Abstract
Metastatic breast cancer (MBC) patients often experience pain which can trigger pain behaviors, such as distorted ambulation. Psychological variables, such as individuals’ attitudes toward pain, play a role in pain intervention. In this study, we used the cognitive-behavioral model of pain to examine the influence of patients’ attitudes toward pain (as measured by the survey of pain attitudes or SOPA) on their pain behaviors (as measured by the pain behaviors checklist). Two hundred-one MBC patients completed surveys at treatment initiation and again 3 and 6 months later. Linear Mixed Model with repeated measures analyses showed that SOPA-solicitude, SOPA-emotions, SOPA-cure, SOPA-disability, and SOPA-medication pain attitudes were consistently significantly associated with pain behaviors at each assessment time point. Additionally, the belief that a medical cure for pain exists buffered the positive association between pain severity and pain behaviors. Our findings support and extend the cognitive-behavioral model of pain and suggest that it may be useful to target pain attitudes in pain management interventions for MBC patients.
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Notes
In a base repeated measures mixed model, in which time was included as the sole predictor of PBCL, time was not a significant predictor of PBCL (F = .86, p = .43).
References
Ahles, T. A., Blanchard, E. B., & Ruckdeschel, J. C. (1983). The multidimensional nature of cancer-related pain. Pain, 17(3), 277–288. doi:10.1016/0304-3959(83)90100-8
Ahles, T. A., Coombs, D. W., Jensen, L., Stukel, T., Maurer, L. H., & Keefe, F. J. (1990). Development of a behavioral observation technique for the assessment of pain behaviors in cancer patients. Behavior Therapy, 21(4), 449–460. doi:10.1016/S0005-7894(05)80358-2
Badr, H., Carmack, C. L., Kashy, D. A., Cristofanilli, M., & Revenson, T. A. (2010). Dyadic coping in metastatic breast cancer. Health Psychology, 29(2), 169–180. doi:10.1037/a0018165
Badr, H., & Milbury, K. (2011). Associations between depression, pain behaviors, and partner responses to pain in metastatic breast cancer. Pain, 152(11), 2596–2604. doi:10.1016/j.pain.2011.08.002
Butler, L. D., Koopman, C., Cordova, M., Garlan, R., DiMiceli, S., & Spiegel, D. (2003). Psychological distress and pain significantly increase before death in metastatic breast cancer patients. Psychosomatic Medicine, 65, 416–426.
Carson, J. W., Carson, K. M., Porter, L. S., Keefe, F. J., Shaw, H., & Miller, J. M. (2007). Yoga for women with metastatic breast cancer: Results from a pilot study. Journal of Pain and Symptom Management, 33(3), 331–341. doi:10.1016/j.jpainsymman.2006.08.009
Cleeland, C.S. (1991). Pain assessment in cancer. In D. Osoba (Ed.), Effect of cancer on quality of life (pp. 293–305). Boca Raton, FL: CRC Press, Inc. Retrieved from http://scholar.google.com/scholar?q=cleeland+pain+assessment+in+cancer+1991&btnG=&hl=en&as_sdt=0%2C33
Cleeland, C. S., & Syrjala, K. (1992). How to assess cancer pain. In D. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 362–387). New York: Guilford Press.
Coleman, R. E., & Rubens, R. D. (1987). The clinical course of bone metastases from breast cancer. British Journal of Cancer, 55(1), 61–66.
Fairchild, A. (2010). Under-treatment of cancer pain. Current Opinion in Supportive and Palliative Care, 4(1), 11–15. doi:10.1097/SPC.0b013e328336289c
Jensen, M. P., & Karoly, P. (1991). Control beliefs, coping efforts, and adjustment to chronic pain. Journal of Consulting and Clinical Psychology, 59(3), 431–438.
Jensen, M. P., & Karoly, P. (1992). Pain-specific beliefs, perceived symptom severity, and adjustment to chronic pain. The Clinical Journal of Pain, 8(2), 123–130.
Jensen, M. P., Karoly, P., & Huger, R. (1987). The development and preliminary validation of an instrument to assess patients’ attitudes toward pain. Journal of Psychosomatic Research, 31(3), 393–400. doi:10.1016/0022-3999(87)90060-2
Jensen, M. P., Romano, J. M., Turner, J. A., Good, A. B., & Wald, L. H. (1999). Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain. Pain, 81(1–2), 95–104. doi:10.1016/S0304-3959(99)00005-6
Jensen, M. P., Turner, J. A., Romano, J. M., & Lawler, B. K. (1994). Relationship of pain-specific beliefs to chronic pain adjustment. Pain, 57(3), 301–309. doi:10.1016/0304-3959(94)90005-1
Kerns, R. D., Haythornthwaite, J., Rosenberg, R., Southwick, S., Giller, E. L., & Jacob, M. C. (1991). The pain behavior check list (PBCL): Factor structure and psychometric properties. Journal of Behavioral Medicine, 14(2), 155–167. doi:10.1007/BF00846177
Krueger, C., & Tian, L. (2004). A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biological Research For Nursing, 6(2), 151–157. doi:10.1177/1099800404267682
McGuire, D. B., & Sheidler, V. R. (1992). Pain. In S. L. Groenwald, M. H. Frogge, M. Goodman, & C. H. Yarbro (Eds.), Manifestations of cancer and cancer treatment (pp. 985–1041). Boston: Jones and Bartlett Publishers.
Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1–2), 1–13. doi:10.1016/S0304-3959(98)00255-3
Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649–655.
Portenoy, R. K., & Lesage, P. (1999). Management of cancer pain. The Lancet, 353(9165), 1695–1700. doi:10.1016/S0140-6736(99)01310-0
Raphael, J., Ahmedzai, S., Hester, J., Urch, C., Barrie, J., Williams, J., et al. (2010). Cancer pain: Part 1: Pathophysiology; oncological, pharmacological, and psychological treatments: A perspective from the British Pain Society endorsed by the UK Association of palliative medicine and the Royal college of general practitioners. Pain Medicine, 11(5), 742–764. doi:10.1111/j.1526-4637.2010.00840.x
Romano, J. M., Jensen, M. P., Turner, J. A., Good, A. B., & Hops, H. (2000). Chronic pain patient-partner interactions: Further support for a behavioral model of chronic pain. Behavior Therapy, 31(3), 415–440. doi:10.1016/S0005-7894(00)80023-4
Sharp, T. J. (2001). Chronic pain: a reformulation of the cognitive-behavioural model. Behaviour Research and Therapy, 39(7), 787–800. doi:10.1016/S0005-7967(00)00061-9
Simone, C. B., Vapiwala, N., Hampshire, M. K., & Metz, J. M. (2012). Cancer patient attitudes toward analgesic usage and pain intervention. The Clinical Journal of Pain, 28(2), 157–162. doi:10.1097/AJP.0b013e318223be30
Strong, J., Ashton, R., & Chant, D. (1992). The measurement of attitudes towards and beliefs about pain. Pain, 48(2), 227–236. doi:10.1016/0304-3959(92)90062-G
Tait, C. R., & Chibnall, J. T. (1997). Development of a brief version of the survey of pain attitudes. Pain, 70(2–3), 229–235. doi:10.1016/S0304-3959(97)03330-7
Tatrow, K., & Montgomery, G. (2006). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis. Journal of Behavioral Medicine, 29(1), 17–27. doi:10.1007/s10865-005-9036-1
Turk, Dennis. C., Meichenbaum, D., & Genest, M. (1987). Pain and behavioral medicine: A cognitive-behavioral perspective. New York: Guilford Press.
Turk, D. C., Sist, T. C., Okifuji, A., Miner, M. F., Florio, G., Harrison, P., et al. (1998). Adaptation to metastatic cancer pain, regional/local cancer pain and non-cancer pain: Role of psychological and behavioral factors. Pain, 74(2–3), 247–256. doi:10.1016/S0304-3959(97)00187-5
Acknowledgments
Dr. Shen’s work on this project was supported by a cancer prevention fellowship from the National Cancer Institute (5R25CA081137). Dr. Redd’s work was supported through a Research and Mentoring in Psychosocial Oncology award from the National Cancer Institute (5K05CA108955). Dr. Badr’s work was supported by a multi-disciplinary award from the U. S. Army Medical Research and Materiel Command W81XWH-0401-0425 and K07CA124668.
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Shen, M.J., Redd, W.H., Winkel, G. et al. Associations among pain, pain attitudes, and pain behaviors in patients with metastatic breast cancer. J Behav Med 37, 595–606 (2014). https://doi.org/10.1007/s10865-013-9529-2
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DOI: https://doi.org/10.1007/s10865-013-9529-2