Biomedical subjects

Christopher Eccleston

Publications and source records attributed to Christopher Eccleston.

At least 19 recordsLinked to original sources

PubMed2006

Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: effectiveness and clinically significant change.

Interdisciplinary pain management programs have an established record of significantly improving the functioning of persons disabled with chronic pain. There is a group of pain sufferers, however, who have difficulty accessing these programs and for whom the effectiveness of these treatments in unknown, these are patients whose mobility and self-care deficits leave them unable to meet the practical demands of many treatment environments. The purpose of this study was to examine the results of a treatment program designed to meet the needs of these highly disabled individuals (n=53) in comparison to results obtained from a standard less-disabled group attending treatment at the same facility (n=234). Results from the highly disabled patients showed statistically significant change after treatment in eight of nine outcome variables, including improvements in pain-related distress, disability, depression, pain-related anxiety, daytime rest, and performance during an activity tolerance test. Effect size calculations showed a number of large treatment effects, for psychosocial disability, depression, and acceptance of pain. Analysis of reliable change and clinical significance demonstrated that results were not merely statistically significant but clinically meaningful. Results appeared stable at three months following treatment. This research plays an important part in establishing an evidence base to inform service development, ensuring that chronic pain services do not exclude people on the basis of the severity of their disability.

Adaptation, Psychological↗

PubMed2006

Finding a solution to the problem of pain: conceptual formulation and the development of the Pain Solutions Questionnaire (PaSol).

We report the development of the Pain Solutions Questionnaire (PaSol), an instrument designed to measure assimilative (efforts at changing or solving pain) and accommodative (accepting that pain cannot be solved, and changing life goals) responses to the problems associated with pain. Data were collected from 476 adults suffering from chronic pain. Exploratory and confirmatory factor analyses resulted in a 14-item instrument with an adequate oblique 4-factor structure: (1) Solving Pain scale (4 items), (2) Meaningfulness of Life Despite Pain scale (5 items), (3) Acceptance of the Insolubility of Pain scale (3 items), and (4) Belief in a Solution scale (2 items). The validity of the PaSol was further tested by its value in explaining disability and affective distress after controlling for the effects of the demographic characteristics and pain severity. The Meaningfulness of Life Despite Pain scale was important in explaining disability and affective distress. The Solving Pain scale had a unique and independent contribution in explaining affective distress. Results are discussed in terms of how a persistence in assimilative coping, even though the pain problem is insoluble, may increase hypervigilance, catastrophizing, distress and disability.

Adaptation, Psychological↗

PubMed2006

Sex differences in adolescent chronic pain and pain-related coping.

Sex differences exist in pain and the strategies used to cope with pain. Although it is has been proposed that such differences become apparent around puberty, somewhat surprisingly very little research has specifically investigated sex as a moderator of pain within adolescents. The primary aim of the current study was to investigate sex differences in pain and coping within a group of 46 male and 115 female adolescent chronic pain sufferers. All were aged between 11 and 19 years and had been referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases, United Kingdom. Patients completed a battery of measures including pain experiences and a pain coping questionnaire. No sex differences were found in pain chronicity, although males and females did differ in self-reported pain experiences (females reported higher pain). Sex differences were also found in coping behaviours. Females used more social support, positive statements and internalizing/catastrophizing, whereas males reported engaging in more behavioural distraction. Of these strategies internalizing/catastrophizing was found to mediate the relationship between sex and pain. This suggests that not only do sex differences exist in the pain experiences and pain-coping strategies of adolescents with chronic pain, but that internalizing/catastrophizing may be an important mechanism in understanding such differences. More research examining potential sex differences in children and adolescents is recommended.

Adaptation, Psychological↗

PubMed2006

Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing.

This study investigated the reasons that might lead women to choose or not choose epidural analgesia as a strategy for the management of pain in childbirth. In our sample 55% of 114 women chose EA. Logistic regression resulted in a statistical model with four unique and independent predictors: Parity status and the fear of the side effects of EA each reduced the odds of choosing EA by half, whereas the desire to have a pain-free childbirth and positive experiences with EA of family and friends each doubled the odds of choosing EA. Pain catastrophizing was not related to EA use. The lack of an interrelationship between pain catastrophizing and EA use is probably due to an ambivalent attitude towards EA in pain catastrophizers. Pain catastrophizing was positively associated with the fear of being overwhelmed by labour pain and tendencies to avoid the pain, but also positively with the fear of pain during the insertion of the EA needle. Pain catastrophizing was also strongly related to recommendations to use EA from others, in particular from the midwife and from the gynecologist. Results are discussed in terms of the social impact of pain catastrophizing.

Adaptation, Psychological↗

PubMed2006

Being a parent of the adolescent with complex chronic pain: an interpretative phenomenological analysis.

BACKGROUND: Previous quantitative research has shown that parents of adolescents with chronic pain report elevated levels of emotional distress in addition to limitations in social and family functioning. AIM: This study aimed to further explore this parental impact by employing qualitative methodology to investigate parental experiences of caring for an adolescent with chronic pain. METHODS: A sample of 17 parents/carers of adolescents with chronic pain was selected from two UK tertiary clinic sites. Participants were 11 mothers, five fathers, and one grandmother (primary caregiver). Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Transcripts were analysed using interpretative phenomenological analysis (IPA). FINDINGS: Data analysis revealed two superordinate themes that captured the extensive, and largely negative, impact of being a parent of an adolescent with chronic pain. These themes were labelled 'struggle for control and coherence' and 'a very different life'. Both themes represent a fundamental parental struggle to adapt to a life very different than expected, a life fraught with uncertainty, fear, distress and loss. CONCLUSIONS: Parents who are unable to achieve the relief of their adolescent's chronic pain and suffering report significant personal distress that is exemplified by the repetitive search for legitimacy of their child's pain in 'diagnosis'. In the absence of diagnosis parents reported an unwelcome suspension in an unusual pattern of parenting, resembling the infant phase of parenting.

Activities of Daily Living↗

PubMed2006

A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers.

Previous research suggests that to define the problem of chronic pain as a problem of coping may not be as useful as framing it as a problem of acceptance for some patients. The coping approach may encourage, or at least permit, a somewhat inflexible agenda of pain reduction or control while the acceptance approach may allow a more flexible agenda of willingness to have pain in some circumstances where that serves the goal of better life functioning. The purpose of this study was to continue to examine the relative utility of concepts of coping and acceptance of pain. Two hundred and thirty consecutive patients seeking assessment from a pain management service were the participants in the study. Patients completed the Coping Strategies Questionnaire (CSQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). A revised scoring method was used for the CSQ (to correct for technical limitations noted in the past) and recently developed subscales of the CPAQ were examined. Correlation results showed that the acceptance variables were reliably stronger predictors of distress and disability compared with coping variables. Regression analyses confirmed that, compared with coping variables, acceptance accounted larger unique increments in variance in measures of patient functioning regardless of whether the coping variables were given priority in the regression equations. Increasing data support the view that the pain management field may benefit from evolving toward incorporating a less control-oriented and more accommodating view of aversive private experiences in some circumstances.

Adaptation, Psychological↗

PubMed2006

Hypervigilance to learned pain signals: a componential analysis.

UNLABELLED: We report 2 experiments investigating hypervigilance to pain signals in healthy individuals. In order to allow a detailed analysis, we decomposed attention in 3 different processes: 1) initial shifting, 2) engagement, and 3) disengagement. We used a spatial cueing paradigm in which the location of targets is validly or invalidly predicted by spatial cues. In the first experiment, cues were differentially conditioned to create pain signals, allowing the investigation of engagement and disengagement of attention. Because this procedure does not allow an adequate isolation of the shift component, we introduced a new adaptation of the spatial cueing paradigm in the second experiment, in which targets instead of cues were differentially conditioned. We replicated previous findings, showing enhanced engagement to and retarded disengagement from pain signals compared to control signals. In addition, we demonstrated that participants were still hypervigilant to pain signals after extinction. We were not able to demonstrate speeded shifting to pain signals. Instead we found a generally faster detection of pain signals compared to control signals. We conclude that hypervilance to pain signals does not emerge as rapid initial shifting to the pain signal but rather as enhanced processing once it is detected. Theoretical and clinical implications of these findings are discussed. PERSPECTIVE: We investigated the fundamental processes associated with hypervigilance to pain. Our findings suggest that treatment approaches using attention techniques should not focus on preventing patients to shift their attention to the pain but rather on diminishing the threat value and learning to disengage from their pain.

Adolescent↗

PubMed2006

Concerns about medication and medication use in chronic pain.

UNLABELLED: This report describes a study of how patients view their pain medications. Two hundred and twenty patients with chronic pain completed a set of 78 items regarding beliefs and concerns about pain medication, a brief measure of medication use, and measures of depression and disability. Item and scale analyses resulted in a 47-item measure, the Pain Medication Attitude Questionnaire (PMAQ), that assesses 7 areas of patient concern: addiction, perceived need, unfavorable scrutiny by others, adverse side effects, tolerance, mistrust in the prescribing doctor, and withdrawal. These seven scales had excellent internal consistency and predictable relations with the measures of medication use, depression, and disability supporting their validity. Correlation analyses highlighted relatively strong associations between concerns about medication and measures of emotional distress and disability, suggesting that these concerns may add significantly to the burden of chronic pain. We suggest that concerns about medication use warrant further study and may deserve clinical attention. PERSPECTIVE: All medication use by chronic pain sufferers is essentially a pattern of patient behavior over time. As such, it appears to be multiply-determined, by beliefs, emotions, bodily sensations, and the social, cultural, and personal learning history that give these experiences their meaning and functions.

Adolescent↗

PubMed2006

Chronic pain in children and adolescents.

Chronic pain is a widespread and significant clinical problem. It can result in major negative short- and long-term physical and emotional effects in multiple domains of children's and their families' lives as Pain Associated Disability Syndrome. Assessment of chronic pain is challenging but it is an essential clinical task. Management requires a multidimensional response focussing on the whole patient. Specialist pain management units and programmes use cognitive behavioural methods and promote adaptive coping and focus on the child re-engaging with normal activities. While chronic pain is not well understood, there is emerging evidence that young people and their parents can recover from chronic disability, dependency and distress, and return to a normal life.

Adaptation, Psychological↗

PubMed2005

The role of extinction and reinstatement in attentional bias to threat: a conditioning approach.

We investigated the effects of extinction and reinstatement on attentional bias to fear-conditioned signals in healthy individuals using an emotional modification of a spatial cueing paradigm. Spatial cues were emotionally modulated using differential conditioning. The CS+ was sometimes followed by an aversive electrocutaneous stimulus (UCS), whereas the CS- was never followed by the UCS. During a subsequent extinction phase no UCS was presented anymore. The reinstatement phase started with one or four unpredicted UCS-only trials for half of the participants (reinstatement group). For the other half there were no additional UCS presentations (control group). We found that attention was biased to threat signals during acquisition. This biased attention largely disappeared during extinction. During the reinstatement phase attentional bias to threat signals re-emerged in the reinstatement group, but not in the control group.

Adolescent↗

PubMed2005

Worrying about chronic pain. An examination of worry and problem solving in adults who identify as chronic pain sufferers.

Worry is a common feature of chronic pain. The purpose of this study was to examine the extent of worry experienced by adults with chronic pain, and to explore features of problem solving associated with worry and chronic pain. A further purpose was to investigate whether there were differences in worry and problem solving for those presenting at a pain clinic for treatment, compared to those who identified as chronic pain sufferers but who were not presenting for treatment. A final purpose was to examine whether the extent of worry and problem solving attitudes helped to predict the primary clinical features of chronic pain such as intensity, disability and depressive mood. One hundred and eighty five adults with chronic pain provided completed questionnaires assessing worrying, problem solving, pain severity, disability, catastrophic thinking and depressive mood. Analyses showed that worry and problem solving approaches sampled in this study were not abnormal. Furthermore, no differences were found between the clinical and non-clinical sample for worrying and problem solving. In relation to the predictive value of worrying and problem solving, analyses revealed that only worrying had a unique contribution in explaining depressive mood. The results are discussed within a context of a model of worry and chronic pain, in which worry about chronic pain may be functioning to promote awareness of an insoluble problem.

Adaptation, Psychological↗

PubMed2005

The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study.

Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic-related data for this population and estimated the cost-of-illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic-related data (CSRI-Pain). This method was compared and discussed in relation to other widely used methods. The CSRI-Pain was sent to 52 families of adolescents with chronic pain to complete as a self-report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately 8,000 pounds per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non-inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK society of approximately 3,840 million pounds in one year. The implications of the study are discussed.

Adolescent↗

PubMed2005

A prospective study of acceptance of pain and patient functioning with chronic pain.

Acceptance of chronic pain is emerging as an important concept in understanding ways that chronic pain sufferers can remain engaged with valued aspects of life. Recent studies have relied heavily on cross-sectional investigations at a single time point. The present study sought to prospectively investigate relations between acceptance of chronic pain and patient functioning. A sample of adults referred for interdisciplinary treatment of severe and disabling chronic pain was assessed twice, an average of 3.9 months apart. Results showed that pain and acceptance were largely unrelated. Pain at Time 2 was weakly related to measures of functioning at Time 2. On the other hand, acceptance at Time 1 was consistently related to patient functioning at Time 2. Those patients who reported greater acceptance at Time 1 reported better emotional, social, and physical functioning, less medication consumption, and better work status at Time 2. These data suggest that willingness to have pain, and to engage in activity regardless of pain, can lead to healthy functioning for patients with chronic pain. Treatment outcome and process studies may demonstrate the potential for acceptance-based clinical methods for chronic pain management.

Activities of Daily Living↗

PubMed2005

The Bath Adolescent Pain Questionnaire (BAPQ): development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain on adolescents.

Chronic pain causes significant problems in the lives of many adolescents, considerably affecting their physical, psychological and social functioning. The assessment of the multidimensional impact of chronic pain is an essential clinical task. This study reports on the development and psychometric evaluation of the Bath Adolescent Pain Questionnaire (BAPQ); an assessment tool designed specifically for use with adolescents who experience chronic pain. A sample of 222 adolescents (11-18 years) experiencing chronic pain completed the 109-item draft inventory. Participants were recruited from two different UK clinics. All participants responded to items using a 5-point frequency scale. Psychometric evaluation of the data resulted in a reduced inventory length of 61 items. Internal consistency of all seven questionnaire subscales was established using Cronbach's alpha. Comparative validity was undertaken by comparison of all individual subscales with existing validated measures (SCAS, CDI-S, FDI, Brief FAM. PCS and CASAFS). The temporal reliability of each inventory subscale was established using a sub-sample of 30 adolescent participants over a 17-day period. Psychometric evaluation of the data suggests the inventory yields both a reliable and valid assessment of the impact of chronic pain on the lives of adolescents. The BAPQ may offer a comprehensive way to assess the widespread deleterious impact of adolescent chronic pain in both a research and clinical setting. Further investigation is needed on the predictive validity of the subscales. Additional data from samples of patients with diagnoses that are not musculoskeletal in origin would be of great assistance.

Adolescent↗

PubMed2005

The impact of chronic pain on adolescents: a review of previously used measures.

OBJECTIVE: To review the use of instruments to assess the impact of adolescent chronic pain, focussing on the development of instruments, the domains covered, psychometric properties, and published use with adolescent chronic pain patients. METHODS: Systematic literature searching recovered 706 articles, yielding 116 relevant articles, employing a total of 43 separate measurement instruments, which were subjected to content analysis. RESULTS: Most instruments were in the psychological domain (n = 22), with a self-report format (n = 36). Thirty instruments were specifically developed for adolescent populations; only 12 instruments had psychometric evaluation with adolescent chronic pain patients. The median use of any one instrument in published studies was two. Clinically relevant psychometric data were missing for many instruments. CONCLUSIONS: There is a diversity of instrumentation with some pockets of depth of use, but some domains of chronic pain experience with no routine assessment. Further development of the knowledge base of measurement of the impact of chronic adolescent pain is necessary.

Adolescent↗

PubMed2005

Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain.

OBJECTIVE: To investigate the value of pain catastrophizing in explaining pain, disability, and somatic complaints, beyond negative affectivity (NA). METHOD: Two cross-sectional studies, one in a sample of school children (n = 193) and a second in a clinical sample of children with recurrent or chronic pain (n = 43), were conducted. In both studies, measures of pain catastrophizing and NA were examined for their ability to explain pain, disability, and somatic complaints. RESULTS: In both studies, pain catastrophizing significantly accounted for the variance of pain, disability, and somatic complaints, beyond the effects of age, sex, and NA. Furthermore, pain catastrophizing significantly mediated the relationship between NA and somatic complaints in both studies and between NA and functional disability in study 1. CONCLUSIONS: Results suggest the importance of assessing for pain catastrophizing in children. Pain catastrophizing is further discussed in terms of communicating distress to significant others.

Child↗

PubMed2005

Gender moderates the association between depression and disability in chronic pain patients.

Pain-related anxiety and depression are important correlates of disability amongst chronic pain patients. Furthermore, women may differ in their experience of pain, anxiety and depression when compared to men. The aim of the current study was to determine the relative contribution of anxiety and depression on disability in male and female chronic pain patients. The sample consisted of 260 patients (101 males, 159 females) referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases in Bath, UK. As part of an initial assessment, all patients completed measures of depression, pain-related anxiety and disability. As predicted, both anxiety and depression were found to be significant positive predictors of pain, number of medications used and disability. Although gender did not significantly predict disability, it did moderate the relationship between depression and disability, in that when depression was high, women report greater disability than men. Gender was also found to moderate the relationship between depression and number of medications used, in that a positive association was found for men, but not women. However, gender did not significantly moderate the relationship between anxiety and disability. Together these results not only suggest that gender is an important moderator of the relationship between emotional responses and disability, but that such associations may be related more to depression than anxiety.

Adult↗

PubMed2005

Do men and women differ in their response to interdisciplinary chronic pain management?

Women report more pain than men. It also seems that gender may moderate responses to pharmacological agents used to combat pain, suggesting that men and women differ in treatment efficacy. Recent research suggests that gender differences may also exist in response to interdisciplinary pain management interventions. We, therefore, report data from a treatment-outcome program at a UK Pain Management Unit. The sample consisted of 98 chronic pain patients (33 males; 65 females) who completed a series of measures relating to pain and distress at three different time points: immediately prior, on completion, and 3 months following an interdisciplinary pain management intervention. The pain management intervention consisted of a 3- or 4-week residential program that aimed to enhance daily functioning, and which involved physiotherapists, occupational therapists, a nurse, physicians, and clinical psychologists. Analyses revealed that the pain management intervention produced improvements in a range of domains of outcome for both men and women, and that such effects were sustained at 3 months following treatment. However, although both men and women exhibited significant post-treatment reduction in measures of current pain intensity and with one measure of pain-related distress, at 3 months following treatment men showed similar reductions as at post-treatment, whereas for women there were no significant differences from pre-treatment scores. This suggests that gender may play a role in reports of pain and distress following interdisciplinary chronic pain management. However, the current results are different from those previously reported. We discuss potential reasons for such differences.

Adult↗