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FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN WELLMOTIVATED CHRONIC NON-MALIGNANT PAIN PATIENTS EVALUATED FOR SPINAL CORD STIMULATION
Title
FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN WELLMOTIVATED CHRONIC NON-MALIGNANT PAIN PATIENTS EVALUATED FOR SPINAL CORD STIMULATION
Creator
Zalizniak, Kevin C.
Date
2016, 2016-12
Description
Cognitive impairment in individuals with chronic pain is frequently observed and clinically significant (McCracken, & Iverson, 2001). It has...
Show moreCognitive impairment in individuals with chronic pain is frequently observed and clinically significant (McCracken, & Iverson, 2001). It has long been recognized that emotional factors contribute to both patient perception of impaired cognition and verifiable cognitive impairment on testing (Burt, Zembar, & Niederehe, 1995). However, scientific consensus is lacking regarding how specific emotions, such as depression, anxiety, and pain catastrophizing impact cognition in chronic pain patients. Research seeking to clarify such relationships has been hampered by methodological shortcomings, which include limited sample sizes, non-objective measures, and failure to examine multiple emotional dimensions in unique samples (McCracken and Vowels, 2014; Moriarty, McGuire, & Finn, 2011). The present study examined factors that might contribute to cognitive impairment in this population using a sample of 78 chronic pain patients evaluated for surgical candidacy for spinal cord stimulator (SCS) implantation at the University of Illinois at Chicago. Use of such a sample ensured patients were wellmotivated to perform to the best of their ability, so as to increase their chance of being cleared for such a highly desirable procedure. Additionally, the vast majority of participants passed well-validated objective measures of effort. Hypothesized associations between attentional function as measured objectively by the RBANS attention index and a number of predictor variables: depression and anxiety, subjective pain experience, pain catastrophizing, somatization, and engagement in pain behaviors were not found, and subsequent analyses of proposed mediating relationships could not be performed. However, fully a third (35.9 percent) of our well-motivated sample did not show clinically significant impairment (below 85, or 1 SD below the mean), as was expected. Thus, it is possible that a well-motivated sample may have been less likely than samples used in previous investigations to show cognitive impairment overall. Strengths and limitations of the study are discussed, as well as clinical and research implications.
Ph.D. in Psychology, December 2016
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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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