Thesis (Ph. D.)--School of Education. University of Missouri--Kansas City, 2004. / "A dissertation in counseling psychology." Advisor: Alan G. Glaros. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed May 30, 2006. Includes bibliographical references (leaves 172-177 ). Online version of the print edition.

This thesis investigated treatment outcomes and processes in young people with chronic pain. The first chapter describes a systematic review, which examined the effectiveness of acceptance and mindfulness-based interventions in improving pain-related outcomes in young people. Secondary aims were to review changes in proposed treatment processes following the interventions, and to compare the effectiveness of these interventions to control conditions. Although there was evidence to suggest that these treatments may improve outcomes, particularly levels of daily functioning, further research is needed to adequately assess the utility of acceptance and mindfulness-based approaches with paediatric chronic pain populations. The second chapter details a cross-sectional study of contextual and cognitive processes in adolescents with chronic pain. Specifically, the study tested the mediating effects of acceptance, catastrophising and kinesiophobia in the relationship between pain intensity and indicators of adjustment. Both acceptance and kinesiophobia mediated the effects of pain intensity on disability and quality of life, while catastrophising mediated the effect of pain intensity on levels of anxiety and depression. The results demonstrated that both contextual and cognitive factors are important determinants of young people’s well-being. Future research would benefit from gaining a greater understanding of how these processes interact with each other to affect pain-related outcomes.

Class of 2017 Abstract / Objectives: To identify studies that have been conducted on pain self-management interventions to describe the strategies used in the treatment of pain Methods: Eligible studies were determined using a study inclusion-screening tool. To be eligible, studies needed to be randomized controlled trials comparing some type of self-management intervention to an alternative or usual care. Once determined to be eligible, selected studies were analyzed by two investigators using a consensus procedure and full article data extraction form which collected data on the study characteristics, patient characteristics, self-management strategies and relevant study outcomes. Results: The chronic pain management strategies from the 14 randomized controlled trials used in this study included: acupuncture, mobile based intervention, yoga, meditation/relaxation techniques, cupping therapy, musical therapy, cognitive behavioral therapy, physical therapy and self-management therapies. All studies showed a statistically significant reduction in pain from baseline, however, the effect size ranged from very small (0.02) to quite large (2.2). Conclusions: Most studies showed a meaningful reduction in pain, hence, a wide variety of self-management strategies are available for managing pain.

Class of 2017 Abstract / Objectives: The purpose of this systematic review was to identify the types of management strategies reported by individuals with chronic pain to manage chronic pain, the average number of strategies used, outcomes, and side effects. Methods: To be included in the systematic review, reports of population surveys of adult patients with chronic pain, as defined by the authors, had to be published in English, include chronic pain from any cause, and include information on the treatment strategies used by respondents. Search terms included “pain,” “self-care,” “self management,” “self treatment,” and “adult” and the search strategy included systematic searches of Pubmed, Embase, Cochrane Library, PsycINFO, CINAHL, Web of Science, International Pharmaceutical Abstracts, searches of reference lists, and citation searches as well as key websites such as the CDC and NIH. Results: A total of 13 study reports were identified. Sample size ranged from 103 to 4839; mean age ranged from 42 to 81 and 51 to 69% female. All reports included information on medications used to manage pain; 6 reported other medical strategies; 9 reported physical strategies; 6 reported psychological strategies; and 11 reported non- medical strategies. Only 4 studies reported some data on the number of strategies used; one study reported 23% used 6 or more medications, another reported 51% used 3 or more strategies. Six studies reported some type of outcome; including inadequate control of pain (40%) or good relief (87%), and 36% as effective in a third study. Few side effects were reported; two studies reported constipation, nausea and vomiting. Conclusions: Population-based surveys of chronic pain have identified a large number of strategies used to manage pain, however they provide little information on the average number of strategies used, the effectiveness of the strategies, or resulting side effects.

Pain is a sensory experience associated with physical discomfort that is influenced by cognition and emotion and has been linked to an increased risk for aggression. The purpose of the current study was to examine the association between pain and aggression under controlled laboratory conditions using both experimental and non-experimental approaches. The aims of the study were two-fold. First, to manipulate perceived pain tolerance via faux feedback and then observe whether aggression differs as a function of this pain perception manipulation using a laboratory analogue of aggression. Second, to examine whether self-ratings of pain sensitivity and behavioral measures of pain are associated with self-reported or behavioral assessment of aggression. Eighty-three men and women were randomly assigned to one of three conditions: A high pain tolerance feedback group, a low pain tolerance feedback group, and a no pain tolerance feedback (control) group. Participants completed self-report ratings of pain and aggression, including the Life History of Aggression: Aggression subscale, the Buss Perry Aggression Questionnaire: Physical Aggression subscale, and the Pain Sensitivity Questionnaire. Participants then completed an algometer pressure pain task and immediately received high or low pain tolerance feedback (or no feedback) before engaging in an electric shock pain tolerance procedure and subsequently participating in a laboratory task of aggression against an increasingly provocative fictitious "opponent" during a competitive reaction-time task (i.e., the Taylor Aggression Paradigm; TAP). Aggression was operationalized both as the average shock and the number of "extreme" shocks administered to the opponent. The latter were ostensibly twice the opponent's pain threshold. Results indicated that, contrary to the main prediction, individuals who received high pain tolerance feedback tended to select lower mean shocks as provocation increased. Pain sensitivity was also positively related to TAP aggression. These results are consistent with the literature suggesting that low perceived pain tolerance is associated with aggression. However, pressure pain tolerance was positively associated with self-reported aggression, suggesting that the association between pain and aggression is complex, may involve multiple pathways, and is dependent on the method used to assess pain and aggression.

Recent studies have shown the efficacy and practicality of the integration of complementary and alternative therapies and biomedical treatments for various diseases and illnesses, including high blood pressure, diabetes, epilepsy, and cancer. Saper et al. (2013) demonstrated that once-weekly yoga classes were equally as effective for relieving chronic low back pain in low-income, minority populations than twice-weekly yoga classes. Pain medication data collected from this 12-week study was used to examine the effect of yoga on analgesic use. Pain medications were categorized into four major groups: (1) acetaminophen, (2) opiates, (3) non-steroidal anti-inflammatory drugs (NSAIDS), and (4) other. The average number of NSAID pills taken daily decreased from baseline to 12 weeks. In addition, there was no statistically significant difference in the average number of any type of analgesic taken between once- and twice-weekly yoga groups from baseline to 12 weeks. Our findings suggest that yoga is most useful for individuals with mild to moderate chronic low back pain; however, further studies with more powerful sample sizes must be conducted in order to make more precise conclusions.

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Indiana University-Purdue University Indianapolis (IUPUI) / Older adults with persistent pain experience reduced physical functioning, increased disability, and higher rates of depression. Previous research suggests that different types of positive and negative expectancies (e.g., optimism and hopelessness) may be associated with the severity of these pain-related outcomes. Moreover, different types of expectancies may interact with perceived control to predict these outcomes. However, it is unclear whether different types of expectancies are uniquely predictive of changes in pain-related outcomes over time in older adults and whether perceived control moderates these relationships. The primary aims of the current study were to 1) examine how the shared and unique aspects of optimism and hopelessness differentially predict changes in pain-related outcomes (i.e., pain severity, pain interference, disability, and depressive symptoms) in older adults experiencing persistent pain over a 10-year and 2-year timeframe and 2) examine whether perceptions of control over one’s health moderate these relationships. The present study sampled older adults with persistent pain who participated in a nationally representative, longitudinal study (i.e., The Health and Retirement Study) at three timepoints across a 10-year period. First, confirmatory factor analyses (CFA) were conducted to determine appropriate modeling of expectancy variables. Second, mixed latent and measured variable path analyses were created to examine the unique relationships between expectancy variables and changes in pain-related outcomes over both a 10- year and 2-year period. Finally, mixed latent and measured variable path analyses and PROCESS were used to test perceived control as moderator of the relationships between expectancy variables and changes in pain-related outcomes over time. CFA results suggested that measures of optimism and hopelessness were best understood in terms of their valence, as positive (i.e., optimism) or negative (i.e., pessimism and hopelessness) expectations. Results from path analyses suggested that only negative, not positive, expectancies were significantly associated with worsening pain severity, pain interference, disability, and depressive symptoms across both 10-year and 2-year periods. Moderation analyses demonstrated inconsistent results and difficulties with replication. However, post-hoc path analyses found that perceptions of control over one’s health independently predicted some changes in pain-related outcomes over time, even when controlling for expectancies. Altogether, the current findings expand our knowledge of the associations between expectancies and pain by suggesting that negative expectancies are predictive of changes in mental and physical pain-related outcomes across years of time. The current study also suggests that positive and negative expectancies may be related, but distinct factors in older adults with persistent pain and that health-related perceived control may be predictive of changes in pain over time. The current discussion reviews these extensions of our current knowledge in greater detail, discusses the potential mechanisms driving these relationships through a theoretical lens, and identifies the implications of this work.

Veterans experience chronic pain at a rate twice higher than civilians. Brain fog (BF), a phenomenon of mental cloudiness associated with functional challenges in cognition, is one of the least studied symptoms of chronic pain. Pain interference, a construct of chronic pain, can limit participation with activities. Both BF and pain interference can disrupt quality of life (QoL) in Veterans by limiting health and meaningful participation. The relationship between BF and pain interference on QoL has not been investigated. Thus, the objective of this study is twofold: 1) understand the experience and 2) explore the impacts and the possible mitigation of pain interference of BF on the QoL, in Veterans with pain symptoms and BF. First, a qualitative descriptive method was employed using content and matrix analyses, to describe the impacts of brain fog on QoL in Veterans with BF and pain symptoms. The content analysis revealed the triggers, impacts, management strategies, and suggestions for healthcare professionals. The matrix analysis showed that women described difficulty managing BF with competing roles (e.g., motherly duties). Next, we conducted a cross-sectional study Veterans, exploring whether the perceived level of pain interference in Veterans with BF and pain symptoms affected measures of QoL. Results indicated Veterans with BF and high pain interference showed more mental health symptoms (p=0.003), and less perceived level of confidence with abilities (0.036) and physical health (p=0.003), than Veterans with BF and low pain interference. Post-hoc tests revealed no significant differences across gender. Next, to explore how QoL constructs we related, we performed an exploratory correlational analysis, revealing significant correlations between perceived level of confidence with abilities and 1) mental health (r=-0.48), 2) physical health (r=-0.44), and 3) functional cognition (-0.44). This study contributes to the overall knowledge of BF, guiding recommendations for the development of an assessment and research priorities. / Thesis / Master of Science (MS) / ‘Brain fog,’ a symptom seen in chronic pain, is described as feelings of mental cloudiness. Veterans may experience brain fog and pain symptoms more often than civilians. We wanted to learn about the experience of brain fog and how it affects the lives of Veterans with pain symptoms. First, we used a qualitative study to explore their experiences. Veterans told us about the impacts, triggers, and management strategies related to brain fog. Then, to understand the impact of brain fog on Veteran’s quality of life, three related factors were used (health-related quality of life, functional cognition, and perceived confidence with abilities), evaluated in terms of how much pain symptoms interfered with functioning. Veterans with brain fog and high pain interference had more mental health symptoms, and poorer physical health and confidence with their abilities. Overall, this study will hopefully provide some insight into how to better support Veterans.

Yes / Medical cannabis is one of the most commonly reported therapeutic treatments sought for chronic pain. The wide acceptance and research in alternative medicine has put medical cannabis in the limelight, where researchers are widely examining the therapeutic benefits of medical cannabis and its association to treat chronic pain. The purpose of this scoping review is to provide an overview of the perspectives on CBD as an alternative treatment for chronic pain among health professionals and legal cannabis users.