Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology

Nicholas Vasilis Karayannis; John A Sturgeon; Mike K Kemani; Sean C Mackey; Carol M Greco; Rikard K Wicksell; Lance M McCracken

doi:10.1515/sjpain-2022-0107

Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology

Scand J Pain. 2023 Feb 7;23(3):464-475. doi: 10.1515/sjpain-2022-0107. Print 2023 Jul 26.

Authors

Nicholas Vasilis Karayannis¹, John A Sturgeon², Mike K Kemani^{3

4}, Sean C Mackey⁵, Carol M Greco⁶, Rikard K Wicksell⁷, Lance M McCracken⁸

Affiliations

¹ College of Health Sciences and Professions, Ohio University, Athens, USA.
² Department of Psychology, University of Washington, Seattle, USA.
³ Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden.
⁴ Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
⁵ Division of Pain Medicine, Stanford University, Stanford, USA.
⁶ Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA.
⁷ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Sweden.
⁸ Department of Psychology, Uppsala University, Uppsala, Sweden.

Abstract

Objectives: Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference.

Methods: Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180 days of patient care.

Results: Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r²=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r²=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r²=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r²=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes.

Conclusions: Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.

Keywords: acceptance; awareness; engagement; pain interference; predictive modelling; psychological flexibility.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adaptation, Psychological
Chronic Pain* / psychology
Chronic Pain* / therapy
Female
Humans
Longitudinal Studies
Male
Middle Aged
Mindfulness*
Pain Management

Abstract

Publication types

MeSH terms

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