Characteristics and consequences of the co-occurrence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_j.sjpain.2016.03.006_s_001_w2aab2b8c20b1b7b1aab1c16b1Aa"><jats:title>Background and aims</jats:title><jats:p>Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerability factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occurrence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.03.006_s_002_w2aab2b8c20b1b7b1aab1c16b2Aa"><jats:title>Methods</jats:title><jats:p>180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxiety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy).</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.03.006_s_003_w2aab2b8c20b1b7b1aab1c16b3Aa"><jats:title>Results</jats:title><jats:p>Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.03.006_s_004_w2aab2b8c20b1b7b1aab1c16b4Aa"><jats:title>Conclusions</jats:title><jats:p>A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability.</jats:p></jats:sec><jats:sec id="j_j.sjpain.2016.03.006_s_005_w2aab2b8c20b1b7b1aab1c16b5Aa"><jats:title>Implications</jats:title><jats:p>These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.</jats:p></jats:sec>

Opioids in the Treatment of Pain. Beliefs, Knowledge, and Attitudes of the General Spanish Population. Identification of Subgroups Through Cluster Analysis

“…One strength that stands out in this work is the cluster analysis used to identify different groups of subjects based on beliefs, fears, opinions, and attitudes toward opioids. Other studies 12,25 have applied this analysis to cohorts of patients with chronic pain, demonstrating its usefulness. However, as far as we know, this is the first time that this type of analysis has been applied in this kind of study.…”

Group differences in pain interference, psychiatric disorders, and general medical conditions among Hispanics and whites in the U.S. general population

“…The stronger association between social phobia and severe pain interference in white compared to Hispanic respondents is noteworthy since many interdisciplinary treatment programs for persistent pain use group modalities; patients with social anxiety may not benefit from group therapies and may require more individual modality treatments (Wurm et al, 2016). Currently, the temporal associations between psychiatric variables and pain interference among Hispanic and white respondents are unclear and merit further investigation.…”

Understanding the productive author who published papers in medicine using National Health Insurance Database

“…[ 20 ] A chronic pain problem is also common and often cooccurs with other anxiety problems. [ 23 , 24 ] In many situations, it is very hard to observe the association of 2 or more symptoms at 1 moment.…”