Screening for pain-persistence and pain-avoidance patterns in fibromyalgia

Abstract

These findings suggest that a short self-report screening instrument can be used to distinguish between pain-avoidance and pain-persistence patterns within the heterogeneous population of FM patients, which offers promising possibilities to improve treatment efficacy by tailoring treatment to specific patient patterns.

Incorporating Biopsychosocial Characteristics into Personalized Healthcare: A Clinical Approach

“…Reliable and valid screening is a prerequisite for personalized healthcare approaches and can greatly increase their effectiveness - first, because screening of risk groups makes it possible that only those patients in need of help are offered treatment, thus preventing ceiling effects from toning down overall treatment effects, and second, because patients can be offered treatment ingredients or modules specifically tailored to their risk and resilience factors or problems of adjustment [12,17,32,58]. Because the distinction between patients at risk and those not at risk is, by definition, arbitrary in continuous measures of screening instruments, brief screening instruments are generally used to make a first general selection, followed by more extensive and focused assessment to decide which patients might benefit from (which type of) treatment [17].…”

Tratamientos no farmacológicos en fibromialgia : una revisión actual

“…Podrían conseguirse mejores resultados si se logra identificar subgrupos de pacientes de FM susceptibles de beneficiarse de tratamientos específicos. Por ejemplo, algunos estudios han agrupado a diferentes pacientes de FM según sus características psicológicas (Geisecke et al, 2003), sensibilidad al dolor (Müller, Schneider y Stratz, 2007), o según patrones de comportamiento (Van Koulil et al, 2008). Este tipo de distinciones, permitirán crear tratamientos más ajustados a las necesidades de los pacientes y con ello mejorar los resultados.…”

Tailored cognitive-behavioral therapy for fibromyalgia: Two case studies

“…Within this distressed group, a distinction was made between pain-persistence and pain-avoidance patterns, based on the level of pain-avoidance behavior (5-item scale 'Resting when in pain' of the Pain Coping Inventory; PCI; [36,37]). The mean score on this scale for several chronic pain populations (including FM, rheumatoid arthritis, chronic headache and pain clinic patients; [24,37]) was used as the cut-off score to distinguish between pain-persistence (below the mean) and pain-avoidance patterns (above the mean). This screening instrument has been validated in other studies [24].…”

“…The mean score on this scale for several chronic pain populations (including FM, rheumatoid arthritis, chronic headache and pain clinic patients; [24,37]) was used as the cut-off score to distinguish between pain-persistence (below the mean) and pain-avoidance patterns (above the mean). This screening instrument has been validated in other studies [24]. After the screening and intake procedure, patients were assigned to the pain-avoidance or pain-persistence group treatment, depending on their specific pattern.…”

“…For example, the frequently studied fear-avoidance models of chronic pain postulate that mechanisms such as pain-avoidance behavior, fear of pain, catastrophizing and heightened attention for pain, account for the maintenance and exacerbation of complaints [9][10][11][12][13][14][15]. However, preliminary evidence suggests a distinctive pattern in patients who tend to persist in their activities in spite of pain [16][17][18][19][20][21][22][23][24] (see Fig. 1).…”