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Psychological Flexibility and Adjustment to Chronic Pain

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 18448

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Dr. Rosa Esteve-Zarazaga

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Guest Editor

Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Málaga, 29071 Málaga, Spain
Interests: psychology; pain management; pain assessment; chronic pain; back pain; pain research; personality inventory; structural equation modeling; LISREL

Dr. Carmen Ramírez-Maestre

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Assistant Guest Editor

Special Issue Information

Dear Colleagues,

The concept of psychological flexibility unfolds through six core processes: acceptance, present-focused awareness, cognitive defusion, self-as-observer, values, and committed action. The term “psychological flexibility” probably first appeared in a paper on chronic pain in 2006. Since then, numerous studies have demonstrated the enormous heuristic power of this theoretical model, its ability to integrate fragmentary and redundant concepts, as well as its efficacy and efficiency in clinical intervention in patients with chronic pain. However, there is still a long way to go. Of its six constituent processes, the most studied have been acceptance and values-based action. However, little attention to date has been paid to the other processes in the field of chronic pain. Further tests must be conducted on the validity and utility of all the components of the flexibility model and its explanatory power within the treatment context. Moreover, the assessment tools that measure these processes need further refinement in order to avoid content overlap. Finally, research is needed to optimize the delivery of Acceptance and Commitment Therapy in the context of chronic pain to strengthen the maintenance of therapeutic gains. In this Special Issue, we invite researchers working in the field of chronic pain to submit high-quality empirical papers or systematic reviews related to psychological flexibility and chronic pain.

Dr. Rosa Esteve-Zarazaga
Dr. Carmen Ramírez-Maestre
Guest Editors

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Keywords

chronic pain
psychological flexibility
pain acceptance
Acceptance and Commitment Therapy
present-focused awareness
cognitive defusion
self-as-observer
values
committed action

Published Papers (7 papers)

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Research

11 pages, 471 KiB

Open AccessArticle

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

by Miguel A. Vallejo, Laura Vallejo-Slocker, Martin Offenbaecher, Jameson K. Hirsch, Loren L. Toussaint, Niko Kohls, Fuschia Sirois and Javier Rivera

Int. J. Environ. Res. Public Health 2021, 18(14), 7300; https://doi.org/10.3390/ijerph18147300 - 08 Jul 2021

Cited by 3 | Viewed by 2396

Abstract

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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18 pages, 1205 KiB

Open AccessArticle

Activity Patterns and Functioning. A Contextual–Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

by Cecilia Peñacoba, Maria Ángeles Pastor-Mira, Carlos Suso-Ribera, Patricia Catalá, Ainara Nardi-Rodríguez and Sofía López-Roig

Int. J. Environ. Res. Public Health 2021, 18(10), 5394; https://doi.org/10.3390/ijerph18105394 - 18 May 2021

Cited by 8 | Viewed by 2076

Abstract

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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12 pages, 626 KiB

Open AccessArticle

Pain Acceptance Creates an Emotional Context That Protects against the Misuse of Prescription Opioids: A Study in a Sample of Patients with Chronic Noncancer Pain

by Rosa Esteve, Estefanía Marcos, Ángela Reyes-Pérez, Alicia E. López-Martínez and Carmen Ramírez-Maestre

Int. J. Environ. Res. Public Health 2021, 18(6), 3054; https://doi.org/10.3390/ijerph18063054 - 16 Mar 2021

Cited by 7 | Viewed by 2363

Abstract

There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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14 pages, 2290 KiB

Open AccessArticle

The Role of Perfectionistic Self-Presentation in Pediatric Pain

by Elisabet Sánchez-Rodríguez, Alexandra Ferreira-Valente, Anupa Pathak, Ester Solé, Saurab Sharma, Mark P. Jensen and Jordi Miró

Int. J. Environ. Res. Public Health 2021, 18(2), 591; https://doi.org/10.3390/ijerph18020591 - 12 Jan 2021

Cited by 2 | Viewed by 2762

Abstract

This study sought to better understand the associations between perfectionistic self-presentation and measures of pain intensity, pain catastrophizing, pain interference, and fatigue in children and adolescents with pain. In the study, 218 adolescents responded to measures of perfectionistic self-presentation (i.e., perfectionistic self-promotion, nondisplay of imperfection and nondisclosure of imperfection), pain intensity, pain catastrophizing, pain interference, and fatigue. Four hierarchical regression analyses and three mediation analyses were conducted. Our results showed that perfectionistic self-promotion was significantly and independently associated with pain intensity and that nondisplay of imperfection was significantly and independently associated with pain catastrophizing, pain interference, and fatigue. Nondisclosure of imperfection was not significantly associated with any criterion variable. Pain catastrophizing mediated the association between both perfectionistic self-presentation and nondisplay imperfection and pain interference but not between nondisclosure of imperfection and pain interference. The findings provide new information about the role of perfectionistic self-presentation in children and adolescents’ experience of pain. These findings, if replicated, support perfectionism as a potential target of pain treatment in young people. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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11 pages, 349 KiB

Open AccessArticle

Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain

by Tsukasa Kato

Int. J. Environ. Res. Public Health 2020, 17(20), 7426; https://doi.org/10.3390/ijerph17207426 - 12 Oct 2020

Cited by 11 | Viewed by 2392

Abstract

Background: Psychological inflexibility based on an acceptance and commitment therapy model is theoretically well-established as a process to exacerbate psychological distress, such as depressive symptoms and sleep disturbance. This study aimed to examine the associations of psychological inflexibility with depressive symptoms and sleep distribution. We hypothesized that psychological inflexibility would be associated with higher levels of depressive symptoms and sleep disturbance in women with chronic pain. Methods: Female college students in Japan answered a questionnaire on pain status, treatment, and psychological inflexibility as measured by the Acceptance and Action Questionnaire-Ⅱ before answering questionnaires on depressive symptoms and sleep disturbance eight months after. Results: Women with chronic pain (n = 320) reported more severe depressive symptoms and sleep disturbances compared to women without chronic pain (n = 90). Hierarchical multiple regressions revealed that psychological inflexibility predicted higher levels of depressive symptoms and sleep disturbance, independent of the pain intensity, whether they consulted a doctor or used pain medication. Conclusion: Based on our findings self-management interventions aimed at reducing psychological inflexibility should be developed for individuals who are experiencing chronic pain. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

15 pages, 854 KiB

Open AccessArticle

Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age

by Carmen Ramírez-Maestre, Ángela Reyes-Pérez, Rosa Esteve, Alicia E. López-Martínez, Sonia Bernardes and Mark P. Jensen

Int. J. Environ. Res. Public Health 2020, 17(17), 6428; https://doi.org/10.3390/ijerph17176428 - 03 Sep 2020

Cited by 10 | Viewed by 3524

Abstract

Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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12 pages, 722 KiB

Open AccessFeature PaperArticle

Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain

by Rosa Esteve, Alicia Eva López-Martínez, Gema Teresa Ruíz-Párraga, Elena Rocío Serrano-Ibáñez and Carmen Ramírez-Maestre

Int. J. Environ. Res. Public Health 2020, 17(15), 5556; https://doi.org/10.3390/ijerph17155556 - 31 Jul 2020

Cited by 6 | Viewed by 2222

Abstract

Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake. Full article

(This article belongs to the Special Issue Psychological Flexibility and Adjustment to Chronic Pain)

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