Startseite To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale
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To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale

  • Pernilla Abrahamsson EMAIL logo , Katja Boersma und Monica Buhrman
Veröffentlicht/Copyright: 4. November 2024
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Scandinavian Journal of Pain
Aus der Zeitschrift Scandinavian Journal of Pain Band 24 Heft 1

Abstract

Objectives

Inflexibly relying on avoidance of expression may increase and perpetuate pain-related emotional distress in patients with chronic pain. The context-insensitive avoidance (CIA) scale was recently developed to measure the degree to which patients avoid expressing their pain and distress in social situations. This study explored the psychometric properties of the CIA scale in a new sample.

Methods

This study uses baseline data from a treatment trial for n = 115 patients with chronic pain and co-occurring emotional distress. Reliability and construct and criteria validity were studied using the same instruments as in the original psychometric study and further explored in two new measures. A series of multiple regression analyses were conducted to assess the relationship between the CIA scale and criteria variables compared to the other psychological constructs.

Results

The CIA scale showed good reliability. Significant correlations between high scores on the CIA scale and low scores on self-compassion and activity engagement could be replicated. Significant correlations between high scores on the CIA scale and high scores of pain intensity and pain interference could also be replicated. In the exploring part of this study, validity was extended to general problems with emotion regulation and to satisfaction with life in general and contact with friends but not to satisfaction with family, partner, or sexual life. Avoidance of expression was the only significant predictor of pain intensity.

Conclusion

This study could replicate acceptable psychometric properties of a scale measuring CIA of expression. As in the original study, avoidance of expression was associated with increased suffering. Clinically, this instrument may be used to identify patients who may otherwise remain in aggravating silence. Theoretically, it introduces the important concept of context sensitivity to the field of chronic pain. Limitations include uncertainty about causal relationships, and that several important social situations were not examined.

Keywords: chronic pain; emotion; context sensitivity; avoidance; communication

1 Introduction

The social dimension of the biopsychosocial model of chronic pain highlights that pain is not just a private experience, but socially contextualized, experienced, and expressed within social environments and relationships [1]. A central interpersonal function of communicating pain is to receive understanding and validation of one’s inner experiences [2]. Such validating support has been found to soothe and downregulate emotional distress [3]. As sharing can be adaptive in certain circumstances but not in others, being able to attune the expression of pain and distress to the social context is an important skill [4].

Talking about pain and suffering can be difficult, and chronic pain patients report significantly higher levels of self-conscious emotions such as shame, defeat, and fear of negative evaluation compared to healthy controls [5,6,7,8]. Negative self-conscious emotions have been related to pain interference, sleep disturbance, anxiety, depression, and functional and psychosocial disabilities [8,9]. Behaviorally, patients often report that they stay silent to avoid misunderstanding and stigmatization by others, believing that their pain could be perceived by others as illegitimate and not socially acceptable [10]. Thus, while getting pain acknowledged by others is a basic human need, fear of rejection is a crucial issue for chronic pain patients and avoidance of expression is a common behavioral response [11].

Inflexibly relying on behavioral strategies such as avoidance of expression may increase and perpetuate pain-related emotional distress. Indeed, patients who report low self-efficacy in pain communication also have high levels of pain catastrophizing [12]. Social relations are central to successful emotional regulation, and this includes the ability to flexibly adapt to social cues and demands. Bonanno and Burton [13] referred to this ability as context sensitivity, defined as “the degree to which a response is in tune with the ever-changing demands of the context.” To capture this social dimension of pain, Flink et al. [14] developed the context insensitivity avoidance (CIA) scale. It measures avoidance of expression - the degree to which patients hide or avoid expressing their pain and distress in social contexts linked to a range of social emotions and perceived consequences. They found that high scores on the CIA scale were significantly related to higher ratings of catastrophizing, pain intensity, and pain disability and to lower levels of self-compassion, acceptance, and emotion regulation. Thus, this instrument may capture an aspect of the pain experience that is linked to more pain problems and negative interpersonal consequences. Being able to identify avoidance of expression of pain and distress could be important to improve interventions for patients who feel silenced or unsure of how to express themselves. As this instrument is new, the aim of this article is to investigate if psychometric properties can be replicated in a new sample of chronic pain patients with high levels of distress. Because emotional distress often co-occurs in patients with chronic pain, they form an important subgroup [15] for further exploration of this instrument. Two new measures were added in the exploring part of this study. Our research questions were:

  1. Can internal consistency and construct and criterion validity of the CIA scale be replicated?

  2. Can the construct validity of the CIA scale be extended to general emotion regulation difficulties?

  3. Can the criterion validity of the CIA scale be extended to general and social life satisfaction?

  4. Does the CIA scale explain any unique variance in the criterion variables?

Our hypotheses were as follows: the internal consistency of the scale would be high and construct validity would be replicated with small to moderate correlations with pain catastrophizing (positive), self-compassion (negative), and activity engagement (AE) (negative); criterion validity would be replicated with moderate (positive) correlations between CIA and pain intensity and pain interference; pain willingness (PW) could show a small (negative) correlation with CIA, although none was found in the original study. (This would be theoretically plausible and the lack of correlation in the original study could have been sample dependent.) That a moderate (positive) correlation would be found between CIA and general emotion regulation difficulties; a small-to-moderate (negative) correlation would be found between CIA and general and social life satisfaction; and finally, CIA explains unique variance in the criterion variables over and above known psychological correlates, thus capturing a unique aspect of pain psychology.

2 Methods

2.1 Design of the study

This cross-sectional study utilizes baseline data collected in the context of an RCT of the efficacy of a psychological treatment for chronic pain patients with emotional distress [16].

2.2 Recruitment and participants

Baseline data from N = 115 patients were included. Patients were recruited through newspaper advertisements, social media, and clinical pain rehabilitation departments. Eligibility consisted of:

  1. Age between 18 and 70.

  2. Chronic musculoskeletal pain unrelated to any systemic or inflammation diseases.

  3. Functional problems due to pain ≥11 on items 21–24 of the Orebro Musculoskeletal Pain Screening Questionnaire [17].

  4. Emotional problems ≥8 on any of the subscales of the Hospital Anxiety and Depression Scale [18].

  5. No severe psychiatric disorders (for example, alcohol abuse, psychotic disorders, or risk of suicide); no ongoing psychological treatment or psychopharmacological treatment started or changed within the last 3 months.

  6. Able to read and speak Swedish and have digital access.

2.3 Measures

2.3.1 The context insensitive avoidance (CIA) scale

The Context Insensitive Avoidance scale (CIA) [14] measures avoidance of expression – the tendency to hide or avoid expressing pain linked to a range of social emotions and perceived consequences. The scale, displayed in Table 1, includes eleven items scored on a 7-point scale from 1 (not at all true) to 7 (completely true), with total scores ranging from 11 to 77. Higher scores indicate higher levels of avoidance of expression and was related to higher ratings of pain, disability, pain catastrophizing, emotion suppression, and to lower ratings of self-compassion and activity engagement in the original study. Internal consistency was good (α = 0.92).

Table 1

Items included in the context-insensitive avoidance scale

I hide/stay silent about my pain
 To avoid feeling weak
 To avoid feeling like a burden
 To avoid making others to feel sad or worried.
 To avoid having to discontinue or accommodate activities
 To avoid becoming sad/depressed
 To avoid feeling ashamed or guilty
 To avoid others underestimating my abilities
 To avoid becoming scared/worried
 To avoid pain “taking over” or “taking away” my life
When I have pain, I hide it from people in my close environment
I avoid talking about my pain

2.3.2 Construct validity

Three measures, tapping into distinct yet theoretically related constructs that were also employed in the original psychometric study by Flink et al. [14], were used to replicate construct validity. The pain catastrophizing scale (PCS) [19]. The PCS measures an exaggerated negative focus on pain and the pain situation. The scale includes 13 items scored 0 (not at all) to 4 (all the time), with total scores ranging from 0 to 52. Higher scores indicate higher levels of pain catastrophizing. The scale has shown good psychometric properties [20,21] and the Swedish version has acceptable internal consistency (α = 0.92) [22].

The Short Form of Self-Compassion Scale (SCS-SF) [23] measures self-compassion, which includes the ability to treat oneself with care rather than with critical self-judgment. The scale includes 12 items scored 1 (almost never) to 5 (almost always), with total scores ranging from 12 to 60. Higher scores indicate more problems with critical self-judgment. Internal consistency was acceptable in three different samples (α ≥ 0.86) [23] and acceptable in a Swedish sample (α = 0.76) [24].

The 8-item version of Chronic Pain Acceptance Questionnaire (CPAQ-8) [25] measures pain acceptance in people with pain. The questionnaire includes two subscales, measuring activity engagement (AE), which is a physical and social behavior of being active and participating in life despite discomfort, and pain willingness (PW), which is a mental openness to discomfort. Each subscale has 4 items scored 0 (never true) to 6 (always true), with total scores ranging from 0 to 24. Higher scores indicate higher levels of acceptance and willingness. The scale has shown good psychometric properties [25,26,27]. Internal consistency was acceptable for both subscales in a Swedish sample (α = 0.83 for AE and 0.73 for PW [26]).

To explore if construct validity could be extended to emotion regulation, the Difficulties of Emotion Regulation Scale (DERS) [28] was added. The DERS is a global measure of emotion regulation. The scale includes 36 items scored 1 (almost never) to 5 (almost always), with total scores ranging from 36 to 180. Higher scores indicate greater difficulties with emotion regulation. The scale has shown good psychometric properties [29,30]. Internal consistency was acceptable in a Swedish sample (α = 0.94 [31]).

2.3.3 Criterion validity

Two measures used in the original psychometric study by Flink et al. [14] were used to analyze criterion validity.

The Multidimensional Pain Inventory (MPI)-pain intensity subscale [32] consists of two items that ask about pain last week and pain right now. The items are scored on a scale from 0 (no pain) to 6 (very intense pain), with total scores ranging from 0 to 12. The MPI-pain interference subscale [32] consists of 11 items that ask about ability, participation, and enjoyment in work and social life. The items are scored on a scale from 0 to 6, with total scores ranging from 0 to 66. Higher scores indicate higher levels of pain interference in everyday life. The MPI has shown good psychometric properties [33].

To explore if criterion validity could be extended, we used the Life Satisfaction questionnaire (LiSat-9) [34]. The LiSat-9 questionnaire measures life satisfaction – both global (one item) and domain-specific (eight separate items). Each item is scored on a scale from 1 (very dissatisfied) to 6 (very satisfied). Higher scores indicate higher levels of satisfaction in each specific life domain. Besides the global item about satisfaction with life in general, we selected four items related to social domains of life: satisfaction with contact with friends and acquaintances; family life; relation with partner; and sexual life. We excluded the remaining four items related to other domains (self-care, leisure time, vocational-, and financial situation). The LiSat-9 questionnaire has been used in several languages and populations [35,36,37].

2.4 Data analyses

IBM Statistical Package of Social Sciences 26 was used for all analyses. Data were checked for normal distribution, outliers, and missing items. Internal consistency was examined using Cronbach’s alpha. A value between 0.70 and 0.95 was considered good [38]. Descriptive statistics were used to summarize demographic and clinical data. Pearson’s bivariate correlation was used to analyze associations between the CIA and the validity measures. Cohen’s criteria were used to interpret the size of the correlations, with r ≥ 0.10, r ≥ 0.30, and r ≥ 0.50 as boundaries to indicate small, moderate, and large effect sizes [39]. Multiple linear regression was used to analyze the relation between the CIA and criterion variables compared to the other psychological constructs.

3 Results

3.1 Demographic and clinical data

Table 2 presents the demographic and clinical characteristics of the participants. Most of this sample (83.5%) were women, middle-aged (M = 44.4) with multi-site, musculoskeletal pain. More than half of them were working (58.3%), but sick leave was common. Nineteen participants (16.4%) were on sick leave for 15–180 days during the last 12 months due to their current pain problems, while 46 (40%) were on longer sick leave. Most of the participants (81.7%) reported more than two healthcare visits during the last year due to their pain problems.

Table 2

Description of participants’ (N = 115) demographic and clinical characteristics

Gender N (% women) 96 (83.5)
Age, mean (SD) 44.4 (11.7)
Pain locations
 Back, neck, and/or shoulders 115 (100%)
 Legs and arms 115 (100%)
 Other areas 31 (27%)
Pain duration, median years (IQR) 10 (12)
Education N (% university) 42 (36.5%)
Occupational status, N (%)
 Working 67 (58.3%)
 Unemployed 7 (6.1%)
 Student 7 (6.1%)
 Pensioner 15 (13%)
 Other 19 (16.5%)
Sick leave (N, % during the past year)
 0–14 days 50 (43.5%)
 15–180 days 19 (16.4%)
 181–365 days 46 (40%)
Health care visits, median past year (IQR)
 Physician 3 (4)
 Physiotherapist 2 (6)
 Specialist/hospital 0 (2)
 Other (e.g., chiropractor and acupuncturist) 0 (5)
 Total number of visits >2 94 (81.7%)

3.2 Internal consistency of the CIA scale

The internal consistency of the CIA scale was good (α = 0.91), with a mean rating of 43.93 and a standard deviation of 15.42. Results are similar to the original study (α = 0.92, M = 41.65, SD = 16.15).

3.3 Construct validity of the CIA scale, replication and extension

Pearson’s bivariate correlations are presented in Table 3. For the purpose of comparison, correlations found in the original psychometric study by Flink et al. [14] are, when applicable, included in the table. As hypothesized, there were significant correlations between avoidance of expression and the constructs of self-compassion and activity engagement. Correlations were small to moderate in the expected directions, similar to the correlations reported by Flink et al. [14]. Also, in line with the original study, there was no association between avoidance of expression and pain willingness. Contrary to the hypothesis, and unlike the results in the original study, we found no association between avoidance of expression and pain catastrophizing.

Table 3

Pearson’s correlations between the context-insensitive avoidance (CIA) scale and variables used to analyze validity

CIA, this studya CIA, Flink et al. 2017b
Construct validity
Pain catastrophizing (PCS) 0.15 0.29**
Self-compassion (SCS) −0.39** −0.32**
Activity engagement (CPAQ-AE) −0.23* −0.23*
Pain willingness (CPAQ-PW) 0.06 0.04
Emotion regulation (DERS) 0.35** Na
Criterion validity
Pain intensity (MPI) 0.30** 0.37″
Pain interference (MPI) 0.24* 0.40″
Life in general (LiSat) −0.30** Na
Contact with friends (LiSat) −0.29** Na
Family lifec (LiSat) −0.17 Na
Life with partnerd (LiSat) −0.13 Na
Sexual life (LiSat) −0.03 Na

**Significant at p < 0.01 level. *Significant at p < 0.05 level. Na = not applicable; CIA, context-insensitive avoidance. a N = 115, b N = 105, c N = 112, d N = 96.

To explore if construct validity could be extended, correlations between the CIA scale and emotion regulation difficulties were computed. As hypothesized, there was a significant, positive correlation of moderate effect size (r = 0.35) between avoidance of expression and emotion regulation difficulties (Table 3).

3.4 Criterion validity of the CIA scale, replication and extension

Table 3 presents Pearson’s bivariate correlations between the CIA scale and measures used to replicate and extend criterion validity. As can be seen, avoidance of expression had a significant positive correlation with pain intensity. This correlation was of moderate effect size (r = 0.30) in support of our hypothesis and was similar to the correlation reported in Flink et al. [14]. The correlation between avoidance of expression and pain interference was significant and in the same direction as in the original study, but smaller in magnitude (r = 0.24).

Extending the criterion validity to aspects of life satisfaction, avoidance of expression showed a significant, negative correlation with general life satisfaction and with the social domains of friends. In line with the hypothesis, these correlations were small to moderate. However, no correlation was found between avoidance of expression and satisfaction with family, partner, or sexual life.

3.5 Unique variance explained by the CIA scale in criterion variables

A series of multiple regression analyses were performed to assess the unique contribution of avoidance of expression to variance in criterion measures, over and above the other associated variables. For this analysis, four criteria variables that had a significant correlation with the CIA scale were selected (specifically pain intensity, pain interference, general life satisfaction, and satisfaction with friends). Results are presented in Table 4. As can be seen, avoidance of expression was the only variable with a unique contribution to pain intensity, accounting for 8% of the variability in pain (F(4,110) = 3.619, p = 0.008). Avoidance of expression did not contribute unique variance to the other criterion variables. Instead, activity engagement explained 32% of the variance in pain interference (F(4,110) = 14.51, p < 0.001) and 34% of the variance in satisfaction with life in general (F(4,110) = 15.72, p < 0.001). Self-compassion and activity engagement explained 19% of the variance in satisfaction with contact with friends (F(4,110) = 7.79, p < 0.001).

Table 4

Multiple regression analyses

Outcome Predictors ΔR 2 95% CI
B SE B LB UB β p
Pain intensity 0.08 0.008
Constant 7.01 1.90 3.25 10.78 0.000
CIA 0.03 0.02 0.00 0.06 0.22 0.031*
SCS −0.03 0.03 −0.08 0.04 −0.09 0.416
AE −0.05 0.05 −0.15 0.05 −0.09 0.340
DERS 0.01 0.01 −0.02 0.03 0.06 0.609
Pain interference 0.32 000
Constant 61.94 7.79 46.50 77.38 0.000
CIA 0.09 0.06 −0.04 0.21 0.12 0.17
SCS −0.01 0.12 −0.24 0.25 −0.01 0.954
AE −1.38 0.21 −1.79 −0.97 −0.56 0.001**
DERS −0.01 0.05 −0.10 0.08 −0.03 0.762
General life satisfaction 0.34 0.000
Constant 2.00 0.84 0.33 3.67 0.020
CIA −0.01 0.00 −0.02 0.00 −0.12 0.155
SCS 0.02 0.01 −0.01 05 0.13 0.175
AE 0.13 0.02 0.08 0.17 0.46 0.001**
DERS −0.00 0.01 −0.01 0.01 −0.07 0.463
Contact with friends 0.19 0.000
Constant 1.40 0.95 −0.48 3.28 0.142
CIA −0.01 0.01 −0.03 0.00 −0.15 0.101
SCS 0.04 0.02 0.01 0.07 0.27 0.015*
AE 0.07 0.03 0.02 0.12 0.25 0.008**
DERS 0.00 0.01 −0.01 0.01 0.07 0.520

**Significant at p < 0.01 level. *Significant at p < 0.05 level. CIA, context-insensitive avoidance; SCS, self-compassion scale; AE, activity engagement subscale of chronic pain acceptance questionnaire; DERS, difficulties in emotional regulation scale.

4 Discussion

The purpose of this study was to investigate if the reliability and validity of the context insensitivity avoidance (CIA) scale [14] could be replicated and extended. In summary, internal consistency of the scale was high, and construct validity was replicated with small to moderate correlations in expected directions with self-compassion and activity engagement. A positive correlation with pain catastrophizing was not replicated. In line with the original study, the CIA scale was not correlated to pain willingness. Criterion validity was mostly replicated with a moderate correlation with pain intensity and a small correlation with pain interference. Construct validity was extended with a moderate correlation with general emotion regulation difficulties. Criterion validity was extended with a moderate correlation with general life satisfaction and a small correlation with satisfaction with contact with friends. Finally, compared with correlated psychological constructs, the CIA scale explained unique variance in pain intensity but not in pain interference, general life satisfaction, or satisfaction with contact with friends.

As hypothesized, construct validity could be extended to the important area of emotion regulation. In the original study, avoidance of expression was significantly correlated with suppression – a subscale of another measure of emotion regulation (ERQ-S) [40]. Despite different theoretical backgrounds, the scales have some similarities [41], which make our result comparable to the original finding of a moderate correlation between avoidance of expression and suppression [14]. Together, the results indicate that relying too much on avoidance of expression as an emotion regulation strategy could be a relevant topic to raise with patients whose scores on the CIA scale are elevated. Indeed, treatments targeting emotional awareness and expression in patients with chronic pain have shown positive outcomes [16,42].

As hypothesized, a significant, positive correlation was found between avoidance of expression and pain intensity. Clearly, patients with higher pain intensity levels are more likely to speak less of it. This link was also present in the multiple regression analysis, where avoidance of expression explained an 8% variance in pain intensity (see below). Also as hypothesized, a significant, positive correlation was found between avoidance of expression and pain interference. The size of the correlation was small compared to the original study (r = 0.24 vs 40), indicating that other factors were more important to explain disability in this sample. It has been proposed that the influence of psychological factors on pain disability is overestimated [43], but the influence may differ depending on sample specifics.

Partly as expected, criteria validity could be extended to significant, negative correlations between avoidance of expression and satisfaction with life as a whole and with contact with friends. Life satisfaction studies have shown that satisfaction with family and partners remains intact despite the adverse experience of pain, while contact with friends clearly deteriorates [35,44,45]. Other studies have shown that chronic pain patients are more likely to talk to their partner or spouse about their pain and pain-related distress than to others [46,47]. In couples, the simple presence of a partner brings benefits even if verbalizations are not the most satisfactory to the patient [11,48], and our findings can be interpreted as a sign of (un)satisfaction with family, partner, and sexual life regardless of pain communication.

Avoidance of expression was the only psychological factor with a small but unique contribution to variance in pain intensity. The finding indicates that the scale captures a new aspect of pain psychology that is not shared with self-compassion, activity engagement, or emotion regulation. Considering the many factors that may influence pain intensity [49], the size of 8% explained variance is not negligible.

4.1 Clinical implications

Elevated scores on the CIA scale could inform clinicians to approach patients who are struggling to get through to others for the support and understanding they need. The struggle may be at any end of the communication process: finding the words to begin with or the situations in which they are appropriate to share; how to identify support or respond to invalidation. Also, high scores on the CIA scale can alert healthcare professionals to their own communication which is sometimes lacking. A number of studies have shown that disbelief and negative labeling [50] or invalidation [2,51] is part of the stigmatization process that silence patients. Reversely, Ruben et al. [52] demonstrated that more positive provider communication was related to higher levels of patients’ self-efficacy for managing chronic disease, which in turn was related to lower levels of pain intensity and pain disability.

4.2 Theoretical implications

Context sensitivity is a broad concept. In the original study, Flink et al. [14] set out to explore if an interpersonal aspect could be measured in a chronic pain setting. The focus was on disclosure vs expression. Although four factors were found, only one was confirmed. The authors discussed the problem of a self-report to measure context sensitivity in individuals who are less aware of inappropriate social communication. On the other hand, they argued that context-insensitive avoidance may be the most prominent aspect. In support of that argument, Wurm et al. [53] found that chronic pain patients with social anxiety are a vulnerable subgroup with remaining emotional problems after treatment. Their overreliance on avoidance of expression as a coping strategy may remain unnoticed unless it can be identified with the help of a self-report. We agree with the problem of a self-report in less socially conscious individuals but suggest that inappropriate social communication is readily observed, as opposed to avoidance of expression, and will be a matter for the clinicians’ communication skills to approach. This study can confirm that the final scale of CIA captures a key skill of context sensitivity which is essential for flexible emotional regulation. Although narrow, the scale is an early attempt to introduce the important concept of emotion regulation to the field of pain. Future studies could compare it to measures of emotional suppression and social anxiety to see how much they overlap, or if the scale measures a dilemma specific to patients with chronic pain.

4.3 Strengths and limitations

The participants in this study had chronic pain with co-occurring emotional distress, representing a common group of patients in clinical practice. This strengthens the external validity of the CIA scale. The validity was properly tested by using the same variables as the original study in a new sample. Adding new variables had the twofold advantage of further validation of the scale and to delineate its borders. For example, avoidance of expression was negatively correlated to satisfaction with contact with friends, but not to the other social domains of family, partner, or sexual life. A limitation is that correlations between variables say nothing about their causal relationships. For example, avoidance of expression may be the result of increased pain intensity, and patients with less pain could be better at perceiving others as available to them. Another weakness is the limited number of social situations used in the exploring part of the study. Avoidance of expression was more common outside the home and family; yet, we did not ask for other social contexts, such as the workplace where colleagues may wonder about the pain. Healthcare encounters may also provide a challenge for patients who may disagree about the meaning of chronic pain. For example, patients tend to understand chronic pain through a biological lens, whereas clinicians have a biopsychosocial view [54]. Finally, as mentioned in the original study, self-reported data are subject to bias of memory and over- or underestimations [14].

5 Conclusions

In summary, this study could replicate the reliability of the CIA scale, which measures avoidance of expression – a social aspect of context sensitivity. Construct and criteria validity could be replicated in four of the five variables originally used, and further extended to three of the six added variables. Avoidance of expression was correlated with lower self-compassion, AE, and emotion regulation, and with more pain and disability. It was also correlated with lower satisfaction with life as a whole and with contact with friends. Being too silent about one’s pain and pain-related distress could contribute to the suffering in persons with chronic pain.

Acknowledgement

No artificial intelligence or machine learing tools have been used in the preparation of this manuscript.

  1. Research ethics: The study by Boersma et al. [16], from which data in this study were taken, was approved by the Research Ethics Board in Uppsala (2015/479), and the trial was preregistered at Clinicaltrails.gov (NCT02808286). Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as amended in 2013).

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: Katja Boersma is an Editor of Scandinavian Journal of Pain (Psychology and Pain Management). The authors state no conflict of interest.

  5. Research funding: This research was financially supported by the Centre for Clinical Research Sörmland, Uppsala University.

  6. Artificial intelligence/Machine learning tools: Not applicable.

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Received: 2024-05-16
Revised: 2024-10-04
Accepted: 2024-10-04
Published Online: 2024-11-04

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

  1. Editorial Comment
  2. From pain to relief: Exploring the consistency of exercise-induced hypoalgesia
  3. Christmas greetings 2024 from the Editor-in-Chief
  4. Original Articles
  5. The Scandinavian Society for the Study of Pain 2022 Postgraduate Course and Annual Scientific (SASP 2022) Meeting 12th to 14th October at Rigshospitalet, Copenhagen
  6. Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries
  7. Clinical Pain Researches
  8. The effect of tourniquet use on postoperative opioid consumption after ankle fracture surgery – a retrospective cohort study
  9. Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain
  10. Tonic cuff pressure pain sensitivity in chronic pain patients and its relation to self-reported physical activity
  11. Reliability, construct validity, and factorial structure of a Swedish version of the medical outcomes study social support survey (MOS-SSS) in patients with chronic pain
  12. Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework
  13. Exploring the outcome “days with bothersome pain” and its association with pain intensity, disability, and quality of life
  14. Fatigue and cognitive fatigability in patients with chronic pain
  15. The Swedish version of the pain self-efficacy questionnaire short form, PSEQ-2SV: Cultural adaptation and psychometric evaluation in a population of patients with musculoskeletal disorders
  16. Pain coping and catastrophizing in youth with and without cerebral palsy
  17. Neuropathic pain after surgery – A clinical validation study and assessment of accuracy measures of the 5-item NeuPPS scale
  18. Translation, contextual adaptation, and reliability of the Danish Concept of Pain Inventory (COPI-Adult (DK)) – A self-reported outcome measure
  19. Cosmetic surgery and associated chronic postsurgical pain: A cross-sectional study from Norway
  20. The association of hemodynamic parameters and clinical demographic variables with acute postoperative pain in female oncological breast surgery patients: A retrospective cohort study
  21. Healthcare professionals’ experiences of interdisciplinary collaboration in pain centres – A qualitative study
  22. Effects of deep brain stimulation and verbal suggestions on pain in Parkinson’s disease
  23. Painful differences between different pain scale assessments: The outcome of assessed pain is a matter of the choices of scale and statistics
  24. Prevalence and characteristics of fibromyalgia according to three fibromyalgia diagnostic criteria: A secondary analysis study
  25. Sex moderates the association between quantitative sensory testing and acute and chronic pain after total knee/hip arthroplasty
  26. Tramadol-paracetamol for postoperative pain after spine surgery – A randomized, double-blind, placebo-controlled study
  27. Cancer-related pain experienced in daily life is difficult to communicate and to manage – for patients and for professionals
  28. Making sense of pain in inflammatory bowel disease (IBD): A qualitative study
  29. Patient-reported pain, satisfaction, adverse effects, and deviations from ambulatory surgery pain medication
  30. Does pain influence cognitive performance in patients with mild traumatic brain injury?
  31. Hypocapnia in women with fibromyalgia
  32. Application of ultrasound-guided thoracic paravertebral block or intercostal nerve block for acute herpes zoster and prevention of post-herpetic neuralgia: A case–control retrospective trial
  33. Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia
  34. A positive scratch collapse test in anterior cutaneous nerve entrapment syndrome indicates its neuropathic character
  35. ADHD-pain: Characteristics of chronic pain and association with muscular dysregulation in adults with ADHD
  36. The relationship between changes in pain intensity and functional disability in persistent disabling low back pain during a course of cognitive functional therapy
  37. Intrathecal pain treatment for severe pain in patients with terminal cancer: A retrospective analysis of treatment-related complications and side effects
  38. Psychometric evaluation of the Danish version of the Pain Self-Efficacy Questionnaire in patients with subacute and chronic low back pain
  39. Dimensionality, reliability, and validity of the Finnish version of the pain catastrophizing scale in chronic low back pain
  40. To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale
  41. Pain catastrophizing levels differentiate between common diseases with pain: HIV, fibromyalgia, complex regional pain syndrome, and breast cancer survivors
  42. Prevalence of substance use disorder diagnoses in patients with chronic pain receiving reimbursed opioids: An epidemiological study of four Norwegian health registries
  43. Pain perception while listening to thrash heavy metal vs relaxing music at a heavy metal festival – the CoPainHell study – a factorial randomized non-blinded crossover trial
  44. Observational Studies
  45. Cutaneous nerve biopsy in patients with symptoms of small fiber neuropathy: a retrospective study
  46. The incidence of post cholecystectomy pain (PCP) syndrome at 12 months following laparoscopic cholecystectomy: a prospective evaluation in 200 patients
  47. Associations between psychological flexibility and daily functioning in endometriosis-related pain
  48. Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis
  49. Access to psychological treatment for chronic cancer-related pain in Sweden
  50. Validation of the Danish version of the knowledge and attitudes survey regarding pain
  51. Associations between cognitive test scores and pain tolerance: The Tromsø study
  52. Healthcare experiences of fibromyalgia patients and their associations with satisfaction and pain relief. A patient survey
  53. Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention
  54. Role of history of traumatic life experiences in current psychosomatic manifestations
  55. Social determinants of health in adults with whiplash associated disorders
  56. Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial
  57. A preliminary examination of the effects of childhood abuse and resilience on pain and physical functioning in patients with knee osteoarthritis
  58. Differences in risk factors for flare-ups in patients with lumbar radicular pain may depend on the definition of flare
  59. Real-world evidence evaluation on consumer experience and prescription journey of diclofenac gel in Sweden
  60. Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population
  61. Topical Reviews
  62. Bridging the translational gap: adenosine as a modulator of neuropathic pain in preclinical models and humans
  63. What do we know about Indigenous Peoples with low back pain around the world? A topical review
  64. The “future” pain clinician: Competencies needed to provide psychologically informed care
  65. Systematic Reviews
  66. Pain management for persistent pain post radiotherapy in head and neck cancers: systematic review
  67. High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis
  68. Reliability and measurement error of exercise-induced hypoalgesia in pain-free adults and adults with musculoskeletal pain: A systematic review
  69. Noninvasive transcranial brain stimulation in central post-stroke pain: A systematic review
  70. Short Communications
  71. Are we missing the opioid consumption in low- and middle-income countries?
  72. Association between self-reported pain severity and characteristics of United States adults (age ≥50 years) who used opioids
  73. Could generative artificial intelligence replace fieldwork in pain research?
  74. Skin conductance algesimeter is unreliable during sudden perioperative temperature increases
  75. Original Experimental
  76. Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up
  77. Pain catastrophizing in the elderly: An experimental pain study
  78. Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns
  79. Concurrent validity of dynamic bedside quantitative sensory testing paradigms in breast cancer survivors with persistent pain
  80. Transcranial direct current stimulation is more effective than pregabalin in controlling nociceptive and anxiety-like behaviors in a rat fibromyalgia-like model
  81. Paradox pain sensitivity using cuff pressure or algometer testing in patients with hemophilia
  82. Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial
  83. Measuring pain intensity through physical interaction in an experimental model of cold-induced pain: A method comparison study
  84. Pharmacological treatment of pain in Swedish nursing homes: Prevalence and associations with cognitive impairment and depressive mood
  85. Neck and shoulder pain and inflammatory biomarkers in plasma among forklift truck operators – A case–control study
  86. The effect of social exclusion on pain perception and heart rate variability in healthy controls and somatoform pain patients
  87. Revisiting opioid toxicity: Cellular effects of six commonly used opioids
  88. Letter to the Editor
  89. Post cholecystectomy pain syndrome: Letter to Editor
  90. Response to the Letter by Prof Bordoni
  91. Response – Reliability and measurement error of exercise-induced hypoalgesia
  92. Is the skin conductance algesimeter index influenced by temperature?
  93. Skin conductance algesimeter is unreliable during sudden perioperative temperature increase
  94. Corrigendum
  95. Corrigendum to “Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors”
  96. Obituary
  97. A Significant Voice in Pain Research Björn Gerdle in Memoriam (1953–2024)
https://doi.org/10.1515/sjpain-2024-0039
Schlagwörter für diesen Artikel
chronic pain; emotion; context sensitivity; avoidance; communication
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Editorial Comment
  2. From pain to relief: Exploring the consistency of exercise-induced hypoalgesia
  3. Christmas greetings 2024 from the Editor-in-Chief
  4. Original Articles
  5. The Scandinavian Society for the Study of Pain 2022 Postgraduate Course and Annual Scientific (SASP 2022) Meeting 12th to 14th October at Rigshospitalet, Copenhagen
  6. Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries
  7. Clinical Pain Researches
  8. The effect of tourniquet use on postoperative opioid consumption after ankle fracture surgery – a retrospective cohort study
  9. Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain
  10. Tonic cuff pressure pain sensitivity in chronic pain patients and its relation to self-reported physical activity
  11. Reliability, construct validity, and factorial structure of a Swedish version of the medical outcomes study social support survey (MOS-SSS) in patients with chronic pain
  12. Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework
  13. Exploring the outcome “days with bothersome pain” and its association with pain intensity, disability, and quality of life
  14. Fatigue and cognitive fatigability in patients with chronic pain
  15. The Swedish version of the pain self-efficacy questionnaire short form, PSEQ-2SV: Cultural adaptation and psychometric evaluation in a population of patients with musculoskeletal disorders
  16. Pain coping and catastrophizing in youth with and without cerebral palsy
  17. Neuropathic pain after surgery – A clinical validation study and assessment of accuracy measures of the 5-item NeuPPS scale
  18. Translation, contextual adaptation, and reliability of the Danish Concept of Pain Inventory (COPI-Adult (DK)) – A self-reported outcome measure
  19. Cosmetic surgery and associated chronic postsurgical pain: A cross-sectional study from Norway
  20. The association of hemodynamic parameters and clinical demographic variables with acute postoperative pain in female oncological breast surgery patients: A retrospective cohort study
  21. Healthcare professionals’ experiences of interdisciplinary collaboration in pain centres – A qualitative study
  22. Effects of deep brain stimulation and verbal suggestions on pain in Parkinson’s disease
  23. Painful differences between different pain scale assessments: The outcome of assessed pain is a matter of the choices of scale and statistics
  24. Prevalence and characteristics of fibromyalgia according to three fibromyalgia diagnostic criteria: A secondary analysis study
  25. Sex moderates the association between quantitative sensory testing and acute and chronic pain after total knee/hip arthroplasty
  26. Tramadol-paracetamol for postoperative pain after spine surgery – A randomized, double-blind, placebo-controlled study
  27. Cancer-related pain experienced in daily life is difficult to communicate and to manage – for patients and for professionals
  28. Making sense of pain in inflammatory bowel disease (IBD): A qualitative study
  29. Patient-reported pain, satisfaction, adverse effects, and deviations from ambulatory surgery pain medication
  30. Does pain influence cognitive performance in patients with mild traumatic brain injury?
  31. Hypocapnia in women with fibromyalgia
  32. Application of ultrasound-guided thoracic paravertebral block or intercostal nerve block for acute herpes zoster and prevention of post-herpetic neuralgia: A case–control retrospective trial
  33. Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia
  34. A positive scratch collapse test in anterior cutaneous nerve entrapment syndrome indicates its neuropathic character
  35. ADHD-pain: Characteristics of chronic pain and association with muscular dysregulation in adults with ADHD
  36. The relationship between changes in pain intensity and functional disability in persistent disabling low back pain during a course of cognitive functional therapy
  37. Intrathecal pain treatment for severe pain in patients with terminal cancer: A retrospective analysis of treatment-related complications and side effects
  38. Psychometric evaluation of the Danish version of the Pain Self-Efficacy Questionnaire in patients with subacute and chronic low back pain
  39. Dimensionality, reliability, and validity of the Finnish version of the pain catastrophizing scale in chronic low back pain
  40. To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale
  41. Pain catastrophizing levels differentiate between common diseases with pain: HIV, fibromyalgia, complex regional pain syndrome, and breast cancer survivors
  42. Prevalence of substance use disorder diagnoses in patients with chronic pain receiving reimbursed opioids: An epidemiological study of four Norwegian health registries
  43. Pain perception while listening to thrash heavy metal vs relaxing music at a heavy metal festival – the CoPainHell study – a factorial randomized non-blinded crossover trial
  44. Observational Studies
  45. Cutaneous nerve biopsy in patients with symptoms of small fiber neuropathy: a retrospective study
  46. The incidence of post cholecystectomy pain (PCP) syndrome at 12 months following laparoscopic cholecystectomy: a prospective evaluation in 200 patients
  47. Associations between psychological flexibility and daily functioning in endometriosis-related pain
  48. Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis
  49. Access to psychological treatment for chronic cancer-related pain in Sweden
  50. Validation of the Danish version of the knowledge and attitudes survey regarding pain
  51. Associations between cognitive test scores and pain tolerance: The Tromsø study
  52. Healthcare experiences of fibromyalgia patients and their associations with satisfaction and pain relief. A patient survey
  53. Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention
  54. Role of history of traumatic life experiences in current psychosomatic manifestations
  55. Social determinants of health in adults with whiplash associated disorders
  56. Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial
  57. A preliminary examination of the effects of childhood abuse and resilience on pain and physical functioning in patients with knee osteoarthritis
  58. Differences in risk factors for flare-ups in patients with lumbar radicular pain may depend on the definition of flare
  59. Real-world evidence evaluation on consumer experience and prescription journey of diclofenac gel in Sweden
  60. Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population
  61. Topical Reviews
  62. Bridging the translational gap: adenosine as a modulator of neuropathic pain in preclinical models and humans
  63. What do we know about Indigenous Peoples with low back pain around the world? A topical review
  64. The “future” pain clinician: Competencies needed to provide psychologically informed care
  65. Systematic Reviews
  66. Pain management for persistent pain post radiotherapy in head and neck cancers: systematic review
  67. High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis
  68. Reliability and measurement error of exercise-induced hypoalgesia in pain-free adults and adults with musculoskeletal pain: A systematic review
  69. Noninvasive transcranial brain stimulation in central post-stroke pain: A systematic review
  70. Short Communications
  71. Are we missing the opioid consumption in low- and middle-income countries?
  72. Association between self-reported pain severity and characteristics of United States adults (age ≥50 years) who used opioids
  73. Could generative artificial intelligence replace fieldwork in pain research?
  74. Skin conductance algesimeter is unreliable during sudden perioperative temperature increases
  75. Original Experimental
  76. Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up
  77. Pain catastrophizing in the elderly: An experimental pain study
  78. Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns
  79. Concurrent validity of dynamic bedside quantitative sensory testing paradigms in breast cancer survivors with persistent pain
  80. Transcranial direct current stimulation is more effective than pregabalin in controlling nociceptive and anxiety-like behaviors in a rat fibromyalgia-like model
  81. Paradox pain sensitivity using cuff pressure or algometer testing in patients with hemophilia
  82. Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial
  83. Measuring pain intensity through physical interaction in an experimental model of cold-induced pain: A method comparison study
  84. Pharmacological treatment of pain in Swedish nursing homes: Prevalence and associations with cognitive impairment and depressive mood
  85. Neck and shoulder pain and inflammatory biomarkers in plasma among forklift truck operators – A case–control study
  86. The effect of social exclusion on pain perception and heart rate variability in healthy controls and somatoform pain patients
  87. Revisiting opioid toxicity: Cellular effects of six commonly used opioids
  88. Letter to the Editor
  89. Post cholecystectomy pain syndrome: Letter to Editor
  90. Response to the Letter by Prof Bordoni
  91. Response – Reliability and measurement error of exercise-induced hypoalgesia
  92. Is the skin conductance algesimeter index influenced by temperature?
  93. Skin conductance algesimeter is unreliable during sudden perioperative temperature increase
  94. Corrigendum
  95. Corrigendum to “Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors”
  96. Obituary
  97. A Significant Voice in Pain Research Björn Gerdle in Memoriam (1953–2024)
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