Review by Gurjeet Bhangu
Kratz, A. L., Ehde, D. M., Bombardier, C. H., Kalpakjian, C. Z., & Hanks, R. A. (2016). Pain Acceptance Decouples the Momentary Associations Between Pain, Pain Interference, and Physical Activity in the Daily Lives of People With Chronic Pain and Spinal Cord Injury. The Journal of Pain.
Chronic pain acceptance is an important predictor of adjustment to pain. Preliminary evidence has illustrated that pain acceptance breaks the links between pain and emotional distress. However, no known research has investigated whether pain acceptance can decouple the connection between pain intensity and general pain interference or physical activity. This week at Research Corner we will review this article published in The Journal of Pain which examines the significance of pain acceptance in the context of chronic pain.
This is a cross-sectional study of 128 patients with chronic pain and a spinal cord injury (SCI). A combination of baseline surveys, ecological momentary assessment (EMA) of subjective symptoms and functioning (used to examine the dynamics of pain acceptance in daily life), and objectively measured physical activity (with a wrist-worn accelerometer called the PRO-Diary) was used. Data were collected over a 20 month period from June 2014 to January 2016 at 3 collaborating sites: the University of Michigan, the Wayne State University/Rehabilitation Institute of Michigan, and the University of Washington. Participants completed 7 days of ecological momentary assessments of pain intensity and pain interference (5 times per day) with continuous accelerometry (physical activity). Multilevel modeling was utilized to evaluate whether pain acceptance significantly moderated the momentary association between pain intensity and pain interference.
Pain acceptance, measured using the total score of the CPAQ (a 20 item questionnaire assessing 2 domains of pain-related acceptance: activities engagement and pain willingness), significantly moderated the association between momentary changes in pain intensity and concurrent pain interference. The momentary association between pain intensity and pain interference was positive across all levels of pain acceptance. However, higher levels of pain acceptance decoupled this association, with a smaller increase in pain interference when pain was higher than normal. Also, pain acceptance significantly moderated the association between momentary changes in pain intensity and physical activity. Individuals with low levels of acceptance show a decline in or negative association with physical activity when pain is high, whereas those with higher levels of acceptance show a positive association between pain intensity and physical activity (they show increased levels of activity).
The findings are correlational and directions of associations are not definitive. Longitudinal and experimental designs should be utilized to examine these relationships in the future.
Momentary pain acceptance was not measured and as a result, the impact of fluctuations in pain acceptance on moment-to-moment experiences and responses to pain was not evaluated.
This study focused on individuals with chronic pain and spinal cord injury. Thus, the generalizability of these findings need to be further evaluated in other clinical populations.
This study highlights the role of pain acceptance in decoupling the moment-to-moment associations between pain intensity and activity measures (pain interference and physical activity). These findings extend existing literature by indicating that pain acceptance may not only buffer emotional distress associated with pain but also the effects of pain on pain interference and physical activity.
The findings from this study adds to the growing literature on chronic pain acceptance by illustrating the impact it has on physical activity levels and function. We offer a number of CHANGEpain Together Self-Management Programs and Group Medical Visits to teach patients tools, knowledge, and strategies to cope with chronic pain and take control of their condition. For more information follow up with Registered Psychologists Dr. Judy LePage and Dr. Tony LePage or our psychiatrist Dr. Michael Butterfield.