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APPLICATION OF THE FEAR-AVOIDANCE MODEL OF CHRONIC PAIN TO UNDERSTAND NEUROCOGNITIVE AND BEHAVIORAL FACTORS THAT CONTRIBUTE TO FUNCTIONAL IMPAIRMENT AND DEPRESSION IN ADULTS WITH SICKLE CELL DISEASE
Title
APPLICATION OF THE FEAR-AVOIDANCE MODEL OF CHRONIC PAIN TO UNDERSTAND NEUROCOGNITIVE AND BEHAVIORAL FACTORS THAT CONTRIBUTE TO FUNCTIONAL IMPAIRMENT AND DEPRESSION IN ADULTS WITH SICKLE CELL DISEASE
Creator
Piper, Lauren E.
Date
2017, 2017-07
Description
Acute and chronic pain in sickle cell disease (SCD) are associated with functional impairment and depressive symptoms. Given the suboptimal...
Show moreAcute and chronic pain in sickle cell disease (SCD) are associated with functional impairment and depressive symptoms. Given the suboptimal management of pain in SCD and serious health risks associated with current treatment methods for pain, there is a need to identify factors associated with pain that impact functional outcomes and depression. The fear-avoidance (FA) model of chronic pain has been examined in other chronic pain populations as a means to understand how pain-related cognitive and behavioral factors contribute to functional impairment and depression, but has not been applied in individuals with SCD. The purpose of the present study was to apply the FA model of chronic pain to adults with SCD via mediation analyses. Additionally, mental flexibility was examined as a possible moderator in the FA model. Results demonstrated that pain catastrophizing mediated the relationship between pain severity and pain-related fear. No other mediators within the model were identified. Additionally, results did not demonstrate that mental flexibility moderated the relationship between pain severity and pain catastrophizing. Post-hoc exploratory analyses demonstrated that pain catastrophizing and pain-related fear significantly predicted functional impairment and depression, respectively, above and beyond pain severity. Overall, results suggest that the FA model of chronic pain does not apply to individuals with SCD and the predictive roles that pain catastrophizing and pain-related fear play in functional impairment and depression are not consistent with results in other chronic pain populations. Further studies are needed to identify factors that explain the relationship between pain, functional impairment, and depression so that these factors may be targeted for intervention as a means to improve pain, mood, and functional independence.
Ph.D. in Psychology, July 2017
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NEUROPSYCHOLOGICAL PROFILES IN ADULTS WITH SICKLE CELL DISEASE
Title
NEUROPSYCHOLOGICAL PROFILES IN ADULTS WITH SICKLE CELL DISEASE
Creator
Piper, Lauren E.
Date
2014, 2014-12
Description
Cognitive impairment is documented in individuals with sickle cell disease (SCD). Studies investigating cognitive impairment in this...
Show moreCognitive impairment is documented in individuals with sickle cell disease (SCD). Studies investigating cognitive impairment in this population have primarily examined group differences in neuropsychological performance, which may have overlooked the heterogeneity of cognitive functioning. The objectives of this study were to determine whether distinct cognitive profiles occur in individuals with SCD and, if so, to examine potential differences in demographic, clinical, and psychosocial characteristics. Participants with SCD (n = 73) and similarly matched controls (n = 82), completed a brief neuropsychological protocol (Hachinski et al., 2006) and self-report measures of pain and mood-related symptoms. Cluster analysis was used to identify groups of participants based on their cumulative scores across the domains of executive functioning, language, memory, and visuospatial ability. Multivariate analysis of variance (MANOVA) was used to compare the cluster groups across the four cognitive domains. Analysis of variance (ANOVA) and chi-square tests were used to compare cluster groups on demographic, clinical, and psychosocial characteristics. Results indicated three distinct cognitive subtypes: (1) executive and memory impaired (56% of participants); (2) globally impaired (14%); and (3) cognitively intact (30%). The three cluster groups did not differ on most demographic factors, stroke history, or pain severity, but differed on level of education and current mood-related distress. Results demonstrated the presence of distinct cognitive profiles in adults with SCD, with a proportion of cognitively intact individuals. Implications for intervention and cognitive rehabilitation are discussed.
M.S. in Psychology, December 2014
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