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Acceptance and patient functioning in chronic pain: the mediating role of physical activity

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Abstract

Purpose

Activity engagement, which refers to pursuing activities despite pain, is conceptually related to pain acceptance. A recent diary study suggested that pain acceptance precedes and directly influences physical activity, and thus, pain acceptance appears to be an important aspect of eliciting better functioning by allowing patients with chronic pain (PCPs) to participate in physical activity despite the pain. This retrospective, cross-sectional cohort study was conducted to investigate the mediating effect of physical activity on the association between pain acceptance and functioning and the association between physical activity level and functioning in PCPs.

Methods

The study participants were 176 patients seeking treatment for chronic pain at a tertiary pain center in Korea. The Chronic Pain Acceptance Questionnaire, International Physical Activity Questionnaire-Short Form, and Short Form-36 were used to assess pain acceptance, physical activity, and patient functioning. The mediating effects of physical activity were tested using procedures described by Baron and Kenny. Also, three hierarchical multiple linear regression analyses were conducted to identify levels of physical activity that predict measures of patient functioning.

Results

Physical activity partially mediated the association between pain acceptance and patient functioning except for pain intensity. Furthermore, walking and moderate activity were found to be associated with improvements in all areas of patient functioning except for pain intensity.

Conclusion

To improve the functioning of PCPs, health professionals may need to help patients accept private experiences related to pain and plan activity pacing programs that focus on value-based activities.

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Abbreviations

PCPs:

Patients with chronic pain

ACT:

Acceptance and commitment therapy

CPAQ:

Chronic Pain Acceptance Questionnaire

IPAQ-SF:

The International Physical Activity Questionnaire-Short Form

NRS:

Numerical rating scale

SF-36:

The Short Form-36

References

  1. Merskey, H., & Bogduk, N. (1994). Classification of chronic pain (2nd ed., p. 1). Seattle: IASP Press.

    Google Scholar 

  2. Singh, M. K., Patel, J., & Gallagher, R. M. (2005). Chronic pain syndrome. Physical Medicine and Rehabilitation. http://emedicine.medscape.com/article/310834-overview.

  3. Kim, Y. S. (2011). Spinal cord stimulation for control of chronic pain. Hanyang Medical Reviews, 31(2), 85–89.

    Article  CAS  Google Scholar 

  4. Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70(3), 678.

    Article  PubMed  Google Scholar 

  5. Sullivan, M. J., Rouse, D., Bishop, S., & Johnston, S. (1997). Thought suppression, catastrophizing, and pain. Cognitive Therapy and Research, 21(5), 555–568.

    Article  Google Scholar 

  6. Cho, S., McCracken, L. M., Heiby, E. M., Moon, D. E., & Lee, J. H. (2013). Pain acceptance-based coping in complex regional pain syndrome Type I: Daily relations with pain intensity, activity, and mood. Journal of Behavioral Medicine, 36(5), 531–538.

    Article  PubMed  Google Scholar 

  7. Petrie, K. J., Booth, R. J., & Pennebaker, J. W. (1998). The immunological effects of thought suppression. Journal of Personality and Social Psychology, 75(5), 1264.

    Article  CAS  PubMed  Google Scholar 

  8. McCracken, L. M. (2005). Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain, 113(1), 155–159.

    Article  PubMed  Google Scholar 

  9. Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., et al. (2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: Empirical evidence and reappraisal. Pain, 106(1), 65–72.

    Article  PubMed  Google Scholar 

  10. McCracken, L. M., Carson, J. W., Eccleston, C., & Keefe, F. J. (2004). Acceptance and change in the context of chronic pain. Pain, 109(1), 4–7.

    Article  PubMed  Google Scholar 

  11. McCracken, L. M., & Vowles, K. E. (2006). Acceptance of chronic pain. Current Pain and Headache Reports, 10(2), 90–94.

    Article  PubMed  Google Scholar 

  12. Hayes, S. C. (2004). Acceptance and Commitment Therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 1–29). New York:Guilford.

  13. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.

    Article  PubMed  Google Scholar 

  14. Reneman, M. F., Dijkstra, A., Geertzen, J. H., & Dijkstra, P. U. (2010). Psychometric properties of chronic pain acceptance questionnaires: A systematic review. European Journal of Pain, 14(5), 457–465.

    Article  PubMed  Google Scholar 

  15. McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30(4), 339–349.

    Article  PubMed  Google Scholar 

  16. Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287.

    Article  PubMed  Google Scholar 

  17. Van Damme, S., Crombez, G., & Eccleston, C. (2004). Disengagement from pain: The role of catastrophic thinking about pain. Pain, 107(1), 70–76.

    Article  PubMed  Google Scholar 

  18. McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107(1), 159–166.

    Article  PubMed  Google Scholar 

  19. Habib, S., Morrissey, S., & Helmes, E. (2005). Preparing for pain management: A pilot study to enhance engagement. Journal of Pain, 6(1), 48–54.

    Article  PubMed  Google Scholar 

  20. Biesanz, J. C., Falk, C. F., & Savalei, V. (2010). Assessing mediational models: Testing and interval estimation for indirect effects. Multivariate Behavioral Research, 45(4), 661–701.

    Article  PubMed  Google Scholar 

  21. Cho, S., Heiby, E. M., McCracken, L. M., Moon, D. E., & Lee, J. H. (2012). Psychometric properties of a Korean version of the Chronic Pain Acceptance Questionnaire in chronic pain patients. Quality of Life Research, 21(6), 1059–1064.

    Article  PubMed  Google Scholar 

  22. Sjøstrom, M., Ekelund, U., Poortvliet, E., Hurting-Wennlof, A., & Yngve, A. (2000). Assessment of physical activity using IPAQ (version 4) and activity monitors (CSA). Measurement in Physical Education and Exercise Science, 4, 263–264.

    Google Scholar 

  23. Oh, J. Y., Yang, Y. J., Kim, B. S., & Kang, J. H. (2007). Validity and reliability of Korean version of International Physical Activity Questionnaire (IPAQ) short form. Journal of the Korean Academy of Family Medicine, 28(7), 532–541.

    Google Scholar 

  24. Jensen M. P., & Karoly P. (2011). Self-report scales and procedures for assessing pain in adults. In: Turk D. C, Melzack R (Eds), Handbook of pain assessment (pp. 19–41). 3rd Edn. New York, NY: Guilford Press.

  25. Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.

    Article  PubMed  Google Scholar 

  26. Hays, R. D., Sherbourne, C. D., & Mazel, R. M. (1993). The rand 36-item health survey 1.0. Health Economics, 2(3), 217–227.

    Article  CAS  PubMed  Google Scholar 

  27. Koh, S. B., Chang, S. J., Kang, M. G., Cha, B. S., & Park, J. K. (1997). Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean Journal of Preventive Medicine, 30(2), 251–266.

    Google Scholar 

  28. Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.

    Article  PubMed  Google Scholar 

  29. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173.

    Article  CAS  PubMed  Google Scholar 

  30. Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In S. Leinhart (Ed.), Sociological Mhodology (pp 290–312). San Francisco: Jossey-Bass.

  31. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  32. Yun, H. K. (2005). The therapeutic mechanisms of on-maeum counseling. Korean Journal Counseling Psychotherapy, 17(1), 1–13.

    Google Scholar 

  33. Moon, H. M. (2006). Development and validation of the program for facilitation of psychological acceptance based on Acceptance and Commitment Therapy model. Unpublished doctoral dissertation.

  34. Parkinson, W. L., Krames, L., Kumbhare, D., D’Arcy, B., Gromkowska, G., & Balsor, B. (2006). Use of pedometers in chronic pain: Associations with self-reported coping measures. Archives of Physical Medicine and Rehabilitation, 87(11), e39.

    Article  Google Scholar 

  35. Nielson, W. R., Jensen, M. P., & Hill, M. L. (2001). An activity pacing scale for the chronic pain coping inventory: Development in a sample of patients with fibromyalgia syndrome. Pain, 89(2), 111–115.

    Article  CAS  PubMed  Google Scholar 

  36. Hasenbring, M. I., & Verbunt, J. A. (2010). Fear-avoidance and endurance-related responses to pain: New models of behavior and their consequences for clinical practice. Clinical Journal of Pain, 26(9), 747–753.

    Article  PubMed  Google Scholar 

  37. Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332.

    Article  CAS  PubMed  Google Scholar 

  38. Birkholtz, M., Aylwin, L., & Harman, R. M. (2004). Activity pacing in chronic pain management: One aim, but which method? Part one: Introduction and literature review. The British Journal of Occupational Therapy, 67(10), 447–452.

    Article  Google Scholar 

  39. McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. Journal of Pain, 14(8), 828–835.

    Article  PubMed  Google Scholar 

  40. Cavanaugh, J. M., & Weinstein, J. N. (1994). Low back pain epidemiology, anatomy and neurophysiology. In P. D. Wall & R. Melzack (Eds.), Textbook of pain. New York, NY: Livingstone.

    Google Scholar 

  41. Kindermans, H. P., Roelofs, J., Goossens, M. E., Huijnen, I. P., Verbunt, J. A., & Vlaeyen, J. W. (2011). Activity patterns in chronic pain: Underlying dimensions and associations with disability and depressed mood. The Journal of Pain, 12(10), 1049–1058.

    Article  PubMed  Google Scholar 

  42. Trompetter, H. R., Ten Klooster, P. M., Schreurs, K. M., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25(4), 1235.

    Article  PubMed  Google Scholar 

  43. Antcliff, D., Keeley, P., Campbell, M., Oldham, J., & Woby, S. (2013). The development of an activity pacing questionnaire for chronic pain and/or fatigue: A Delphi technique. Physiotherapy, 99(3), 241–246.

    Article  PubMed  Google Scholar 

  44. Park, Y., Kim, D., & Cho, S. (2015). The relative utility of pacing and committed action for predicting adjustment to chronic pain. Journal of Pain, 4(16), S104.

    Article  Google Scholar 

  45. McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14(8), 828–835.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by research fund of Chungnam National University in 2013.

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Authors and Affiliations

  1. Department of Psychology, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, Korea

    Saetbyeol Jeong & Sungkun Cho

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  1. Saetbyeol Jeong
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  2. Sungkun Cho
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Correspondence to Sungkun Cho.

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Saetbyeol Jeong and Sungkun Cho declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Jeong, S., Cho, S. Acceptance and patient functioning in chronic pain: the mediating role of physical activity. Qual Life Res 26, 903–911 (2017). https://doi.org/10.1007/s11136-016-1404-5

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