Department of Psychology
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Browsing Department of Psychology by Author "Asmundson, Gordon"
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Item Open Access Emotional numbing and pain intensity predict the development of pain disability up to one year after lateral thoracotomy(Elsevier, 2009) Katz, Joel; Asmundson, Gordon; McRae, Karen; Halket, EileenLittle is known about the factors that predict the transition of acute, time limited pain to chronic pathological pain following postero-lateral thoracotomy. The aim of the present prospective, longitudinal study was to determine the extent to which (1) pre-operative pain intensity, pain disability, and post-traumatic stress symptoms (PTSS) predict post-thoracotomy pain disability 6 and 12 months later; and (2) if these variables, assessed at 6 months, predict 12 month pain disability. Fifty-four patients scheduled to undergo postero-lateral thoracotomy for intrathoracic malignancies were recruited before surgery and followed prospectively for one year. The incidence of chronic post-thoracotomy pain was 68.1% and 61.1% at the 6 and 12 month follow-ups, respectively. Multiple regression analyses showed that neither pre-operative factors nor acute movement-evoked post-operative pain predicted 6 or 12 month pain disability. However, concurrent pain intensity and emotional numbing, but not avoidance symptoms, made unique, significant contributions to the explanation of pain disability at each follow-up (total R2 = 76.3.0% and 63.9% at 6 and 12 months, respectively, both p < 0.0009). The relative contribution of pain intensity decreased, while that of emotional numbing increased with time, indicating a progressive de-coupling of pain intensity and disability and a concomitant strengthening of the link between emotional numbing and disability. This suggests that pain may serve as a traumatic stressor which causes increased emotional numbing. The results also support recent suggestions that avoidance and emotional numbing constitute separate PTSS clusters. Further research is required to determine the source(s) of emotional numbing after postero-lateral thoracotomy and effective interventions.Item Open Access Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research(Cognitive Behaviour Therapy, 2016) McMurtry, C. Meghan; Taddio, Anna; Noel, Melanie; Martin, Antony; Chambers, Christine; Asmundson, Gordon; Pillai Riddell, Rebecca; Shah, Vibhuti; MacDonald, Noni; Rogers, Jess; Bucci, Lucie; Mousmanis, Patricia; Lang, Eddy; Halperin, Scott; Bowles, Susan K; Halpert, Christine; Ipp, Moshe; Rieder, Michael; Robson, Kate; Uleryk, Elizabeth; Votta-Bleeker, Elizabeth (Lisa); Dubey, Vinita; Hanrahan, Anita; Lockett, Donna; Scott, JeffreyNeedle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.Item Open Access Factorial Validity of the English-Language Version of the Pain Catastrophizing Scale–Child Version(Elsevier, 2013-11) Parkerson, Holly A; Noel, Melanie; Pagé, M. Gabrielle; Fuss, Samantha; Katz, Joel; Asmundson, GordonThe Pain Catastrophizing Scale (PCS) was developed in English to assess 3 components of catastrophizing (rumination, magnification, helplessness). It has been adapted for use and validated with Flemish-speaking children (Pain Catastrophizing Scale for Children [PCS-C]) and French-speaking adolescents. The PCS-C has been back-translated to English and used extensively in research with English-speaking children; however, the factorial validity of the English PCS-C has not been empirically examined. This study assessed the factor structure of the English PCS-C among a community sample of 1,006 English-speaking children (aged 8–18 years). Exploratory factor analysis was conducted using a random subsample (n = 504) to assess the underlying factor structure. Items with poor factor loadings were removed. Confirmatory factor analysis, using the second subsample (n = 502), was used to cross-validate the factor structure revealed by exploratory factor analysis and compare it to the original 3-factor model and other model variants. Exploratory factor analysis revealed that the original PCS-C and a revised 3-factor model comprising 11 of the original 13 PCS-C items, all loading on their original factors, provided adequate fit to the data. The revised model provided statistically better fit to the data compared to all other model variants, suggesting that the English PCS-C may be better understood using a revised 11-item oblique 3-factor model. Perspective: This is the first examination of the factorial validity of the widely used English version of the PCS-C in a large community sample of English-speaking children. A revised 11-item, 3-factor model provided statistically better fit to the data compared to the original model and other model variants.Item Open Access Far from “just a poke”: common painful needle procedures and the development of needle fear(Clinical Journal of Pain, 2015) McMurtry, Meghan; Pillai Riddell, Rebecca; Taddio, Anna; Racine, Nicole; Asmundson, Gordon; Noel, Melanie; Chambers, Christine; Shah, VibhutiBackground: Vaccine injections are the most common painful needle procedure experienced throughout the lifespan. Many strategies are available to mitigate this pain; however, they are uncommonly utilized, leading to unnecessary pain and suffering. Some individuals develop a high level of fear and subsequent needle procedures are associated with significant distress. Objective: The present work is part of an update and expansion of a 2009 knowledge synthesis to include the management of vaccine-related pain across the lifespan and the treatment of individuals with high levels of needle fear. This article will provide a conceptual foundation for understanding: (a) painful procedures and their role in the development and maintenance of high levels of fear; (b) treatment strategies for preventing or reducing the experience of pain and the development of fear; and (c) interventions for mitigating high levels of fear once they are established. Results: First, the general definitions, lifespan development and functionality, needle procedure-related considerations, and assessment of the following constructs are provided: pain, fear, anxiety, phobia, distress, and vasovagal syncope. Second, the importance of unmitigated pain from needle procedures is highlighted from a developmental perspective. Third, the prevalence, course, etiology, and consequences of high levels of needle fear are described. Finally, the management of needle-related pain and fear are outlined to provide an introduction to the series of systematic reviews in this issue. Discussion: Through the body of work in this supplement, the authors aim to provide guidance in how to treat vaccination-related pain and its sequelae, including high levels of needle fear.Item Open Access Pain-related anxiety influences pain perception differently in men and women: A quantitative sensory test across thermal pain modalities(Elsevier, 2013-03) Thibodeau, Michel A.; Welch, Patrick G.; Katz, Joel; Asmundson, GordonThe sexes differ with respect to perception of experimental pain. Anxiety influences pain perception more in men than in women; however, there lacks research exploring which anxiety constructs influence pain perception differentially between men and women. Furthermore, research examining whether depression is associated with pain perception differently between the sexes remains scant. The present investigation was designed to examine how trait anxiety, pain-related anxiety constructs (ie, fear of pain, pain-related anxiety, anxiety sensitivity), and depression are associated with pain perception between the sexes. A total of 95 nonclinical participants (55% women) completed measures assessing the constructs of interest and participated in quantitative sensory testing using heat and cold stimuli administered by a Medoc Pathway Pain and Sensory Evaluation System. The findings suggest that pain-related anxiety constructs, but not trait anxiety, are associated with pain perception. Furthermore, these constructs are associated with pain intensity ratings in men and pain tolerance levels in women. This contrasts with previous research suggesting that anxiety influences pain perception mostly or uniquely in men. Depression was not systematically associated with pain perception in either sex. Systematic relationships were not identified that allow conclusions regarding how fear of pain, pain-related anxiety, and anxiety sensitivity may contribute to pain perception differentially in men and women; however, anxiety sensitivity was associated with increased pain tolerance, a novel finding needing further examination. The results provide directions for future research and clinical endeavors and support that fear and anxiety are important features associated with hyperalgesia in both men and women.Item Open Access Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery(Lippincott, Williams & Wilkins, 2010-07) Martin, Andrea L; Halket, Eileen; Asmundson, Gordon; Flora, David; Katz, JoelObjectives: To (1) use structural equation modeling (SEM) to examine relationships proposed in Turk’s diathesis-stress model of chronic pain and disability as well as (2) investigate what role, if any, posttraumatic stress symptoms (PTSS) play in predicting pain disability, relative to some of the other factors in the model. Methods: The study sample consisted of 208 patients scheduled for general surgery, 21 to 60 years of age (mean age=47.18 y, SD=9.72 y), who reported experiencing persistent pain for an average of 5.56 years (SD=7.90 y). At their preadmission hospital visit, patients completed the Anxiety Sensitivity Index, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Disability Index, posttraumatic stress disorder Checklist, and rated the average intensity of their pain (0 to 10 numeric rating scale). SEM was used to test a model of chronic pain disability and to explore potential relationships between PTSS and factors in the diathesis-stress model. Results: SEM results provided support for a model in which anxiety sensitivity predicted fear of pain and catastrophizing, fear of pain predicted escape/avoidance, and escape/avoidance predicted pain disability. Results also provided support for a feedback loop between disability and fear of pain. SEM analyses provided preliminary support for the inclusion of PTSS in the diathesisstress model, with PTSS accounting for a significant proportion of the variance in pain disability. Discussion: Results provide empirical support for aspects of Turk’s diathesis-stress model in a sample of patients with persistent pain. Findings also offer preliminary support for the role of PTSS in fear-avoidance models of chronic pain.Item Open Access PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models(SAGE Publications, 2002-12) Asmundson, Gordon; Coons, Michael, J.; Taylor, Steven; Katz, JoelIt is common for individuals with symptoms of posttraumatic stress disorder (PTSD) to present with cooccurring pain problems, and vice versa. However, the relation between these conditions often goes unrecognized in clinical settings. In this paper, we describe potential relations between PTSD and chronic pain and their implications for assessment and treatment. To accomplish this, we discuss phenomenological similarities of these conditions, the prevalence of chronic pain in patients with PTSD, and the prevalence of PTSD in patients with chronic pain. We also present several possible explanations for the co-occurrence of these disorders, based primarily on the notions of shared vulnerability and mutual maintenance. The paper concludes with an overview of future research directions, as well as practical recommendations for assessing and treating patients who present with co-occurring PTSD or chronic pain symptoms.Item Open Access Structure of Posttraumatic Stress Disorder Symptoms in Pain and Pain-Free Patients Scheduled for Major Surgery(Elsevier, 2009) Pagé, M. Gabrielle; Kleinman, Valery; Asmundson, Gordon; Katz, JoelFactor-analytic studies of the structure of posttraumatic stress disorder (PTSD) symptoms have yielded inconsistent results. One of the reasons for the inconsistency may be that PTSD is highly comorbid with other disorders; the observed factor structure might depend on the particular comorbid disorder. One such disorder is chronic pain. The goal of the present study was to investigate whether PTSD symptom structure differs between pain and pain-free patients scheduled to undergo major surgery. Four hundred and forty-seven patients who were approached 7 to 10 days prior to scheduled surgery completed the PTSD Checklist-Civilian (PCL-C) Version and the Current Pain and Pain History Questionnaire; the latter was used to divide patients into pain (N = 175) and pain-free (N = 272) groups. Results showed that in pain-free patients, PTSD symptoms were best expressed as 2 symptom clusters (re-experiencing/avoidance; emotional numbing/hyperarousal) accounting for 52.4% of the variance. In pain patients, PTSD symptoms were best expressed as a single symptom cluster accounting for 51.1% of the variance. These results suggest different interrelationships among PTSD symptoms in these 2 populations. Results reflect the need for (1) controlling for pain in studies looking at PTSD-symptom expression and (2) further research on PTSD-symptom expression in pain populations.Item Open Access Understanding pain and posttraumatic stress disorder comorbidity: do pathological responses to trauma alter the perception of pain?(Elsevier, 2008) Asmundson, Gordon; Katz, JoelItem Open Access Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art(Wiley-Blackwell, 2009) Asmundson, Gordon; Katz, JoelThe purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc.