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The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization

  • Calia A. Morais
    Correspondence
    Address reprint requests to Calia A. Morais, PhD, Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Sciences, College of Dentistry, University of Florida, 2004 Mowry Road, PO Box 100404, Gainesville, Florida, 32610, USA
    Affiliations
    Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida

    Center for Pain Research and Behavioral Health, Department of Clinical and Health Psychology, University of Florida, Florida
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  • Andrea K. Newman
    Affiliations
    Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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  • Benjamin P. Van Dyke
    Affiliations
    Department of Psychology, Young Harris College, Young Harris, Georgia
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  • Beverly Thorn
    Affiliations
    Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
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      Highlights

      • Literacy-adapted psychosocial pain treatments produce changes in pain beliefs.
      • Individuals of low-socioeconomic status show improvements in pain beliefs.
      • Teaching patients about the biopsychosocial nature of pain is promising.

      Abstract

      This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) intervention (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes.

      Perspective

      This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changes in pain conceptualization and pain-related functioning argues for its potential clinical relevance.

      Key words

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      References

        • Baird AJ
        • Haslam RA.
        Exploring differences in pain beliefs within and between a large nonclinical (workplace) population and a clinical (chronic low back pain) population using the pain beliefs questionnaire.
        Phys Ther. 2013; 93: 1615-1624
        • Bergbom S
        • Boersma K
        • Linton SJ.
        Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability.
        Behav Res Ther. 2012; 50: 726-734
        • Campbell LC
        • Robinson K
        • Meghani SH
        • Vallerand A
        • Schatman M
        • Sonty N.
        Challenges and opportunities in pain management disparities research: Implications for clinical practice, advocacy, and policy.
        J Pain. 2012; 13: 611-619
        • Cleeland CS
        • Ryan KM.
        Pain assessment: global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Academic press, 2013
        • Dickenson AH.
        Editorial I: Gate Control Theory of Pain Stands the Test of Time.
        Oxford University Press, 2002
        • Downs BW
        • Blum K
        • Baron D
        • Bowirrat A
        • Lott L
        • Brewer R
        • Boyett B
        • Siwicki D
        • Roy AK
        • Podesta A
        • Badgaiyan S
        • Hajela R
        • Fried L
        • Badgaiyan RD.
        Death by Opioids: Are there non-addictive scientific solutions?.
        J Syst Integr Neurosci. 2019; 5https://doi.org/10.15761/JSIN.1000211
        • Edwards LC
        • Pearce SA
        • Turner-Stokes L
        • Jones A.
        The pain beliefs questionnaire: An investigation of beliefs in the causes and consequences of pain.
        Pain. 1992; 51: 267-272
        • Eyer JC
        • Thorn BE.
        The Learning About My Pain study (LAMPS) protocol: Reducing disparities with literacy-adapted psychosocial treatments for chronic pain, a comparative behavioral trial.
        J Health Psychol. 2016; 21: 2063-2074
        • Fontenot K
        • Semega J
        • Kollar M.
        Income and Poverty in the United States: 2017.
        US Census Bureau, Washington, DC2018 (Current Population Reports)
        • Fritz CO
        • Morris PE
        • Richler JJ.
        Effect Size Estimates: Current Use, Calculations, and Interpretation.
        J Exp Psychol Gen. 2012; 141
        • Gatchel RJ
        • McGeary DD
        • McGeary CA
        • Lippe B.
        Interdisciplinary chronic pain management: past, present, and future.
        Am Psychol. 2014; 69: 119-130
        • Gatchel RJ
        • Peng YB
        • Peters ML
        • Fuchs PN
        • Turk DC.
        The biopsychosocial approach to chronic pain: Scientific advances and future directions.
        Psychol Bull. 2007; 133: 581-624
        • Green CR
        • KO Anderson
        • Baker TA
        • Campbell LC
        • Decker S
        • Fillingim RB
        • Kaloukalani DA
        • Lasch KE
        • Myers C
        • Tait RC.
        The unequal burden of pain: Confronting racial and ethnic disparities in pain.
        Pain Med. 2003; 4: 277-294
        • Heutink M
        • Post M
        • Overdulve C
        • Pfennings L
        • van de Vis W
        • Vrijens N
        • Lindeman E.
        Which pain coping strategies and cognitions are associated with outcomes of a cognitive behavioral intervention for neuropathic pain after spinal cord injury?.
        Topics in spinal cord injury rehabilitation. 2013; 19: 330-340
        • Institute of Medicine
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
        National Academies Press, Washington, DC2011
        • Jensen MP
        • Turner JA
        • Romano JM.
        Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning.
        Pain. 2007; 131: 38-47
        • King R
        • Robinson V
        • Elliott-Button HL
        • Watson JA
        • Ryan CG
        • Martin DJ.
        Pain reconceptualization after pain neurophysiology education in adults with chronic low back pain: A qualitative study.
        Pain Res Manag. 2018; 3745651https://doi.org/10.1155/2018/3745651
        • King R
        • Robinson V
        • Ryan CG
        • Martin DJ.
        An exploration of the extent and nature of reconceptualization of pain following pain neurophysiology education: A qualitative study of experiences of people with chronic musculoskeletal pain.
        Patient Educ Couns. 2016; 99: 1389-1393
        • Koes BW
        • van Tulder MW
        • Thomas S.
        Diagnosis and treatment of low back pain.
        BMJ. 2006; 332: 1430-1434
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropractic Med. 2016; 15: 155-163
        • Kroenke K
        • Spitzer RL
        • Williams JB.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Kuhajda MC
        • Thorn BE
        • Gaskins SW
        • Day MA
        • Cabbil CM.
        Literacy and cultural adaptations for cognitive behavioral therapy in a rural pain population.
        Transl Behav Med. 2011; 1: 216-223
        • Lee H
        • McAuley JH
        • Hübscher M
        • Kamper SJ
        • Traeger AC
        • Moseley GL.
        Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?.
        Pain. 2016; 157: 922-930
        • Louw A
        • Zimney K
        • Puentedura EJ
        • Diener I.
        The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature.
        Physiother Theory Pract. 2016; 32: 332-355
        • Maher C
        • Underwood M
        • Buchbinder R.
        Non-specific low back pain.
        Lancet North Am Ed. 2017; 389: 736-747
        • Marshall B
        • Bland MK
        • Hulla R
        • Gatchel RJ.
        Considerations in addressing the opioid epidemic and chronic pain within the USA.
        Pain Manag. 2019; 9: 131-138
        • McCracken LM
        • Turk DC.
        Behavioral and cognitive–behavioral treatment for chronic pain: Outcome, predictors of outcome, and treatment process.
        Spine. 2002; 27: 2564-2573
        • Melzack R.
        From the gate to the neuromatrix.
        Pain. 1999; 82: S121-S126
        • Meredith P
        • Strong J
        • Feeney JA.
        Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability.
        Pain. 2006; 123: 146-154
        • Moseley GL
        • Butler DS.
        Fifteen years of explaining pain: The past, present, and future.
        J Pain. 2015; 16: 807-813
        • Moseley L.
        Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology.
        J Pain. 2003; 4: 184-189
        • Newman AK
        • Morais CA
        • Van Dyke BP
        • Thorn BE.
        An initial psychometric evaluation of the pain concepts questionnaire in a low-SES setting.
        J Pain. 2021;
        • Newman AK
        • Van Dyke BP
        • Torres CA
        • Baxter JW
        • Eyer JC
        • Kapoor S
        • Thorn BE.
        The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population.
        Pain. 2017; 158: 1687-1696
        • Nicholas MK
        • Costa DS
        • Blanchard M
        • Tardif H
        • Asghari A
        • Blyth FM.
        Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers.
        Pain. 2019; 160: 1156-1165
        • Nieto R
        • Raichle KA
        • Jensen MP
        • Miró J.
        Changes in pain-related beliefs, coping, and catastrophizing predict changes in pain intensity, pain interference, and psychological functioning in individuals with myotonic muscular dystrophy and facioscapulohumeral dystrophy.
        Clin J Pain. 2012; 28: 47
        • Nijs J
        • Roussel N
        • Paul van Wilgen C
        • Köke A
        • Smeets R
        Thinking beyond muscles and joints: Therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment.
        Man Ther. 2013; 18: 96-102
        • Pfeiffer E.
        A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.
        J Am Geriatr Soc. 1975; 23: 433-441
        • Schober P
        • Boer C
        • Schwarte LA.
        Correlation coefficients: Appropriate use and interpretation.
        Anesth Analg. 2018; 126: 1763-1768
        • Schreijenberg M
        • Koes BW
        • Lin C-WC.
        Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change?.
        Expert Rev Clin Pharmacol. 2019; 12: 145-157
        • Spitzer RL
        • Kroenke K
        • Williams JB
        • Löwe B.
        A brief measure for assessing generalized anxiety disorder: The GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Sullivan MJ
        • Bishop SR
        • Pivik J.
        The pain catastrophizing scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Thorn BE
        Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain.
        Pain. 2020; 161: S27-S35
        • Thorn BE
        • Eyer JC
        • Van Dyke BP
        • Torres CA
        • Burns JW
        • Kim M
        • Newman AK
        • Campbell LC
        • Anderson B
        • Block PR.
        Literacy-adapted cognitive behavioral therapy versus education for chronic pain at low-income clinics: A randomized controlled trial.
        Ann Intern Med. 2018; 168: 471-480
        • Traeger AC
        • Lee H
        • Hübscher M
        • Skinner IW
        • Moseley GL
        • Nicholas MK
        • Henschke N
        • Refshauge KM
        • Blyth FM
        • Main CJ.
        Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low back pain: A randomized clinical trial.
        JAMA Neurol. 2019; 76: 161-169
        • Turner JA
        • Jensen MP
        • Romano JM.
        Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?.
        Pain. 2000; 85: 115-125
        • Turner JA
        • Mancl L
        • Aaron LA.
        Short-and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial.
        Pain. 2006; 121: 181-194
        • Van Dyke BP
        • Newman AK
        • Moraís CA
        • Burns JW
        • Eyer JC
        • Thorn BE.
        Heterogeneity of treatment effects in a randomized trial of literacy-adapted group cognitive-behavioral therapy, pain psychoeducation, and usual medical care for multiply disadvantaged patients with chronic pain.
        J Pain. 2019; 20: 1236-1248
        • Watson JA
        • Ryan CG
        • Atkinson G
        • Williamson P
        • Ellington D
        • Whittle R
        • Dixon J
        • Martin DJ.
        Inter-individual differences in the responses to pain neuroscience education in adults with chronic musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials.
        J Pain. 2020; 22: 9-20
        • Watson JA
        • Ryan CG
        • Cooper L
        • Ellington D
        • Whittle R
        • Lavender M
        • Dixon J
        • Atkinson G
        • Cooper K
        • Martin DJ.
        Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis.
        J Pain. 2019; 20 (1140.e1-1140.e22)
        • Wilkinson GS
        • Robertson GJ.
        Wide Range Achievement Test 4 Professional Manual.
        Psychological Assessment Resources, Lutz, FL2006
        • Williams DA
        • Thorn BE.
        An empirical assessment of pain beliefs.
        Pain. 1989; 36: 351-358
        • Woby SR
        • Watson PJ
        • Roach NK
        • Urmston M.
        Are changes in fear-avoidance beliefs, catastrophizing, and appraisals of control, predictive of changes in chronic low back pain and disability?.
        Eur J Pain. 2004; 8: 201-210