Alexithymia and Pain in Three Chronic Pain Samples: Comparing Caucasians and African Americans

Lumley, Mark A.; Radcliffe, Alison M.; Macklem, Debra J.; Mosley-Williams, Angelia; Leisen, James; Huffman, Jennifer; D'Souza, Pamela J.; Gillis, Mazy; Meyer, Tina M.; Kraft, Christina A.; Rapport, Lisa J.

doi:10.1111/j.1526-4637.2005.05036.x

Cited by 65 publications

(45 citation statements)

References 75 publications

(77 reference statements)

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“…25 Cronbach's alpha for the TAS-EOT subscale was low (0.48) across all ethnicities in San Francisco public transit workers 25 . A low reliability for this subscale was found in other studies as well [41][42][43][44] . Alexithymia as measured by the TAS-20 is generally seen as a relatively stable trait supported by test-retest reliability of 0.74 (p < 0.001) 41 , however modifiable by psychotherapy enhanced by mindbody techniques 45 or body-oriented psychotherapy 46 .…”

Section: Measurement Of Alexithymiamentioning

confidence: 83%

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

Mehling

Krause

2007

Journal of Psychosomatic Research

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Objective-Alexithymia, a lack of emotional awareness, was positively associated with selfreported low back pain (LBP) in cross-sectional studies. We assessed the association of alexithymia with 7.5-year incidence of LBP prospectively in a cohort study of 1,207 San Francisco transit operators.Methods-Alexithymia was measured by the Toronto Alexithymia Scale (TAS-20). LBP was assessed by physician-confirmed diagnoses from administrative workers' compensation data. Cox proportional hazard analyses controlled for demographic, behavioral, and physical and psychosocial job factors measured by questionnaire and interview.Results-27.7% of all drivers (n=334) filed compensated claims for LBP injuries with workers' compensation insurance during the 7.5-year observation time. The hazard ratios from the fully adjusted model were 0.73 (0.56-0.96) for the TAS-20 scale and 0.82 (0.69-0.98) for the subscale "difficulty describing feelings". Alexithymia scores did not predict the duration of compensated work disability.Conclusion-In contrast to previous cross-sectional positive associations between alexithymia and LBP, alexithymia is negatively associated with compensated LBP claims. We hypothesize that shame and reporting behavior may explain these inconsistent results.

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Section: Measurement Of Alexithymiamentioning

confidence: 83%

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

Mehling

Krause

2007

Journal of Psychosomatic Research

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“…Some health professionals believe that these patients deliberately exaggerate pain (personal comments). However, severe pain could also be attributed to learned factors [6,26,36], to work load [19], emotional distress [2,12,21,22] or doctor-patient interactions [15].…”

Section: Introductionmentioning

confidence: 99%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27-45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain ''right now'' on a 0-100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75-100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P \ 0.001), and reported pain anxiety more often (P \ 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36-69 vs. md 72, IQR 51-85), (P \ 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8-4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40-45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7-10.0 and 2.7; 95% CI 1.1-6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1-3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95-4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.

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“…Considering the construct of alexithymia reflecting deficits in cognitive processing and the regulation of emotions, alexithymia may play some role in pain perception. A high prevalence of alexithymia has been observed in patients with chronic pain (9), including those with RA (14,15). Numerous observational and some experimental studies revealed positive associations between alexithymia and pain intensity and sensitivity (16).…”

Section: Introductionmentioning

confidence: 99%

Alexithymia, Depression, Inflammation, and Pain in Patients With Rheumatoid Arthritis

Kojima

Suzuki

et al. 2014

Arthritis Care & Research

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Objective. We previously reported that depression and inflammation have independent effects on pain severity in patients with rheumatoid arthritis (RA). Alexithymia is a personality trait characterized by deficits in cognitive processing and regulation of emotions. A broad association between alexithymia and various health problems has been suggested, including depression, inflammation, and pain. The objective of this study was to examine the independent influence of alexithymia on pain perception and its relationship to depression and inflammation. Methods. We evaluated 213 RA outpatients who completed self-administered questionnaires, including the Beck Depression Inventory-II (BDI-II) to measure depression severity, the 20-item Toronto Alexithymia Scale (TAS-20) to measure degree of alexithymia, and a visual analog scale to quantify perceived pain. Serum C-reactive protein (CRP) levels were measured to quantify inflammation severity.Results. An initial significant positive association between the TAS-20 score and pain severity (P ‫؍‬ 0.01) lost significance after controlling for BDI-II score and CRP level using regression analysis. An interaction was observed among alexithymia, depression, and inflammation with regard to perceived pain. Among those without alexithymia, pain severity increased linearly with the CRP tertile levels regardless of the presence of depression (P < 0.001 for trend). No linear association between pain severity and CRP level was observed among those with alexithymia. Moreover, depressed patients with alexithymia (BDI-II score >14 and TAS-20 score >61) reported severe pain even at low CRP levels. Conclusion. Alexithymia might have a substantial role in pain perception as well as depression in patients with RA. A biopsychosocial approach is essential to achieve better pain control. INTRODUCTIONRheumatoid arthritis (RA) is a chronic disease in which an autoimmune disorder causes inflammation of the joints and surrounding tissues. Patients with RA experience persistent pain, arising from inflammation. This pain is also known to possess a strong emotional component and is affected by mood and psychosocial factors (1). We previously reported the independent influences of depression severity and inflammation on perceived pain in patients with RA (2). Both the depression score and the serum levels of C-reactive protein (CRP), a biomarker of inflammation, were significantly associated with pain, even after controlling for each other and for clinical covariates by regression analysis. Alexithymia is defined as a personality construct with difficulties in affective self-regulation (3). It has been proposed to be a cluster of cognitive and affective characteristics that are commonly observed among classic psychosomatic patients for whom therapy has been unsuccessful (4). Individuals with alexithymia tend to experience difficulties in identifying and describing their inner feelings and have a limited imaginary capacity and a preference for externally oriented thinking rather than introspection (3)....

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Alexithymia and Pain in Three Chronic Pain Samples: Comparing Caucasians and African Americans

Abstract: Alexithymia is more correlated with pain severity among African Americans with chronic pain disorders than among Caucasians, potentially contributing to the higher pain reports among African Americans.

Cited by 65 publications

References 75 publications

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Alexithymia, Depression, Inflammation, and Pain in Patients With Rheumatoid Arthritis

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