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<p>Based on a biopsychosocial model of mammography pain, the current study assessed if specific biological and psychosocial factors were associated with higher reported mammography pain in early stage breast cancer survivors. One hundred and twenty-seven women completed questionnaires assessing demographic information, cancer treatment history, ongoing breast pain, mammography-related anxiety, and social support immediately prior to receiving a mammogram. They then completed questionnaires assessing mammography pain and mammography-related pain catastrophizing immediately following the mammogram. Using path modeling and mediation analyses, relations among these variables were examined. Results revealed that mammography-related pain catastrophizing was related to higher mammography pain directly, while ongoing breast pain, lower social support quantity, and lower perceived quality of social support related to higher mammography pain indirectly through mammography-related pain catastrophizing. Moderated mediation analyses found that the mediation effects of mammography-related pain catastrophizing were significantly different at varying levels of perceived quality of social support, with more pronounced negative effects for those with higher quality support than those with lower quality support. The theoretical, clinical, and research implications of these findings are discussed.</p> / Dissertation

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes. Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). Psychosocial constructs that have yet to be examined in patients with FAI include self-efficacy, kinesophobia, and pain catastrophizing. The Pain Self-Efficacy Questionnaire (PSEQ) gauges an individual’s confidence, or self-efficacy, in their ability to complete tasks despite their current pain. Previous research has established that a patient’s self-efficacy is an important determinant of long-term success following orthopedic surgery. Kinesophobia, measured via the Tampa Scale for Kinesiophobia (TSK), is a measure of movement-related fear. In contrast to self-efficacy, fear of movement has been identified as a predictor of early success following orthopedic surgery. Lastly, pain catastrophizing is a set of maladaptive behaviors including ruminating on pain, feeling helpless to overcome painful situations, and magnifying the circumstances surrounding the painful experience. Catastrophizing behaviors, measured via the Pain Catastrophizing Scale (PCS), have been repeatedly linked to increased pain and decreased functionality in a variety of orthopedic populations. To date, the relationship between these psychosocial variables and pain has not been examined in patients with FAI. The primary aim of this dissertation was to evaluate the role of psychosocial factors on pre and postoperative pain in patients with FAI undergoing hip arthroscopy. To accomplish this aim we performed a series of three studies. The first study was a retrospective chart review to determine the prevalence of mental health disorders and compare preoperative clinical presentation between patients with and without mental health disorders. The second was a cross-sectional study designed to determine if any psychosocial variables could predict preoperative hip pain. The final study utilized a longitudinal, cohort design. Patients were tested preoperatively and at 12-weeks postoperative. The primary outcomes measured were self-efficacy, kinesiophobia, pain catastrophizing, and hip pain at rest and during activity measured via a visual analog scale (VAS). The purpose of this study was to determine the effect of preoperative psychosocial variables on postoperative pain, and to determine if these variables were predictive of persistent postoperative pain three months following hip arthroscopy. Based on the results from these studies we can conclude the following: 1) Mental health disorders are more common in patients with FAI than other orthopedic populations, and self-reported pain and function are worse in this subset of patients, but neither symptom chronicity nor the severity of joint deformity differs; 2) Low self-efficacy is predictive of worse preoperative pain in patients with FAI; and 3) Patients with high preoperative pain catastrophizing or low self-efficacy are more likely to have increased postoperative pain. Low preoperative self-efficacy is predictive of persistent hip pain during activity three months following hip arthroscopy, while low self-efficacy and mental health disorders are predictive of persistent hip pain at rest. Future studies are necessary to develop and implement interventions targeting low self-efficacy and elevated catastrophizing in patients undergoing hip arthroscopy to improve patient outcomes for this high-risk group.

Tyrimo tikslas: įvertinti skausmo sureikšminimo ir judesių baimės įtaką kelio sąnario funkcijai antruoju reabilitacijos etapu po kelio sąnario operacijų. Uždaviniai: 1. Įvertinti skausmo sureikšminimo ir judesių baimės lygį prieš ir po reabilitacijos; 2. Įvertinti kūno funkcijų ir veiklos sutrikimus prieš ir po reabilitacijos; 3. Įvertinti skausmo sureikšminimo įtaką kelio sąnario funkcijos atsigavimui; 4. Įvertinti judesių baimės įtaką kelio sąnario funkcijos atsigavimui; 5. Įvertinti kineziterapeutų požiūrį į psichologinių veiksnių vertinimą kineziterapeuto darbe. Tyrimo metodai: buvo atlikti du tyrimai. Pirmo tyrimo tikslas buvo įvertinti skausmo sureikšminimo ir judesių baimės įtaką kelio sąnario funkcijai antruoju reabilitacijos etapu po kelio sąnario operacijų. Tyrime dalyvavo 41 tiriamasis, 22 pacientai po priekinių kryžminių raiščių operacijos ir 19 pacientų po meniskų operacijos. Prieš ir po reabilitacijos buvo vertinami tiriamųjų skausmo sureikšminimo ir judesių baimės lygis, skausmo intensyvumas, judesių amplitudė, raumenų jėga ir kelio sąnario funkcinė būklė. Antro tyrimo tikslas buvo įvertinti kineziterapeutų požiūrį į psichologinių veiksnių vertinimą kineziterapeuto darbe. Buvo sudaryti klausimai ir atlikta anoniminė anketinė apklausa. Tyrime dalyvavo 98 kineziterapeutai, dirbantys pagal specialybę ir su suaugusiais žmonėmis. Išvados: 1. Pasibaigus reabilitacijai, pacientams po kelio sąnario operacijų skausmo sureikšminimo ir judesių baimės lygis sumažėjo (p<0,0... [toliau žr. visą tekstą] / The aim of research: to assess the association of pain catastrophizing and fear of movement with knee joint function after knee joint surgery during the second stage of rehabilitation. The tasks of research: 1. To assess the level of pain catastrophizing and fear of movement before and after rehabilitation. 2. To assess body function and activities limitations before and after rehabilitation. 3. To assess the association of pain catastrophizing with knee joint function recovery. 4. To assess the association of fear of movement with knee joint function recovery. 5. To assess physical therapists attitudes toward psychological factors assessment in physical therapist practise. The methods of the research: this research focuses on two studies. The aim of the first study – to assess the association of pain catastrophizing and fear of movement with knee joint function after knee joint surgery during the second stage of rehabilitation. The study involved 41 participants, 21 of them after anterior cruciate ligament reconstruction and 19 after meniscus surgery. Before and after rehabilitation participant‘s level of pain catastrophizing and fear of movement, pain intensity, range of motion, muscle strenght and subjective knee joint function were assessed. The aim of the second study – to assess physical therapists attitudes toward psychological factors assessment. The anonymous survey of physical therapists attitudes was conducted. The study involved 98 physical therapists, which are... [to full text]

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

abstract: The present study examined the association of pain intensity and goal progress in a community sample of 132 adults with chronic pain who participated in a 21 day diary study. Multilevel modeling was employed to investigate the effect of morning pain intensity on evening goal progress as mediated by pain's interference with afternoon goal pursuit. Moderation effects of pain acceptance and pain catastrophizing on the associations between pain and interference with both work and lifestyle goal pursuit were also tested. The results showed that the relationship between morning pain and pain's interference with work goal pursuit in the afternoon was significantly moderated by a pain acceptance. In addition, it was found that the mediated effect differed across levels of pain acceptance; that is: (1) there was a significant mediation effect when pain acceptance was at its mean and one standard deviation below the mean; but (2) there was no mediation effect when pain acceptance was one standard deviation above the mean. It appears that high pain acceptance significantly attenuates the power of nociception in disrupting one's work goal pursuit. However, in the lifestyle goal model, none of the moderators were significant nor was there a significant association between pain interference with goal pursuit and goal progress. Only morning pain intensity significantly predicted afternoon interference with lifestyle goal pursuit. Further interpretation of the present findings and potential explanations of those inconsistencies are elaborated on discussion. Limitations and the clinical implication of the current study were considered, along with suggestions for future studies. / Dissertation/Thesis / M.A. Psychology 2014

Background: Intra-articular corticosteroid injections (IACI) are a commonly used treatment for painful knee osteoarthritis (OA). Response to treatment varies the reason for which is unclear. Further there are no data concerning the impact of accuracy of injection and psychological factors including illness perceptions, pain catastrophizing and depression on outcome following IACI.Objectives: i) to undertake a systematic review looking at predictors of response to IACI in patients with symptomatic knee OA and, ii) to determine the role of psychological factors and accuracy of injection in predicting response to IACI.Methods: A systematic review was conducted using electronic databases for randomised trials and observational studies looking at predictors of response to IACI in knee and hip OA. An observational study of 141 consenting patients (105 primary OA and 36 secondary OA in the context of well controlled rheumatoid arthritis) receiving routine IACI as part of clinical care for knee OA was conducted including baseline assessment and outcome assessments at 3 and 9 weeks. Response was defined as at least 40% reduction of pain from baseline, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Assessment included ultrasound (US) for features of synovial inflammation), radiographs, and assessment of psychological factors including the revised illness perception questionnaire (IPQR). Accuracy of injection was assessed using US. Characteristics of responders and non-responders to IACI at 3 and 9 weeks were determined using univariate statistics and significant factors entered into logistic regression models. Results: The systematic review found no consistent evidence for any disease or non-disease related predictor of response and no systematic exploration of the effects of psychological factors or accuracy of injection on treatment response. In the observational study, 83 (53%) of 141 subjects were responders to IACI at 3 weeks and 56 (44%) at 9 weeks. In univariate analysis, responders to treatment had higher scores for the IPQR domain treatment control and lower scores for IPQR consequences, depression and pain catastrophizing at both 3 and 9 weeks. Physical and patient related factors, including accuracy of injection and US features, were not associated with outcome, with the exceptions of higher baseline pain and previous experience of injection being associated with non-response at 9 weeks. In multiple regression, treatment control was the only independent predictor of response at 3 weeks. At 9 weeks, treatment control, consequences and depression were independent predictors of treatment outcome. Conclusion: In this observational study illness perceptions and depression predicted the outcome of IACI at 3 and 9 weeks. By contrast, physical factors including accuracy of injection did not influence outcome. Further work is needed to replicate these findings and elucidate mechanisms for these effects.

Class of 2013 Abstract / Specific Aims: To assess influence of PCS and FPQ-III on pain tolerance as well as SNPs TRPA1(rs11988795), COMT (rs4646312, rs6269) and FAAH(rs 932816, rs4141964, rs2295633). Methods: A Pain Catastrophizing Scale (PCS) and Fear of Pain Questionnaire (FPQ-III) were completed by a total of 89 healthy adults. A genetic analysis from cheek swabs was performed for single nucleotide polymorphisms(SNPs) within genes: TRPA1, COMT, and FAAH. A cold-pressor test involving the non-dominant hand inserted in circulating water kept at 1-3 degrees Celsius was used and the duration of time subjects were able to leave their hand in the water (pain tolerance) was measured as the primary outcome. Linear regression analysis was used to identify predictors of pain tolerance. Main Results: The subjects were 58% female, the majority were Caucasian (51%) with 26% Asian, 14% Hispanic and 9% other. The mean pain tolerance was 121 ± 66 seconds and regression analysis showed female sex (p=0.001), Asian race (p=0.001), PCS score (<0.001) and FPQ-III score (p=0.014) were associated with decreased pain tolerance while the SNPs were not.      Conclusion: Psychological factors and patient demographics are associated with pain tolerance but the single nucleotide polymorphisms evaluated were not. Future pain studies should utilize a psychological assessment to adjust for this as a confounder.

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