Anesthesia & Pain Management, Toronto General Hospital, Toronto, Ontario, Canada. 2. Department of Psychology, York University, Toronto, Ontario. RESULTS.
Pain acceptance mediates the relationship between pain intensity and pain-related disability in patients with chronic pain after cardiac surgery M A Azam, MSc1,2, Weinrib A, PhD 1,2, Montbriand J, PhD 1, Burns LC, MSc 1,2, Wicks C, MA 2, Clarke H 1, & Katz J, PhD 1,2 1Anesthesia & Pain Management, Toronto General Hospital, Toronto, Ontario, Canada 2Department of Psychology, York University, Toronto, Ontario
Chronic post-surgical pain (CPSP) leads to significant disability [1]. Research is needed on psychological processes that support people with CPSP in improving pain-related disability. One proposed process is pain acceptance [2], characterized as the willingness to experience pain without attempting to control or avoid it. For people with CPSP, pain acceptance may reduce disability by fostering greater re-engagement with valued life activities. The purpose of this study was to test the mediating role of pain acceptance in the relationship between pain intensity and disability in patients who had undergone coronary artery bypass graft surgery (CABGS) at least 6 months earlier.
QUESTIONNAIRES
RESULTS
BACKGROUND
Pain intensity was positively correlated with disability (r = .44, p < .001) and inversely correlated with pain acceptance (r = -.45, p < .001). The mediation model revealed pain acceptance was a significant inverse predictor of disability (β = -.73, p < .001), while the direct effect of pain intensity on disability was not significant (β = .11, p = .22), supporting a full mediation.
For each of the 7 categories of life activity listed, please circle the number on the scale that describes the level of disability you typically experience. A score of 0 means no disability at all, and a score of 10 signifies that all of the activities in which you would normally be involved have been totally disrupted or prevented by your pain. 1. Family/Home Responsibilities 0 - - - - - - - - - 10
Pain Disability
Pain Intensity C β = 0.44, p < 0.001
METHODS N = 133 patients (Age M = 62.67 years, SD = 11.74; 72% Male) reported CPSP. Pain intensity was measured using a 0-10 scale. Disability was measured using the Pain Disability Index. Pain acceptance was measured using the Chronic Pain Acceptance Questionnaire. Mediation with pain acceptance (mediator), pain intensity (predictor), and disability (outcome) was tested according to Hayes (2016) specifications.
Pain Disability Index [3]
2. Recreation
0 - - - - - - - - - 10
3. Social Activity
0 - - - - - - - - - 10
4. Occupation
0 - - - - - - - - - 10
5. Sexual Behavior
0 - - - - - - - - - 10
6. Self-Care
0 - - - - - - - - - 10
7. Life-Support Activities
0 - - - - - - - - - 10
Chronic Pain Acceptance Questionnaire [4] – Sample Items
Pain Acceptance Mediation Model
A β = -0.45 p < 0.001
Pain Acceptance
B β = -0.73 p < 0.001
Below you will find a list of statements. Please rate the truth of each statement as it applies to you. Use the following rating scale to make your choices. For instance, if you believe a statement is ‘Always True,’ you would write a 6 in the blank next to that statement. __ “I would gladly sacrifice important things in my life to control this pain better.” __ “Keeping my pain level under control takes first priority whenever I’m doing something.” __”Controlling my pain is less important than any other goals in my life.”
Pain Disability
Pain Intensity C β = 0.11, p = 0.22
__”Despite the pain, I am now sticking to a certain course in my life.”
REFERENCES [1] Katz, J., & Seltzer, Z. E. (2009). Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics,9(5), 723-744
CONCLUSION Results demonstrate that pain acceptance mediates the relationship between pain and disability in CPSP patients. Acceptance- based chronic pain interventions may assist sufferers in engaging in flexible and committed patterns of valued activities. Figure 1. Coronary artery bypass graft procedure
[2[ Harrison, A. M., Scott, W., Johns, L. C., Morris, E. M., & McCracken, L. M. (2017). Are We Speaking the Same Language? Finding Theoretical Coherence and Precision in “Mindfulness-Based Mechanisms” in Chronic Pain. Pain Medicine. [3] Tait, R. C., Pollard, C. A., Margolis, R. B., Duckro, P. N., & Krause, S. J. (1987). The Pain Disability Index: psychometric and validity data. Arch Phys Med Rehabil, 68(7), 438-41. [4] Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008). The Chronic Pain Acceptance Questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain, 140(2), 284-291.
