Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared. Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted. Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems. Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points. Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

The aim of the study was to investigate the application of aspects of Lazarus and Folkman's theory of Stress, Appraisal and Coping, to the chronic pain experience. In this context, the researcher explored the relationship between pain intensity and stress level. The association between pain intensity and the intensity of negative or positive attitudes towards the pain experience was also investigated. In addition, the relationship between pain intensity and the frequency of employing active, problem focused coping-strategies, or passive, emotion focused strategies, was explored. 105 subjects completed the South African Chronic Pain Questionnaire; an assessment tool based on adapted internationally validated measures. Findings suggest that there is a proportional relationship between pain intensity and stress level in the present chronic pain population. A positive relationship between pain intensity and the intensity of negative attitudes was revealed. A positive relationship was also reflected between pain intensity and the employ of passive, emotion-focused coping-strategies. There is a paucity of research that provides a theoretical framework in which to conceptualize the association between stress, appraisal and coping in chronic pain. To this end, the researcher has employed Lazarus and Folkman's theory in order to conceptualize the relationship between these variables and chronic pain intensity. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed.

This thesis is a report of a study on patients suffering one of two painful chronic illnesses (rheumatoid arthritis (RA) or migraine), and attempts to discover possible determinants of psychological reactions to long term painful illness. One hundred and sixty chronically ill individuals were interviewed, (80 migraine and 80 RA sufferers). In keeping with other evidence, the extent of psychological disturbance was found to be higher for chronically ill individuals than for general population samples. There were no zero order correlations between reported pain and psychological distress. Age and length of suffering have often been cited as possible factors influencing mood state, but no evidence was found for this in the data gained in this survey. The results provide no evidence for the use of coping strategies as a method of adapting to the demands of the painful chronic illnesses studied here. Beliefs in control over illness have been posited as possible factors that may influence psychological state, and were measured in this research using a health locus of control scale. However locus of control scores were not found to be associated with mood state, although, in keeping with other research, scores were found to be associated with age and social class, with both lower social class and older sufferers scoring higher on externality than those from higher social classes, or whom were younger. The strongest association was found between aspects of subjective health status and mood state. The major finding of this study is that patients assessment of their own health state, in both illnesses, is the major factor associated with psychological state.

Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Chronic low back pain (CLBP) is one of the most prevalent and disabling health conditions in the US and worldwide. Biomedical explanations of acute injury fail to account for why some individuals experience remission of pain and restoration of physical function while others do not. Pain-related fear, accompanied by elevated appraisals of physical exertion and avoidance of physical activity, has emerged as a central psychosocial risk factor for transition from acute injury to chronic pain and disability. Research has indicated that these pain-related factors may be maintained through observational learning mechanisms. To date, no studies have experimentally examined the role of observational learning and pain-related fear in the context of actual musculoskeletal injury. Accordingly, the present study examined the impact of observational learning and pain-related fear on activity appraisals and exertion following experimentally- induced acute low back injury. Healthy participants' appraisal of standardized movement tasks along with measures of physical exertion were collected prior to and following a procedure designed to induce delayed onset muscle soreness (DOMS) to the lower back. Following induction of DOMS, participants observed a video prime depicting CLBP patients exhibiting either high or low pain behavior during similar standardized movements. In line with hypothesized effects, participants assigned to the high pain behavior prime demonstrated greater elevation in pain and harm appraisals as well as greater decrement in physical exertion. Further in line with hypotheses, significant changes in appraisal and physical performance following the high pain behavior prime were only observed among participants endorsing high pain-related fear during baseline assessment. Discussion of findings addresses potential mechanisms of action as well as study limitations and direction for future research.

Pain has been described as the most complex human experience and most frequent reason patients seek medical treatment. Few people fail to experience the pain associated with disease, injury, or medical/surgical procedures. However, the impact of unemployment that results from chronic pain suffering has not been widely researched. To present a comprehensive view of the effect unemployment has upon the chronic pain experience, this study focused upon stress philosophy, chronic pain, employment, and coping effectiveness. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and a Personal Data Questionnaire (PDQ) were administered to 96 persons (four groups of 24 subjects) representing either unemployed or employed and either chronic or non-chronic (acute) pain populations.

This study investigated the relationship between preferred coping strategies, and major stressors for nondepressed, and depressed chronic pain patients. The subjects for this study were 67 chronic pain patients who are participating in a pain/spinal rehabilitation program. The information collected from the individuals or their records included: (1) basic demographic information, (2) level of activity, (3) level of perceived pain, (4) medication usage, (5) therapist rating of level of stabilization, (6) scores on three inventories including the Coping Strategies Questionnaire, the Ways of Coping Checklist, and the Beck Depression Inventory. Analyses included an examination of the relationship between level of depression and (1) type of stressors, (2) coping strategies, and (3) level of perceived pain. Further analyses included multiple regression with outcome as defined by therapist ratings at the end of treatment, and patients' ratings at follow up as the criterion variables.

Chan, Hoi Sze Gloria. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 204-241). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

"December, 2003" / Bibliography: leaves 283-311. / xiv, 311 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Dept. of Psychology, 2005