pain (Linton et al., 2008).

    First, catastrophizing, anxiety, and depression were studied as possible treatment moderators. We found evidence that catastrophizing was a moderator of treatment outcome in exposure. When further exploring the nature of the relationship between catastrophizing and outcome, the results showed that the exposure was effective only for patients with low or moderate levels of catastrophizing. High catastrophizers did not improve from the treatment. On the other hand, anxiety was a general predictor of poor outcome, and not a specific moderator of outcome in exposure. In contrast, depression was not significantly related to outcome.

    Next, patients were divided into high change participants and low change participants based on their improvement in disability after treatment in order to investigate the change in psychological variables during treatment. Descriptive data indicated that high change participants had large improvements across treatment on depression, anxiety, catastrophizing, and fear-avoidance beliefs whereas low change participants virtually did not change at all on these variables across treatment.

    These findings denote that catastrophizing is a moderator of treatment outcome in exposure whereas several psychological variables might be important for the treatment process

  • 5.
    Flink, Ida K.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Mroczek, Magdalena Z.
    Örebro University, School of Law, Psychology and Social Work.
    Sullivan, Michael J. L.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Pain in childbirth and postpartum recovery: the role of catastrophizing2009In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, no 3, p. 312-316Article in journal (Refereed)
    Abstract [en]

    This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty-eight women giving birth for the first time completed the first questionnaire before delivery. Eighty-two of those returned the second questionnaire after delivery. Participants were classified as catastrophizers (n=38) or non-catastrophizers (n=44) based on their scores on the Pain Catastrophizing Scale. Comparison of the groups showed that catastrophizers anticipated and experienced more intense pain (p<.0125) and had poorer physical recovery (p<.0125), measured as the level of self-reported functioning in activities of daily living, than non-catastrophizers. These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the fear-avoidance model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy.

  • 6.
    Gatzounis, R.
    et al.
    Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium; Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Crombez, G.
    Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
    Vlaeyen, J. W. S.
    Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Forgetting to remember?: Prospective memory within the context of pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 3, p. 614-625Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

    METHODS: Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues.

    RESULTS: Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context.

    CONCLUSIONS: Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed.

    SIGNIFICANCE: This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.

  • 7.
    Holm, S.
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Ljungman, G.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Åsenlöf, P.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Linton, Steven J
    Örebro University, School of Law, Psychology and Social Work.
    Söderlund, A.
    School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises2016In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 626-638Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework.

    Methods: The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PTs) was compared with exercise-based treatment (CT). Thirty-two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain-related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self-efficacy were collected.

    Results: The pain-related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = -18 and CT = -11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post-treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self-efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results.

    Conclusion: In this study, differences between tailored behavioural medicine treatment delivered by PTs and exercise-based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain-related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.

  • 8.
    Johansson, Ann-Christin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gunnarsson, Lars-Gunnar
    Örebro University, School of Health and Medical Sciences.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Bergkvist, Leif
    Stridsberg, Mats
    Nilsson, Olle
    Cornefjord, Michael
    Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 633-640Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic–pituitary–adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns.The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation.

    Method: This study had a cross-sectional design. Forty-two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires.

    Results: The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p < 0.05). The patients with a low diurnal cortisol variability had significantly lower coping self-statement scores, but higher pain coping catastrophising scores (p < 0.05).

    Conclusion: Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability. 

  • 9.
    Karsdorp, Petra A.
    et al.
    Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Department of Psychology, Utrecht University, Utrecht, The Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Geenen, Rinie
    Department of Psychology, Utrecht University, Utrecht, The Netherlands.
    Attentional control and the competition between nonpain goals and the threat of pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 1, p. 181-190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fully understanding attention to pain requires taking into account the motivational context. Both pain- and (nonpain) goal-related information attracts attention. An intriguing question is which attentional bias prevails when pain- and goal-related information co-occurs? Reduced attentional bias towards pain- and goal-related information was predicted when the other competing information was presented simultaneously. Moreover, trait attentional control was predicted to be associated with stronger attentional bias towards goal-related information particularly in the presence of pain-related information.

    METHODS: Attentional competition between pain- and (nonpain) goal-related information was measured in ninety participants using a dot-probe task presenting two stimuli (pain-related, goal-related or neutral) simultaneously. Reaction time was the dependent variable. Dot-probe trials alternated with goal trials to induce a temporary goal. Trait attentional control was measured with the attentional control scale.

    RESULTS: For pain-related neutral stimulus pairs, participants responded fastest when probes appeared on the same, compared to the opposite, location as the pain-related stimulus. For pain-goal-related stimulus pairs, responses were fastest when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Higher trait attentional control was associated with faster responding when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Unpredicted, this effect was irrespective of the co-occurring stimulus (neutral vs. pain-related).

    CONCLUSIONS: The findings suggest that the unintentional allocation of attention towards events related to a temporary (nonpain) goal prevails over attentional bias to events predicting pain. Trait attentional control predicts stronger attentional allocation towards events related to a temporary goal.

    SIGNIFICANCE: These findings indicate that treatment interventions facilitating goal pursuit in patients with chronic pain are beneficial in reducing attentional biases towards pain-related events.

  • 10.
    Linton, Steven J.
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Boersma, Katja
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Jansson, Markus
    Overmeer, Thomas
    Lindblom, Karin
    Vlaeyen, Johan W. S.
    A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 6, p. 722-730Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain-related fear is related to disability in persistent pain conditions. Exposure treatment has been reported to be of great benefit in replicated single case experiments.

    AIM: To evaluate the effects of exposure in vivo on fear and function in patients with persistent pain and work disability.

    METHOD: We recruited 46 patients suffering from long-term back pain and reduced function, who also were deemed fearful according to standardized measures. Participants were randomized into either an exposure plus usual treatment or waiting list control plus usual treatment group. After the waiting period the control group crossed over and received the exposure treatment.

    RESULTS: Between group comparisons showed a significantly better result for the exposure group on function, but not for fear or pain and effect sizes were modest (function=.6; fear=.4; pain=.1). When the control group crossed over to treatment significant treatment effects were noted for fear and function. For all patients treated, the pre to post-treatment effect sizes were large (function=.7; fear=1.1; pain=.9). There were 12 dropouts (8 in exposure and 4 in the control) during the first treatment phase and an additional 4 when the control group crossed over to exposure.

    CONCLUSIONS: Compared to a group receiving usual treatment and waiting for exposure, the exposure in vivo group demonstrated a significantly larger improvement on function. Overall exposure had moderate effects on function, fear and pain intensity. We conclude that exposure may be important in treatment, but is not recommended as a "stand alone" adjunct to usual treatment.

  • 11.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Vangronsveld, K.
    Department of Experimental-Clinical and Health Psychology, Gent University, Gent, Belgium.
    Fruzzetti, A.
    Department of Psychology, University of Nevada, Reno NV, USA.
    Painfully reassuring?: The effects of validation on emotions and adherence in a pain test2012In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 16, no 4, p. 592-599Article in journal (Refereed)
    Abstract [en]

    Communicating reassurance to patients with musculoskeletal pain complaints, but no red flags, presents a dilemma of dampening worry while refraining from reinforcing undue pain behaviors. Previous research shows that reassurance does not decrease negative affect and may be perceived as not taking the symptoms seriously. Validation offers an alternative where the patient's experiences and feelings are acknowledged and has demonstrated, for other problems, a decrease in arousal which may set the stage for behavioral change. The purpose of this study was to investigate experimentally whether validation, as compared to invalidation, impacts on emotions and adherence during repeated pain tests.

    To this end, 50 participants were randomized to either a validation or invalidation condition. Each participant was told they would undergo four pain trials involving holding a bucket at arm's length to tolerance. During the inter-trial interval, the experimenter provided validating or invalidating responses according to the randomization. As a proxy measure of adherence subjects were asked to engage in an additional pain test.

    Results indicated that validation relative to invalidation resulted in significantly more positive affect and significantly less worry. Both groups had reductions in negative affect over the trials, but there were no difference between the groups on negative affect or pain. However, adherence was more than twice as high in the validation group as compared to invalidation.

    These results show that a relatively simple validation procedure had significant and positive effects on emotion and increased adherence. Further research should extend these findings and explore their clinical application.

  • 12.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nicholas, Michael K.
    MacDonald, Shane
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Bergbom, Sofia
    Örebro University, School of Law, Psychology and Social Work.
    Maher, Chris
    Refshauge, Kathy
    The role of depression and catastrophizing in musculoskeletal pain2011In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, no 4, p. 416-422Article in journal (Refereed)
    Abstract [en]

    Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built-in replication from two clinical samples of patients with sub-acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross-sectionally and at follow-up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.

  • 13.
    Schrooten, Martien G S
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Karsdorp, P A
    University of Utrecht, Utrecht, The Netherlands.
    Vlaeyen, J W S
    University of Leuven, Leuven, Belgium.
    Pain catastrophizing moderates the effects of pain-contingent task interruptions2013In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, no 7, p. 1082-92Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A prominent behavioural consequence of pain is the temporary suspension of current activities with intent to resume them later. Little is known about the effects of such pain-contingent task interruptions. This experiment examines the influence of pain-contingent interruptions on the amount of time spent performing a cognitive achievement task: We expected that people would spend more time on task when task performance was interrupted in response to pain (vs. no interruption), and that negative mood and pain catastrophizing would enhance this negative impact.

    METHODS: Healthy volunteers read behaviour descriptions until they felt they could form a good impression. Before task performance, participants underwent a negative or positive mood induction. During the task, all participants expected painful stimulation. Half of the participants in each mood induction group received an acute (electrocutaneous) pain stimulus, resulting in a 2-min break from the task. The other participants received no sensory stimulation during task performance and their performance was not interrupted.

    RESULTS: Results revealed no effect of mood on task performance (i.e., total number of descriptions read). There was, however, a significant interaction between task interruption and pain catastrophizing, indicating that participants with low levels of catastrophizing tended to read more descriptions when performance was interrupted than when not, whereas participants reporting relatively high levels of catastrophizing showed the reverse behavioural pattern.

    CONCLUSIONS: The impact of pain-contingent task interruptions was reversed in participants reporting relatively high levels of pain catastrophizing. Results are discussed with regard to interruption management in the context of chronic pain.

  • 14.
    Schrooten, Martien G. S.
    et al.
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium.
    Vancleef, L.
    Department of Clinical Psychological Science, Maastricht University,Maastricht, The Netherlands.
    Vlaeyen, J. W. S.
    Research Group Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Attention allocation to ambiguous health/somatic threat cues2015In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 7, p. 1002-1011Article in journal (Refereed)
    Abstract [en]

    Background: An influential idea is that attentional bias to information related to pain or pain-related negative affect underlies persistent pain problems. Such information is however often ambiguous. If ambiguous input is perceived as pain or threat related, attention to this stimulus would be enhanced compared with stimuli with no (dominant) pain-/threat-related meaning. Attentional bias to ambiguous stimuli related to somatic/health threat was expected to be more pronounced with higher levels of pain catastrophizing.

    Methods: University students performed a spatial cueing task including four types of word cues that were combinations of word content (somatic/health threat vs. non-threat), and word ambiguity (unambiguous vs. ambiguous), each presented for 500 or 750 ms. Attentional bias to somatic/health threat is reflected in larger cue validity effects for somatic/heath threat words than for non-threat words.

    Results: In the 500-ms condition, cue validity effects were larger for threat than for non-threat words in participants reporting low catastrophizing, but did not depend on word content in participants reporting higher catastrophizing. In the 750-ms condition, cue validity effects did not depend on pain catastrophizing or word content. Cue validity effects did not significantly differ between unambiguous words and ambiguous homographs.

    Conclusions: Low catastrophizers demonstrated attentional bias to threat content. Participants reporting higher catastrophizing showed overall enhanced attentional orienting. There was no evidence for differences in (biased) attention to unambiguous and ambiguous words. Further research is needed to determine attentional bias for ambiguous pain-/threat-related stimuli in the context of consistent attentional bias for unambiguous pain-/threat-related stimuli.

  • 15.
    Vangronsveld, Karoline L.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    The effect of validating and invalidating communication on satisfaction, pain and affect in nurses suffering from low back pain during a semi-structured interview2012In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 16, no 2, p. 239-246Article in journal (Refereed)
    Abstract [en]

    When physicians interview patients with ambiguous or nonspecific symptoms, they often try to reassure them with the purpose of explaining that no dangerous illness or disease is causing the symptoms. Unfortunately the evidence suggests that patients with benign (back) pain instead feel misunderstood, frustrated and unsatisfied with the consultation. Validation is a communication method that focuses on understanding and empathy as a platform for problem solving and it may be applicable for interviews in medical settings. The aim of this study was to examine the effects of validation on patient satisfaction, pain and affect.

    To this end 28 nurses with (re)current back pain were recruited and randomly assigned to be interviewed in a validating or invalidating condition. Patient satisfaction, affect, pain, disability, pain catastrophizing, and fear of movement were assessed immediately after the interview.

    The results show that the participants in the validated group were more satisfied with the interview than participants in the invalidating condition. Moreover, they showed a significant decrease on all measures of negative affect as well as for pain. For example, there was a significant between group difference in frustration where frustration decreased in the validation group, while it increased in the invalidation condition.

    A validating communication style seems to be beneficial for enhancing patient satisfaction, as well as diminishing negative affect and pain intensity ratings. Our results suggest that validation might be a viable technique to use in clinical examinations of patients suffering pain.

  • 16.
    Westman, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Öhrvik, J.
    Wahlén, P.
    Leppert, J.
    Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain?: A validation of the Örebro Musculoskeletal Pain Screening Questionnaire2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 641-649Article in journal (Refereed)
    Abstract [en]

    Purpose

    Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the ÖMPSQ for patients with non-acute pain problems (e.g. 1–6 months sick leave) and compare to other relevant questionnaires.

    Method

    One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years.

    Results

    The ÖMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant.

    Conclusion

    The results demonstrate that psychosocial factors as measured by ÖMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The ÖMSPQ was a good predictor of outcome.

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