Posttraumatic Stress Symptoms and the Diathesis-Stress Model of Chronic Pain and Disability in Patients Undergoing Major Surgery

Abstract

Objectives: To (1) use structural equation modeling (SEM) to examine relationships proposed in Turk's diathesis-stress model of chronic pain and disability as well as (2) investigate what role, if any, posttraumatic stress symptoms (PTSS) play in predicting pain disability, relative to some of the other factors in the model. Methods:The study sample consisted of 208 patients scheduled for general surgery, 21 to 60 years of age (mean age= 47.18 y, SD = 9.72 y), who reported experiencing persistent pain for an average of 5.56 years (SD = 7.90 y). At their preadmission hospital visit, patients completed the Anxiety Sensitivity Index, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Disability Index, posttraumatic stress disorder Checklist, and rated the average intensity of their pain (0 to 10 numeric rating scale). SEM was used to test a model of chronic pain disability and to explore potential relationships between PTSS and factors in the diathesis-stress model.Results: SEM results provided support for a model in which anxiety sensitivity predicted fear of pain and catastrophizing, fear of pain predicted escape/avoidance, and escape/avoidance predicted pain disability. Results also provided support for a feedback loop between disability and fear of pain. SEM analyses provided preliminary support for the inclusion of PTSS in the diathesisstress model, with PTSS accounting for a significant proportion of the variance in pain disability. Discussion: Results provide empirical support for aspects of Turk's diathesis-stress model in a sample of patients with persistent pain. Findings also offer preliminary support for the role of PTSS in fear-avoidance models of chronic pain.

The Revised Formal Social Support for Autonomy and Dependence in Pain Inventory (FSSADI_PAIN): Confirmatory Factor Analysis and Validity

“…Therefore, absolute fit indexes -χ 2 and Root Mean Square Error of Approximation (RMSEA) were used to determine how well the apriori model fit the data [25]. Also, incremental fit indexes -Incremental Fit Index (IFI), the Normed Fixed Index (NFI) and the Comparative Fit Index (CFI) indicated the fit of the model when compared to the baseline model [15].…”

“…We argue that the impact of PSS on pain and pain-related disability might depend on the extent to which it is promoting functional autonomy versus dependence [26]. Our contention is based on the assumptions that: 1) avoidance behaviors represent a main predictor of functional disability in CP, as postulated by fearavoidance [21,39,20] and diathesis-stress models [37,25]; 2) PSS, by promoting functional autonomy or dependence, may influence the extent to which individuals engage in activity avoidance versus engagement.…”

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning

“…In our previous work (Matos, et al, 2015), we established that the ability to perform daily activities -physical functioning -was positively associated with perceived promotion of autonomy and negatively associated with perceived promotion of dependence. As low physical functioning has been associated with painrelated disability (e.g., Leeuw et al, 2007;Lethem et al, 1983;Martin et al, 2010;Turk, 2002;Vlaeyen et al, 1995), we wanted to investigate whether the level of physical functioning could be a mechanism through which perceived promotion of autonomy and dependence would be related to pain-related disability. Thus, the second aim of the present study was to explore the mediating role of self-reported physical functioning in the relationship between perceived promotion of autonomy and dependence and pain-related disability, in older adults with chronic pain.…”

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery

“…[164][165][166][167] Recognizing the importance of pain-related fear and anxiety in the transition to chronicity, this section describes how these constructs may be relevant to the experience of acute and chronic pain and their impact on physical function in post-surgical patients.…”