Abstract
Purpose: The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury. Methods: 187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-treatment assessment: (1) clients whose pre-treatment catastrophizing scores and measures of mental health problems were below clinical threshold, (2) clients whose pre-treatment catastrophizing scores were above clinical threshold but who scores on measures of mental health problems were below clinical threshold, (3) clients whose pre-treatment catastrophizing scores were above clinical threshold and whose scores on measures of mental health problems were also above clinical threshold, and (4) clients whose pre-treatment catastrophizing scores were below clinical threshold but whose scores on measures of mental health problems were above clinical threshold. Results: The most prevalent risk profile consisted of clients with high levels of pain catastrophizing and high mental health problems (37 %), followed by the low catastrophizing and low mental health problems profile (35 %), the high catastrophizing and low mental health problems profile (16 %), and low catastrophizing and high mental health problems profile (10 %). Clients were considered non-responders if their post-treatment catastrophizing score remained above clinical threshold following treatment. Chi square analyses revealed a significantly higher proportion of non-responders in the high catastrophizing and mental health problem group than in any other group. Conclusions: The presence of mental health symptoms markedly reduces the effectiveness of physical therapy for reducing catastrophizing scores. The ‘risk value’ of high catastrophizing scores thus appears to vary as a function of the presence or absence of mental health symptoms. The findings argue for the inclusion of measures of mental health problems in the routine screening of individuals treated in physical therapy.
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Buer N, Linton SJ. Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population. Pain. 2002;99:485–91.
Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80:329–39.
de Boer MJ, Struys MM, Versteegen GJ. Pain-related catastrophizing in pain patients and people with pain in the general population. Eur J Pain 2012. doi:10.1002/j.1532-2149.2012.00136.x.
Sullivan MJL, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17:52–64.
Sullivan MJ, Feuerstein M, Gatchel R, Linton SJ, Pransky G. Integrating psychosocial and behavioral interventions to achieve optimal rehabilitation outcomes. J Occup Rehab. 2005;15:475–89.
Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7:261–71.
Spinhoven P, Ter Kuile M, Kole-Snijders AM, Hutten Mansfeld M, Den Ouden DJ, Vlaeyen JW. Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain. 2004;8:211–9.
Sullivan MJL, Neish N. The effects of disclosure on pain during dental hygiene treatment: the moderating role of catastrophizing. Pain. 1999;79:155–63.
George SZ, Zeppieri G Jr, Cere AL, Cere MR, Borut MS, Hodges MJ, et al. A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain. 2008;140:145–57.
Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20:324–30.
Sullivan MJL, Adams H, Rhodenizer T, Stanish WD. A psychosocial risk factor–targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys Ther. 2006;86:8–18.
Linton S, Boersma K, Jansson M, Svard L, Botvalde M. The effects of cognitive-behavioral and physical therapy preventive interventions in pain-related sick leave: a randomized controlled trial. Clin J Pain. 2005;21:109–19.
Jensen MP, Turner JA, Romano JM. Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment. J Consult Clin Psychol. 2001;69(655):62.
Sullivan MJL, Adams H. Psychosocial techniques to augment the impact of physical therapy interventions for low back pain. Physiother Can. 2010;62:180–9.
Miciak M, Gross DP, Joyce A. A review of the psychotherapeutic ‘common factors’ model and its application in physical therapy: the need to consider general effects in physical therapy practice. Scand J Caring Sci. 2012;26:394–403.
Wampold BE. The great psychotherapy debate: models, methods, and findings. Mahwah: L. Erlbaum Associates; 2001.
Sullivan MJL, Ward LC, Tripp D, French DJ, Adams H, Stanish WD. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehab. 2005;15:377–92.
Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1:277–99.
Turk DC, Rudy T, Salovey P. The McGill pain questionnaire: confirming the factor analysis and examining appropriate uses. Pain. 1985;21:385–97.
Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.
Wideman TH, Adams H, Sullivan MJ. A prospective sequential analysis of the fear-avoidance model of pain. Pain. 2009;145:45–51.
Beck AT, Steer RA, Brown GK. Manual for the beck depression inventory—II. San Antonio: Psychological Corporation; 1996.
Bishop SR, Edgley K, Fisher R, Sullivan MJL. Screening for depression in chronic low back pain with the beck depression inventory. Can J Rehab. 1993;7:143–8.
Harris CA, D’Eon JL. Psychometric properties of the beck depression inventory-second edition (BDI-II) in individuals with chronic pain. Pain. 2008;137:609–22.
Brunet A. Validation of the French version of the impact of event scale—revised. Can J Psychiat. 2002;20:174–82.
Sullivan MJL, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009;145:325–31.
Weiss D, Marmar C. The impact of events scale—revised. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: Guilford; 1997. p. 399–411.
Neal LA, Busuttil W, Herapath R, Strike PW. Development and validation of the computerized clinician administered post-traumatic stress disorder scale-1-revised. Psychol Med. 1994;24:701–6.
Scott W, Sullivan MJL. Validity and determinants of clinicians’ return to work judgments for individuals following whiplash injury. Psychol Inj Law. 2010;3:220–9.
Simmonds M, Olson S, Novy D, Jones S, Hussein T, Lee C, et al. Physical performance tests: are they psychometrically souind and clinically useful for patients with low back pain? Spine. 1999;23:2412–21.
Simmonds MJ, Novy DM, Sandoval R. The influence of pain and fatigue on physical performance and health status in ambulatory patients with HIV. Clin J Pain. 2005;21:200–6.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300.
Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–91.
Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001;81:1701–17.
Wideman TH, Scott W, Martel MO, Sullivan MJ. Recovery from depressive symptoms over the course of physical therapy: a prospective cohort study of individuals with work-related, orthopaedic injuries and symptoms of depression. J Ortho Sports Phys Ther 2012.
Wideman TH, Sullivan MJ. Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers’ compensation claimants. Pain. 2011;152:376–83.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy for depression. New York: Guilford; 1978.
Linton SJ, Nicholas MK, MacDonald S, Boersma K, Bergbom S, Maher C, et al. The role of depression and catastrophizing in musculoskeletal pain. Eur J Pain. 2011;15(4):416–22.
Leeuw M, Goossens ME, van Breukelen GJ, de Jong JR, Heuts PH, Smeets RJ, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 2008;138:192–207.
Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8:39–45.
Wideman TH, Sullivan MJL. Reducing catastrophic thinking associated with pain. Pain Manag. 2011;1:249–56.
Main C, Sullivan MJL, Watson PJ. Pain management: practical applications of the biopsychosocial perspective in clinical and occupational settings. 2nd ed. Edinburg: Churchill Livingstone; 2007.
Thibault P, Loisel P, Durand MJ, Catchlove R, Sullivan MJ. Psychological predictors of pain expression and activity intolerance in chronic pain patients. Pain. 2008;139(1):47–54.
Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
Brison RJ, Hartling L, Dostaler S, Leger A, Rowe BH, Stiell I, et al. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Spine. 2005;30(16):1799–807.
Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine. 1999;24:2484–91.
George SZ, Teyhen DS, Wu SS, Wright AC, Dugan JL, Yang G, et al. Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting. Eur Spine J. 2009;18:1050–8.
Fordyce WE, Fowler RS Jr, Lehmann JF, Delateur BJ, Sand PL, Trieschmann RB. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehab. 1973;54:399–408.
Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30:77–94.
George SZ, Wittmer VT, Fillingim RB, Robinson ME. Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. J Ortho Sports Phys Ther. 2010;40(11):694–704.
Ehlers A, Clark DM. A cognitive model of post-traumatic stress disorder. Behav Res Ther. 2000;38:319–45.
Foa EB, Keane TM, Friedman MJ, Cohen JA, editors. Effective treatments for PTSD. Practice guidelines from the international society for traumatic stress studies. 2nd ed. New York: Guilford Press; 2008.
Sullivan MD, Robinson JP. Antidepressant and anticonvulsant medication for chronic pain. Phys Med Rehabil Clin N Am. 2006;17:381–400.
Sullivan MJ, Adams H, Tripp D, Stanish WD. Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression. Pain. 2008;135:151–9.
Wideman TH, Sullivan MJ. Development of a cumulative psychosocial factor index for problematic recovery following work-related musculoskeletal injuries. Phys Ther. 2012;92:58–68.
Sullivan MJL, Adams A, Tripp D, Stanish W. Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression. Pain. 2007;135:151–9.
Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain. 1997;13:163–70.
Sullivan MJL, Gauthier N, Tremblay I. Mental health outcomes of chronic pain. In: Wittink H, editor. Evidence, outcomes and quality of life in pain treatment: a handbook for pain treatment professionals. Amsterdam: Elsevier; 2008.
Poole H, Bramwell R, Murphy P. Factor structure of the beck depression inventory-II in patients with chronic pain. Clin J Pain. 2006;22:790–8.
Geisser M, Roth R, Theisen M, Robinson M, Riley J. Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain. Clin J Pain. 2000;16:110–20.
Hill JC, Lewis M, Sim J, Hay EM, Dziedzic K. Predictors of poor outcome in patients with neck pain treated by physical therapy. Clin J Pain. 2007;23(8):683–90.
Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220–8.
Acknowledgments
This research was supported by funds from the Fonds de la recherche en santé du Québec (FRSQ), the Institut de recherche Robert-Sauvé en santé et en securité du travail (IRSST).
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The authors have no financial interest in the results of this research.
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Slepian, P., Bernier, E., Scott, W. et al. Changes in Pain Catastrophizing Following Physical Therapy for Musculoskeletal Injury: The Influence of Depressive and Post-traumatic Stress Symptoms. J Occup Rehabil 24, 22–31 (2014). https://doi.org/10.1007/s10926-013-9432-2
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DOI: https://doi.org/10.1007/s10926-013-9432-2