This study sought to provide a description of the psychosocial profile of persons with complex regional pain syndrome (CRPS). CRPS is an excruciatingly painful and debilitating condition that is poorly understood by medical professionals. Its profound impact on an individual's quality of life prompts a closer examination of the psychosocial profile of individuals suffering from CRPS. The extant literature examining psychological variables associated with CRPS is inconclusive with regard to the role that these factors play in the course of the syndrome. It has been shown, however, that CRPS patients suffer tremendous physical discomfort and this is often reflected in increased emotional distress. The present study assesses level of pain, anxiety, depression, disability, intrusive thoughts, quality of life, and demographic variables utilizing a national sample obtained from an online survey distributed to members of an organization that provides resources to CRPS patients. Descriptive data are presented for all data gathered and specific correlates of quality of life were examined. Results of the study demonstrated that this sample endorsed high levels of anxiety and depression and reported low levels of both physical and mental quality of life. When compared to normative data, this sample endorsed more pain and anxiety than other pain populations and also endorsed lower mental and physical quality of life than other pain conditions. The psychosocial profile of individuals with CRPS type I did not vary significantly from individuals with type II. Intrusive thoughts were uniquely predictive of disability, physical quality of life, and mental quality of life after controlling for age, gender, and pain level. The role of intrusive thoughts in predicting disability and quality of life suggests a potential mechanism by which clinicians can target psychotherapeutic treatment. Understanding the psychosocial profile and psychological sequelae of this disorder will help both physicians and psychologists understand the impact of CRPS on patients and provide a pathway for improved comprehensive interdisciplinary treatments.

Cognitive-behavioural based models of chronic pain contend that appraisals of harm affect the individual�s response to pain. It has been suggested that fear of pain and/or anxiety sensitivity predispose individuals to chronicity. However, other factors such as pain self-efficacy are believed to mediate between experience of pain and disability. According to this view, pain is maintained through hypervigilance towards painful sensations and subsequent avoidance. Four studies were conducted in order to evaluate the structure of fear-avoidance models of chronic pain, and also, to examine the role of hypervigilance as an underlying mechanism in maintenance of pain. In study one, using a sample of 207 consecutive patients, two models were tested. First, fear of movement model as proposed by Vlaeyen et al. (1995a) was examined. It was found that negative affectivity has direct effects on the fear and avoidance of pain, which in turn, contributes to disability. In total, fear/avoidance accounted for a significant amount of the variance of disability. In addition, severity of pain was found to increase pain disability, while itself is influenced still by negative affectivity. These findings supported the model of fear of pain as described by Vlaeyen et al. (1995a). Further, we found that self-efficacy may mediate the impact of fear of pain on disability and reduces the perceived physical disability. At the same time, self-efficacy was shown to have direct reductive impact on disability. However, both studies indicated that people who are fearful in response to pain are more likely to develop disability, although self-efficacy may play a moderating role. In the studies one, two, and three, the role of hypervigilance in over attending to pain was investigated. In study one a large sample of 168 chronic pain patients were studied. Questionnaires measuring different aspects of pain and a computerised version of the Dot-Probe Task were administered. Four types of words related to different dimensions of pain and matched neutral words were used as stimuli. Reaction times in response to the stimuli were recorded. A factorial design 3x4x2x2 and ANOVAs were employed to analyse the data. Chronic pain patients showed a cognitive bias to sensory pain words relative to affective, disability, and threat-related words. However, contrary to expectations, those high in fear of pain responded more slowly to stimuli than those less fearful of pain. These results suggest that patients with chronic pain problems selectively attend to sensory aspects of pain. However, selective attention appears to depend upon the nature of pain stimuli. For those who are highly fearful of pain they may not only selectively attend to pain-related information but also have difficulty disengaging from those stimuli. In study two, 35 chronic pain patients were compared with the same number matched healthy subjects. Both groups completed measures of fear of pain, anxiety sensitivity, depression and anxiety, in addition to dot probe task. Results indicated that both groups show similar attentional bias to sensory words in comparison with other word types. However, the level of this biasness was higher for chronic pain patients. Lack of significant differences between patients and controls is discussed in the context of possible evolutionary value of sensitivity to pain as an adaptive reaction in healthy controls, and contrary, as a maladaptive response to pain in chronic pain patients. The results of the previous research suggest that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. The forth study examined the degree to which a successful cognitive-behavioural program was able to modify the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre- to post- treatment changes in fear of movement (Tampa Scale for Kinesiophobia) but not other relevant variables, such as fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.

Chronic pain has been identified as a major and underestimated health care problem, with extensive individual, social and economic ramifications. It has been estimated that the annual economic cost of chronic pain in Australia exceeds AU$34 billion. The available epidemiological evidence suggests chronic pain is a relatively common health problem in Australia which is a significant public health issue. Chronic pain is a complex phenomenon which is not easily defined. However, it is important to consider the ways in which chronic pain is conceptualised, as this can have significant implications for the individual in terms of how they think about their pain, and the way they are treated within the health care system and the broader society. In the late nineteenth and early twentieth centuries, pain was predominantly considered a symptom of a biological problem in the body. Absence of physical disease was thought to indicate pain was the result of aberrant psychological processes. However, chronic pain proved resistant to this ‘mind-body’ approach, and the lack of efficacy of many biomedical interventions, combined with an apparently increasing prevalence of chronic pain, pointed to the inadequacy of purely biomedical approaches to pain treatment. The latter part of the twentieth century saw the recognition of pain as a multidimensional experience influenced by the interaction of numerous biological, psychological and social factors. Consequently, the biopsychosocial model of health, which emphasised such a ‘holistic’ perspective, gained substantial recognition in the pain management domain, and was endorsed as the preferred model of pain management. This has contributed to the development of new approaches to chronic pain treatment, particularly in the area of cognitive behavioural therapy and the establishment of multidisciplinary pain centres. There is evidence, however, that the ‘promise’ of the multidimensional conceptualisation and treatment of chronic pain has not been realised in the daily lives of people with chronic pain. Review of the literature indicates a tendency for research and practice to focus on the biological and psychological aspects of chronic pain, while minimising social environmental factors, such as the health care system and cultural belief systems regarding pain, which may also be significant. This thesis proposes that in order to more comprehensively respond to the complex phenomenon of chronic pain, it is necessary to further develop the social domain of the biopsychosocial model. A study was conducted to explore and describe individual experiences of living with chronic pain, as a basis for improving knowledge about the influence of the social environment on the individual. The thesis focuses not only on the individual descriptions of living with chronic pain, but also on the inter-relatedness between the individual and their social environment. Further, this thesis uses a process of critical interpretive analysis to identify aspects of the social environment which can exert a constraining or enabling effect on the individual with chronic pain. The thesis draws on critical realism theory, particularly the morphogenetic approach developed by Archer (1995), to guide the analysis process and to develop potential strategies for addressing identified social disadvantages. The integration of the individual stories of living with chronic pain with an interpretive analysis process, and the underlabouring philosophical perspective of critical realism, provided the framework to investigate the influence of the social environment on individual experience of living with chronic pain. In this thesis, a journey metaphor is used as an overarching framework to tie together the three principal themes identified through the analysis of the interview transcripts. The themes focused on the biomedical, psychological and cultural paths that participants followed in search of understanding and cure for their pain; the social suffering they experienced through lack of understanding and legitimation of their condition; and the identification and development of strategies for living with chronic pain. The thesis highlights the critical importance of focusing not only on the individual with chronic pain but also on the social environment within which the individual lives, and the ways in which these domains intersect and influence each other. The social environment was found to condition the individual and others in society, including health care practitioners, in relation to how they think and behave regarding pain, which in turn can have enabling or constraining consequences for the individual with pain. In particular, cultural beliefs about ‘normal’ pain, and the material structures of the health care system and employment and work places, were found to have a potentially negative impact on the individual with pain. It is concluded that these aspects of society will continue to exert constraining influences on people’s lives until the focus of policy and practice is expanded to include not just the individual with pain, but also the social environment in which they live. To address this, a number of policy and practice improvements are suggested.

<p>Litteraturstudiens syfte var att beskriva vilka copingresurser som individer med långvarig smärta använder sig av samt hur dessa resurser förbättrar eller försämrar individernas möjlighet att acceptera sin smärta. Designen för litteraturstudien var deskriptiv och studien baserades på 17 vetenskapliga artiklar med både kvantitativ och kvalitativ ansats. Litteratursökningarna utfördes i databaserna Medline (via PubMed) samt CINAHL. Huvudresultatet visade att individer med långvarig smärta använde sig av inre copingresurser som fysiska och psykosociala copingresurser samt förmågor vid acceptans av långvarig smärta. Individer använde sig även av yttre copingresurser som socialt stöd och materiella copingresurser. Dessa copingresurser kunde förbättra eller försämra individers möjlighet att acceptera långvarig smärta. Litteraturstudiens slutsats belyste vikten av att sjuksköterskan har kunskap om att fysiska, psykiska, sociala och existentiella aspekter genererade smärtupplevelsen. Sjuksköterskan behövde även ha kännedom om copingresurser för att kunna uppmärksamma individens unika förutsättningar och behov. Detta gjorde det möjligt för sjuksköterskan att erbjuda professionellt stöd anpassat efter individens unika copingresurser och hjälpa denne att uppnå acceptans av långvarig smärta. </p> / <p>The aim of the literature rewiev was to describe which coping skills individuals with chronic pain use and how these skills improve or impair the individuals' ability to accept their pain. The design for the literature study was descriptive and the study was based on 17 scientific articles of both quantitative and qualitative approach. The literature searches were carried out in the databases Medline (via PubMed) and CINAHL. The main result showed that individuals with chronic pain use internal skills such as physical and psychosocial skills and abilities to accept chronic pain. Individuals also use external skills such as social support and material resources. These skills can improve or impair individuals' possibility to accept chronic pain. The conclusion highlighted that a nurse should have knowledge about that physical, psychological, social and existential aspects generated the pain experience. A nurse should also have knowledge about coping skills in order to pay attention to the individual's unique circumstances and needs. This enabled the nurse to offer professional support tailored to the individual's unique coping skills and help the individual to achieve acceptance of chronic pain.</p>

Pain coping is the purposeful effort people use to manage and minimize the negative impacts of pain. The scientific literature on pain coping conceptualizes its role in recovery as a reciprocal interactive process of psychological, social, and biological factors. The objective of this dissertation was to investigate how workers cope with pain and how coping relates to recovery. Paper one-How Do Injured Workers Cope with Pain? A Descriptive Study of Injured Workers with Occupationally Related Long Term Pain, aimed to identify pain coping strategies used by workers and identify characteristics related to each strategy. This study hypothesized that workers coping may be a function of biological, social, and psychological factors. The results indicated that the most frequently used coping strategy was coping self statements, followed by praying and hoping, and catastrophizing. Additionally, coping strategies differed according to gender, marital status, education, part of the body injured, levels of depressed symptomatology, and pain. The objective of paper two, Predicting Recovery for Workers with Chronic Pain: Does Pain Coping Matter?, was to measure the prognostic values of pain coping strategies, using polynomial logistic regression and Cox regression, on two commonly used measures of recovery, self perceived disability and time to suspension of benefits. The adjusted polynomial models showed that coping self statements predicted moderate disability. The Cox regressions showed that increases in diverting attention, pain related behaviours, and perceived control meant small but significant decreased chances of suspended benefits. Paper three, Self Perceived Disability in Workers with Chronic Pain: Does Depression Matter?, sought to identify factors associated with self perceived disability at the beginning of rehabilitation. Depression and pain interacted to affect disability therefore, two multivariable models were built. For depressed workers, every one point increase in pain was associated with a 58% increased odds of moderate disability and a 258% increased odds of severe disability, compared to low disability. Pain control was protective for moderate and severe disability. For non-depressed workers, a one point increase in pain was associated with a 97% increased odds of moderate and a 109% increased odds for severe disability. However, Pain control was non-significant. / Epidemiology

Psychosocial variables such as attachment style, depression and the working alliance were examined as predictors of treatment outcomes in the context of chronic pain patients receiving physical therapy. Four treatment outcomes were examined: change in pain severity, change in pain interference, patient satisfaction with physical therapy services and patient compliance with treatment recommendations. A model of the interplay between depression and chronic illness presented by Katon (2003) was used as a framework for the current model. Two main hypotheses were suggested. (1) The working alliance is positively related to treatment outcomes. (2) Depression is negatively associated with treatment outcomes. Data were gathered at three outpatient rehabilitation clinics and the physical therapy unit of a multidisciplinary pain clinic in two Midwestern cities. A total of 59 subjects participated and regression analyses found evidence supporting both main hypotheses. The working alliance was found to be positively correlated to the change in pain severity, the change in pain interference, patient satisfaction and patient compliance. Depression was found to be negatively correlated to the change in pain interference, patient satisfaction and patient compliance. Implications for physical therapists working with chronic pain patients include clinical recommendations for developing a good working alliance and screening for depression.

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.

Abstract PURPOSE: The aim of this study was to describe and compare possible differences regarding selected prognostic factors for disability between patients with non-specific chronic pain who were about to start a multidisciplinary treatment program (MMR), either within primary care (MMR1) or hospital care (MMR2). METHODS: The study had a descriptive and comparative cross sectional design. Eighty-nine patients were recruited consecutively when they were about to start their team treatment (50 in MMR1,39 in MMR2). The measurements were; Evaluation of self-reported self-efficacy for eight daily activities (STIVA-8), The Pain Belief Screening Instrument (PBSI) and Hospital Anxiety and Depression Scale (HADS). RESULTS: The study found some significant differences between the answers from patients in MMR1 and those from patients in MMR2. For instance, patients in MMR2 estimated lower self-efficacy according to STIVA-8 than patients in MMR1. Also, there were fewer low risk patients and more high risk patients in MMR2 than in MMR1 regarding pain intensity according to PBSI. In addition to this, there were fewer patients without depression and more with moderate depression in MMR2 than in MMR1 according to HADS. No significant differences could be shown for either anxiety according to HADS or for low- and high risk regarding activity disability according to PBSI. No significant differences could be found when pain intensity was measured with mean values on a scale from 0-10. CONCLUSIONS: Patients in MMR2 experienced more negative consequences from their pain disease than patients in MMR1. Systematic use of standardized self-reported instruments for selected prognostic factors could be helpful when screening for complexity and make it easier to decide whether the rehabilitation should be within MMR1 or MMR2 for patients in need of MMR. / Sammanfattning SYFTE: Syftet med denna studie var att beskriva och jämföra om patienter med långvarig smärtproblematik inom primärvård (MMR1) respektive specialiserad sjukhusvård (MMR2), som stod i begrepp att påbörja multimodal smärtrehabilitering (MMR), skattade olika avseende ett antal prognostiska faktorer för funktionsförmåga. METOD: Studien hade en deskriptiv och komparativ tvärsnittsdesign. Åttionio konsekutivt tillfrågade patienter deltog (50 i MMR1, 39 i MMR2). Datainsamlingen gjordes vid start av MMR med tre självskattningsformulär; Skattning av tilltro till sin förmåga att utföra åtta specificerade vardagsaktiviteter (STIVA-8), The Pain Belief Screening Instrument (PBSI) och Hospital Anxiety and Depression Scale (HADS). RESULTAT: Studien visade statistiskt signifikanta skillnader avseende att patienterna i MMR2 skattade lägre tilltro till sin förmåga enligt STIVA-8, det var färre andel lågriskpatienter och större andel högriskpatienter i MMR2 avseende smärtintensitet enligt PBSI samt färre andel patienter utan depression i MMR2 och fler med måttliga depressionsbesvär i MMR2 enligt HADS. Inga signifikanta skillnader kunde visas avseende låg- och högrisk för aktivitetsbegränsning enligt PBSI och inte heller för ångest enligt HADS. När smärtintensitet beräknades med medelvärde på skalan 0-10 fanns inga signifikanta skillnader. KONKLUSION: Patienterna i MMR2 skattade mer negativa konsekvenser av sin smärtsjukdom än i MMR1. Systematisk användning av skattningsformulär som ringar in olika prognostiska faktorer bör kunna underlätta selektion och sortering vid val av vårdnivå för patienter i behov av MMR.

Bakgrund: Långvarig smärta är ett stort folkhälsoproblem både internationellt och i Sverige. I Sverige används uttrycket kronisk smärta för att benämna långvarig smärta men det anses idag olämpligt eftersom ordet ”kronisk” associeras med livslång och obotlig smärta. Ofta har personer med långvarig smärta svårt att uttrycka sig och dela sina smärtsamma känslor för någon annan därför känner de sig irriterade, frustrerade, missförstådda, deprimerade. Att lindra lidande hos personer med långvarig smärta är en av sjuksköterskans viktigaste uppgifter. För att kunna förstå hur sjuksköterskan bör hjälpa dessa patienter är det viktigt att studera patienternas upplevelser. Syfte: Syftet med denna studie är att beskriva patientens upplevelser av långvarig smärta Metod: Metoden är en litteraturstudie och baserad på tio kvalitativa artiklar som är publicerade mellan åren 1995-2011. Databaserna som använts är CINAHL, PubMed och Medline. Dataanalysen influerades av Fribergs (2006) bok, Dags för uppsats. Resultat: Resultatet är baserat på fyra huvudkategorier och varje huvudkategori har subkategorier förutom den sista huvudkategorin. I den första huvudkategorin, ”Förändringar i det sociala livet”, beskriver författarna hur en individs sociala liv påverkas av långvarig smärta i förhållande till hans eller hennes familj, vänner och arbete. I övriga huvudkategorier och sex subkategorier redogörs patientens olika känslor och strategier samt dennes upplevelser av vården vid långvarig smärta. Diskussion: Här diskuterar författarna studiens resultat och försöker hålla sig så nära som möjligt till syftet och dessutom kopplar författarna det till Joyce Travelbees omvårdnadsteori om lidande, hopp, sympati och kommunikation.