The Correlation of Cognitive Flexibility with Pain Intensity and Magnitude of Disability in Upper Extremity Illness

Abstract

Cognitive flexibility -the ability to restructure one's knowledge, incorporate new facts, widen perspective, and adapt to the demands of new and unexpected conditionscan help one adapt to illness. The aim of this study was to assess the relationship between cognitive flexibility and hand and upper extremity specific disability in patients presenting to a hand surgeon. Secondarily, we determined predictors of cognitive flexibility and pain. Eighty-nine consecutive outpatients completed the Cognitive flexibility questionnaire (CFS), Short Health Anxiety Inventory-5 (SHAI-5), Pain SelfEfficacy Questionnaire (PSEQ), Disabilities of Arm, Shoulder and Hand, short form (QuickDASH), and Patient Health Questionnaire for Depression-2 (PHQ-2) in a cross-sectional study. CFS did not correlate with disability or pain intensity. Disability correlated with PSEQ (r=−0.66, p<0.01), PHQ-2 (r=0.38, p=<0.01), and SHAI-5 (r=0.33, p<0.01). Pain intensity correlated with PSEQ (r=−0.51 p<0.01) and PHQ-2 (r=0.41 p<0.01). There was a small correlation between the CFS and PSEQ (r=0.25, p=0.02). The best multivariable models for QuickDASH and pain intensity included PSEQ and PHQ and explained 35 % and 28 % of the variability respectively. Upper extremity specific disability and pain intensity are limited more by self-efficacy than cognitive flexibility. Interventions to improve self-efficacy might help patients with upper extremity illness.

Pain Catastrophizing Mediates the Effect of Psychological Inflexibility on Pain Intensity and Upper Extremity Physical Function in Patients with Upper Extremity Illness

“…Our study also confirms prior research on the relationship of psychological inflexibility to both depression and anxiety, of depression and anxiety to pain intensity, and of anxiety to upper extremity physical function . However, neither depression nor anxiety were supported as mediators when entered together with pain catastrophizing in the mediation models, suggesting that only pain catastrophizing carries the effect of psychological inflexibility on pain and upper extremity physical function in patients with musculoskeletal pain.…”

“…A second goal of this study is to test potential mechanisms of development of pain and upper extremity physical function in this population. Prior research in this population has shown the pivotal roles of pain catastrophizing, anxiety, and depression in reports of pain intensity and upper extremity disability, but the relationships of a general construct of psychological inflexibility to pain catastrophizing, anxiety, and depression in patients with musculoskeletal pain in orthopedic surgical practices have not been studied. We propose that psychological inflexibility will impact pain intensity and upper extremity physical function both directly, as well as indirectly through increased pain catastrophizing, depression, and anxiety.…”

Pain during physical examination of a healing upper extremity fracture

“…The decision to prolong cast immobilization is often influenced by pain during physical examination, fracture tenderness in particular. Evidence has established a considerable influence of emotions and cognitive bias on pain intensity and magnitude of physical limitations (Gruber et al., 2014; Hadlandsmyth et al., 2017; Hageman et al., 2014; Kortlever et al., 2015; Nota et al., 2015; Oh et al., 2017; Ozkan et al., 2017; Ring et al., 2006; Vranceanu et al., 2014). People feel better and can do more when they accurately interpret symptoms and feel secure and hopeful.…”

“…Pain intensity varies substantially for a given signal entering the central nervous system after stimulation of sensory receptors (nociception) (Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior, 1987; Menendez and Ring, 2016). This variation in pain intensity is largely determined by stress, distress and cognitive bias regarding pain (Gruber et al., 2014; Hadlandsmyth et al., 2017; Hageman et al., 2014; Kortlever et al., 2015; Ozkan et al., 2017; Ring et al., 2006; Vranceanu et al., 2014). For instance, patients with greater levels of catastrophic (worst-case) thinking tend to experience more pain (Darnall, 2016).…”

Attitudes Toward Aging Among Patients With Upper Extremity Illness

“…18 The finding that lower magnitude of physical limitations was independently associated with greater self-efficacy and greater pain intensity was associated with greater catastrophic thinking and lower self-efficacy is in line with previous evidence. 15,[20][21][22] There is consistent and extensive evidence that psychological factors-effective coping strategies such as self-efficacy and ineffective strategies such as catastrophic thinking in particular-account for a large portion (often the majority) of the magnitude of physical limitations and pain intensity for several specific and nonspecific upper extremity conditions. [23][24][25] Greater satisfaction with the visit was independently associated with greater self-efficacy.…”