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Biomedical subjects

Jennifer A Haythornthwaite

Publications and source records attributed to Jennifer A Haythornthwaite.

At least 19 recordsLinked to original sources
PubMed2006

Symptoms of distress as prospective predictors of pain-related sciatica treatment outcomes.

Prior studies evaluating predictors of pain-related outcomes following treatment for sciatica have been limited by methodological problems, including retrospective study design, use of unvalidated outcome measures, and short-term follow-up periods. Despite these limitations, some reports have suggested that symptoms of psychological distress may predict individual differences in pain treatment-related outcomes (e.g., higher levels of depressive and anxious symptomatology are associated with greater pain and disability after treatment). In this study, we sought to determine whether acute symptoms of depression and anxiety were prospectively associated with treatment outcomes over a 3-year follow-up period in surgically treated and non-surgically treated patients with sciatica. Patients were recruited from the practices of community-based physicians throughout the state of Maine, and underwent in-person baseline assessments, with mailed follow-up questionnaires at 3, 6, 12, 24, and 36 months. Study outcomes included patient-reported symptoms of pain and disability. For each outcome variable, we examined whether baseline mood (i.e., mood assessed prior to the initiation of treatment), as well as mood at the immediately preceding assessment point, prospectively predicted outcomes over 3 years in multivariate repeated-measures analyses. In most analyses, symptoms of depression and anxiety, both at baseline and at the preceding time point, were significant independent predictors of worse pain and function after controlling for relevant covariates. Collectively, elevated distress appears to be a significant risk factor for reduced treatment benefit (i.e., less improvement in pain and disability) over short and medium-term follow-up periods in patients with sciatica. Future research should determine whether the prospective identification and treatment of patients with high levels of distress (a "yellow flag") is associated with improved treatment outcomes.

Adult↗
PubMed2006

Associations between family support, family intimacy, and neighborhood violence and physical activity in urban adolescent girls.

We examined the association between various dimensions of the family environment, including family intimacy and involvement in activities, family support for physical activity, and neighborhood violence (perceived and objective) and physical activity among urban, predominantly African American, ninth-grade girls in Baltimore, Md. Greater family intimacy (P = .05) and support (P = .01), but not neighborhood violence, was associated with physical activity. Family factors, including family intimacy and support, are potential targets in physical activity interventions for urban high-school girls.

Adolescent↗
PubMed2006

Pain-related catastrophizing and perceived social responses: Inter-relationships in the context of chronic pain.

Pain-related coping, particularly catastrophizing, plays a significant role in shaping pain responses. One way catastrophizing is hypothesized to amplify pain and disability is via its effect on patients' social environments (e.g., communal coping model), though empirical support is limited. The present study tested whether the association between catastrophizing and deleterious pain-related outcomes was mediated by patients' perceptions of significant others' responses to their pain in a sample of 1356 pain patients. Regression analyses showed that perceived significant other punishing responses partially mediated catastrophizing's relationship with pain-related disability, and with depressive symptoms. Further, several variables moderated the association between catastrophizing and perceived social responses to pain. Catastrophizing was more strongly associated with greater perceived solicitous responses for patients of relatively short pain duration. Also, higher catastrophizing was more strongly associated with perceived punishing responses among patients perceiving lower social support. In addition, the mediational effects of perceived punishing responses on catastrophizing's relationship with depressive symptoms, and with pain-related disability were only found in individuals reporting low levels of perceived social support. In sum, perceived social responses were found to play a small role in mediating the relationship between catastrophizing and pain-related outcomes, and these mediational effects may be strongest in particular patient subgroups. The present data suggest that interpersonal mechanisms may not constitute a primary route by which catastrophizing exerts its maladaptive effects on pain responses. The study and further understanding of what principal factors mediate catastrophizing's deleterious effects on pain will be important in illuminating the biopsychosocial model of pain.

Adult↗
PubMed2006

A clinical genetic method to identify mechanisms by which pain causes depression and anxiety.

BACKGROUND: Pain patients are often depressed and anxious, and benefit less from psychotropic drugs than pain-free patients. We hypothesize that this partial resistance is due to the unique neurochemical contribution to mood by afferent pain projections through the spino-parabrachial-hypothalamic-amygdalar systems and their projections to other mood-mediating systems. New psychotropic drugs for pain patients might target molecules in such brain systems. We propose a method to prioritize molecular targets by studying polymorphic genes in cohorts of patients undergoing surgical procedures associated with a variable pain relief response. We seek molecules that show a significant statistical interaction between (1) the amount of surgical pain relief, and (2) the alleles of the gene, on depression and anxiety during the first postoperative year. RESULTS: We collected DNA from 280 patients with sciatica due to a lumbar disc herniation, 162 treated surgically and 118 non-surgically, who had been followed for 10 years in the Maine Lumbar Spine Study, a large, prospective, observational study. In patients whose pain was reduced >25% by surgery, symptoms of depression and anxiety, assessed with the SF-36 Mental Health Scale, improved briskly at the first postoperative measurement. In patients with little or no surgical pain reduction, mood scores stayed about the same on average. There was large inter-individual variability at each level of residual pain. Polymorphisms in three pre-specified pain-mood candidate genes, catechol-O-methyl transferase (COMT), serotonin transporter, and brain-derived neurotrophic factor (BDNF) were not associated with late postoperative mood or with a pain-gene interaction on mood. Although the sample size did not provide enough power to persuasively search through a larger number of genes, an exploratory survey of 25 other genes provides illustrations of pain-gene interactions on postoperative mood--the mu opioid receptor for short-term effects of acute sciatica on mood, and the galanin-2 receptor for effects of unrelieved post-discectomy pain on mood one year after surgery. CONCLUSION: Genomic analysis of longitudinal studies of pain, depression, and anxiety in patients undergoing pain-relieving surgery may help to identify molecules through which pain alters mood. Detection of alleles with modest-sized effects will require larger cohorts.

Anxiety Disorders↗
PubMed2006

Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases.

OBJECTIVE: Pain is among the most frequently reported, bothersome, and disabling symptoms described by patients with osteoarthritis, rheumatoid arthritis, fibromyalgia, and other musculoskeletal conditions. This review describes a growing body of literature relating catastrophizing, a set of cognitive and emotional processes encompassing magnification of pain-related stimuli, feelings of helplessness, and a generally pessimistic orientation, to the experience of pain and pain-related sequelae across several rheumatic diseases. METHODS: We reviewed published articles in which pain-related catastrophizing was assessed in the context of one or more rheumatic conditions. Because much of the available information on catastrophizing is derived from the more general chronic pain literature, seminal studies in other disease states were also considered. RESULTS: Catastrophizing is positively related, in both cross-sectional and prospective studies across different musculoskeletal conditions, to the reported severity of pain, affective distress, muscle and joint tenderness, pain-related disability, poor outcomes of pain treatment, and, potentially, to inflammatory disease activity. Moreover, these associations generally persist after controlling for symptoms of depression. There appear to be multiple mechanisms by which catastrophizing exerts its harmful effects, from maladaptive influences on the social environment to direct amplification of the central nervous system's processing of pain. CONCLUSION: Catastrophizing is a critically important variable in understanding the experience of pain in rheumatologic disorders as well as other chronic pain conditions. Pain-related catastrophizing may be an important target for both psychosocial and pharmacologic treatment of pain.

Arthritis↗
PubMed2006

Effects of a life skills intervention for increasing physical activity in adolescent girls.

BACKGROUND: Although adolescence is a time when physical activity levels decline, few interventions have targeted high school-aged girls in the school setting. OBJECTIVE: To evaluate the effects of a life skills-oriented physical activity intervention for increasing overall physical activity in high school-aged girls. DESIGN: Randomized controlled trial. SETTING: Baltimore magnet high school. PARTICIPANTS: A total of 221 ninth-grade girls, 83.0% of whom were African American. Intervention Participants were randomized to an 8-month physical intervention conducted in physical education class or to a standard physical education class (control). MAIN OUTCOME MEASURES: Self-reported estimated daily energy expenditure (physical activity), self-reported sedentary activities (television viewing and computer or Internet use), cardiorespiratory fitness, and selected cardiovascular disease risk factors. RESULTS: Intervention classes spent 46.9% of physical education class time in moderate to vigorous activity compared with 30.5% of time for control classes (P<.001). There were no significant between-treatment group differences for mean daily energy expenditure (P = .93), moderate-intensity energy expenditure (P = .77), or hard to very hard energy expenditure (P = .69). The proportion of participants who spent 3 or more hours viewing television during school days declined from 22.3% to 17.0% in the intervention group, but remained at 26.7% for the control group (P = .03). Both groups improved their cardiorespiratory fitness (P<.001). CONCLUSION: A life skills-oriented physical education curriculum may need to be combined with other approaches to increase the magnitude of effects on physical activity behavior in predominantly African American high school-aged girls.

Adolescent↗
PubMed2006

Cognitive-Behavioral self-help for chronic pain.

Cognitive behavioral self-help is a potentially cost-saving method of delivering evidence-based treatment to a wide range of chronic pain patients. This article provides a rationale for self-help and focuses on the effectiveness of self-help in the management of chronic pain, which typically includes some degree of lay leader or professional facilitation. The evidence for these treatments is generally positive (e.g., reductions in pain and pain-related disability) across such illnesses as arthritis, back pain, headache, and temporomandibular joint disorders. When implementing self-help, professionals need to consider individual differences in suitability for using a self-management treatment and evaluate the outcome in the context of a stepped care approach. This article uses three case examples to illustrate the use of cognitive behavioral self-help delivered in the care of scleroderma patients.

Breathing Exercises↗
PubMed2006

Basal heat pain thresholds predict opioid analgesia in patients with postherpetic neuralgia.

BACKGROUND: A variety of analgesics have been studied in the treatment of postherpetic neuralgia, with several medications demonstrating some degree of efficacy. However, existing trials have documented large individual differences in treatment responses, and it is important to identify patient characteristics that predict the analgesic effectiveness of particular interventions. Several animal studies have indicated that reduced basal nociceptive sensitivity, in the form of relatively high heat pain thresholds, is associated with greater opioid analgesia, but this finding has not been applied to human studies of opioid treatment for chronic pain. METHODS: Using data from a previously published crossover trial of opioids and tricyclics in postherpetic neuralgia, the authors evaluated baseline thermal pain thresholds, assessed at a body site contralateral to the affected area, as a predictor of treatment responses. RESULTS: During opioid treatment, a greater reduction in pain and higher ratings of pain relief were observed in patients with relatively higher heat pain thresholds at baseline. Baseline pain thresholds did not predict responses to tricyclics or placebo. Interestingly, other individual-difference variables such as age and baseline pain intensity also significantly predicted opioid responses (i.e., higher baseline pain and younger age were related to greater opioid-associated pain reduction, with nearly 20% of the variance in opioid analgesia explained by these two factors). CONCLUSIONS: These findings, which will require replication, suggest that pretreatment assessment of heat pain sensitivity might prove useful in identifying those patients most likely to respond to opioids.

Aged↗
PubMed2006

Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain.

OBJECTIVE: Pain-related coping strategies, especially catastrophizing, play an influential role in shaping pain responses. However, although numerous studies have examined the impact of catastrophizing on chronic pain outcomes, relatively few have evaluated relationships between individual differences in pain-related catastrophizing and pain perception, with most of those studies examining only pain threshold or pain tolerance. We assessed, for the first time, catastrophizing's association with the magnitude of temporal summation of pain, a primary marker for central nervous system sensitizability. METHODS: Thirty-eight healthy young women underwent standardized experimental pain testing, followed by administration of a brief questionnaire that assessed catastrophizing cognitions during the pain-testing session. RESULTS: Higher levels of pain-related catastrophizing were related to higher suprathreshold pain ratings and greater temporal summation of thermal pain, suggesting that catastrophizing may play a facilitatory role in the processing of pain-related information, though the specific pathways underlying this facilitation are not clear. CONCLUSIONS: These preliminary findings highlight the importance of coping in shaping individuals' responses to noxious stimuli, and suggest that interventions that decrease pain catastrophizing may reduce the burden of acute and chronic pain.

Adaptation, Physiological↗
PubMed2006

Measuring emotional labor among young workers: refinement of the Emotions at Work Scale.

This analysis examines the applicability of the emotional labor scale from the Emotions at Work Scale (EWS) through the assessment of its psychometric properties in a sample of young workers. Factor analysis and test-retest reliability were conducted on a 13-item scale measuring emotional labor. The EWS 13-item emotional labor scale was refined to 9 items. Two subscales were delineated: 5 items measured surface acting and 4 items measured deep acting, each with a mean inter-item correlation of 0.33. Cronbach's alpha was .96 for the 9-item scale, and .71 and .67 for the surface acting and deep acting subscales, respectively. Test-retest reliability was 0.64 for surface acting and 0.51 for deep acting during a mean interval of 3 months. Emotional labor can be quantitatively measured among young workers using the derived 9-item scale, although additional studies further evaluating its use should be conducted.

Adolescent↗
PubMed2005

Clinical trials studying pharmacotherapy and psychological treatments alone and together.

Pharmacologic treatment of pain has made tremendous advances in recent years, and multiple clinical trials support the usefulness of psychological interventions in reducing pain, disability, and even costs, in a number of chronically painful conditions. Despite the widespread use of combined pharmacologic and psychological treatments in clinical care, little is known about the potential for these two very different types of interventions to provide additive or possibly synergistic effects. After briefly reviewing of the clinical trial literature comparing and combining psychological and pharmacologic interventions for chronically painful conditions, this article discusses two key challenges to future trials. The first section encourages investigators to systematically identify the parameters that limit or enhance the efficacy of pharmacologic, psychological, and combined treatments. Strategies for addressing adherence and drop-outs, identifying nonresponders and other subgroups, understanding the impact of selection factors, and delineating treatment characteristics need to be developed. The second challenge pertains to issues of trial design when pharmacologic and psychological treatments for pain are compared and combined. Trials comparing active treatments that are as diverse as psychological and pharmacologic treatments require specific features, such as large sample sizes, active placebo controls, both immediate and delayed outcome assessments, and broad measures of outcome that include health-care utilization and cost. Some lessons learned from the psychiatric literature comparing and combining psychological and pharmacologic treatments are integrated into recommendations for future trials evaluating existing and new treatments for chronically painful conditions.

Chronic Disease↗
PubMed2004

Psychological factors in pelvic/urogenital pain: the influence of site of pain versus sex.

Chronic pelvic pain (CPP), a fairly common gynecological complaint in women, has been associated with multiple psychological sequelae, including depression and somatization. Previous work has compared these patients to gynecological controls and women with headache, but has failed to include male comparison groups with a comparable site of chronic pain. In order to test possible sex and pain site differences, the present study compared 22 women with CPP, 22 men with either penile or testicular pain, 22 women with low back pain and 28 men with low back pain referred for a psychological evaluation as part of multidisciplinary pain treatment. Depression, coping, pain intensity and interference were assessed. Two-way analyses of variance (sex by pain site) were conducted to determine if there were group differences on demographic variables and medical history. Pain duration, age, and pain severity differed among the groups and were entered as covariates in hierarchical regression analyses designed to identify predictors of adjustment and pain coping. Sex and pain site did not contribute independently to the prediction of depressive symptoms. Pain site predicted physical functioning with low back pain patients reporting greater pain-related interference. Similar findings were demonstrated for coping. A variety of pain-coping strategies, including catastrophizing, were more frequently utilized by low back pain patients, regardless of sex. In the present study, pain severity and pain site explained more variance in depressive symptoms, physical functioning, and pain-coping than sex.

Activities of Daily Living↗
PubMed2004

Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory-induced pain.

Sex differences in the experience of pain have been widely reported, with females generally reporting more frequent clinical pain and demonstrating greater pain sensitivity. However, the mechanisms underpinning such differences, while subject to intense speculation, are not well-characterized. Catastrophizing is a cognitive and affective process that relates strongly to enhanced reports of pain and that varies as a function of sex. It is thus a prime candidate to explain sex differences; indeed, several prior studies offer evidence that controlling for catastrophizing eliminates the gap between men and women in reported pain. We recruited 198 healthy young adults (115 female) who took part in laboratory studies of pain responses, including thermal pain, cold pain, and ischemic pain, and who also completed questionnaires assessing catastrophizing, mood, and day-to-day painful symptoms (e.g. headache, backache). Women reported greater levels of catastrophizing, more recent painful symptoms, and demonstrated lower pain thresholds and tolerances for noxious heat and cold relative to men. Mediational analyses suggested that after controlling for negative mood, catastrophizing mediated the sex difference in recent daily pain but did not mediate the much larger sex differences in pain threshold and tolerance. These findings highlight the role of catastrophizing in shaping pain responses, as well as illuminating potentially important differences between experimental pain assessment and the clinical experience of pain.

Adaptation, Psychological↗
PubMed2004

How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature.

Sleep disturbance is perhaps one of the most prevalent complaints of patients with chronically painful conditions. Experimental studies of healthy subjects and cross-sectional research in clinical populations suggest the possibility that the relationship between sleep disturbance and pain might be reciprocal, such that pain disturbs sleep continuity/quality and poor sleep further exacerbates pain. This suggests that aggressive management of sleep disturbance may be an important treatment objective with possible benefits beyond the improvement in sleep. Little is known, however, about how to effectively treat sleep disturbance associated with pain or whether such treatment might have beneficial effects on reducing pain. A small, but growing literature has applied cognitive-behavioral therapies (CBT) for either pain management or insomnia to patients with chronic pain. In this article, we review the longitudinal literature on sleep disturbance associated with chronic pain and clinical trial literatures of cognitive-behavior therapy for pain management and insomnia secondary to chronic pain with the aim of evaluating whether the relationship between clinical pain and insomnia is reciprocal. While methodological problems are common, the literature suggests that the relationship is reciprocal and CBT treatments for pain or insomnia hold promise in reducing pain severity and improving sleep quality. Directions for future research include the use of validated measures of sleep, longitudinal studies, and larger randomized clinical trials incorporating appropriate attentional controls and longer periods of follow-up.

Chronic Disease↗
PubMed2003

Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations.

Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism-based approach.

Analgesics↗