The Mediating Role of Pain Catastrophizing: Understanding the Relationship Between Psychological Distress and Functional Disability in Mild Traumatic Brain Injury
Main Article Content
Abstract
Background. Recovery following brain injury can be significantly impeded by the way in which an individual appraises pain, which in turn, can affect ability to cope with pain, and result in psychological distress. Pain catastrophizing, implicated in the appraisal of pain, can exacerbate the intensity of pain-related distress and impact psychological well-being. However, the concurrent evaluation of these phenomena via functional outcomes has not been examined in mild traumatic brain injury.
Material and methods. The present study evaluated de-identified archival data of 190 patients with mild traumatic brain injury following injury in motor vehicle accidents. Of primary interest was whether pain catastrophizing mediated the relationship among psychological distress (i.e., anxiety, depression) and functional disability outcomes in patients with mild traumatic brain injury.
Results. Pain catastrophizing was found to have a significant mediating effect on the relationship between anxiety and functional disability, as well as for depression and functional disability. Age, gender, time since injury, and/or pain intensity, were not significant predictors of outcome. Although, pain severity was linked to pain catastrophizing. Moreover, the current work also evaluated feigning amongst a subset of patients with mild traumatic brain injury. Interestingly, it appears that the presence of psychological distress, irrespective of the nature of that reporting, is itself predictive of functional well-being. This is an important clinical finding and supports the role of psychological factors on real-life functional compromise in patients with mild traumatic brain injury.
Conclusion. The present study found that psychological distress and functional disability are mediated by pain catastrophizing in patients with mild traumatic brain injury. It also appears that the presence of psychological distress, irrespective of the level of reported complaints (i.e., the over-reporting of symptomatology) itself, is predictive of functional well-being.
Keywords:
catastrophizing, pain, depression, anxiety, disability, mild traumatic brain injury
Article Details
How to Cite
ORNSTEIN, Tisha J. et al.
The Mediating Role of Pain Catastrophizing: Understanding the Relationship Between Psychological Distress and Functional Disability in Mild Traumatic Brain Injury.
Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3386>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.18103/mra.v10i11.3386.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Ponsford J, Draper K, Schönberger M. Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status. J Int Neuropsychol Soc. 2008;14(2):233-242. doi:10.1017/S1355617708080272
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5. Lamontagne G, Belleville G, Beaulieu-Bonneau S, Souesme G, Savard J, Sirois MJ, Giguère M, Tessier D, Le Sage N, Ouellet MC. Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury. Rehabil Psychol. 2022 Feb;67(1):90-99. doi:10.1037/rep0000422
6. McCrea M, Iverson GL, McAllister TW, Hammeke TA, Powell MR, Barr WB, Kelly JP. An integrated review of recovery after mild traumatic brain injury (MTBI): Implications for clinical management. Clin Neuropsychol. 2009;23(8);1368–90. doi: 10.1080/13854040903074652.
7. Voormolen DC, Cnossen MC, Polinder S, von Steinbuechel N, Vos PE, Haagsma JA. Divergent Classification Methods of Post-Concussion Syndrome after Mild Traumatic Brain Injury: Prevalence Rates, Risk Factors, and Functional Outcome. J Neurotrauma. 2018;35(11):1233-1241. doi:10.1089/neu.2017.5257
8. Merskey H, Bogduk N. Classification of chronic pain. 2nd ed. Seattle: IASP Press, 1994. p. 1.
9. Cancelliere C, Kristman VL, Cassidy JD, Hincapié CA, Côté P, Boyle E, Carroll LJ, Stålnacke BM, Nygren-de Boussard C, Borg J. Systematic review of return to work after mild traumatic brain injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil. 2014;95(3);S201–9. doi: 10.1016/j.apmr.2013.10.010.
10. Kawi J, Reyes AT, Arenas RA. Exploring pain management among asian immigrants with chronic pain: self-management and resilience. J Immigr Minor Health. 2019;21(5):1123–1136. PMID: 30182206. doi:10.1007/s10903-018-0820-8.
11. Müller R, Landmann G, Béchir M, et al. Chronic pain, depression and quality of life in individuals with spinal cord injury: mediating role of participation. J Rehabil Med. 2017;49(6):489–496. PMID: 28597908. doi:10.2340/16501977-2241.
12. Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psycho- social and functional impact of chronic pain. J Pain. 2016;17(9Suppl): T21–49. PMID: 27586830. doi:10.1016/j.jpain.2016.02.006.
13. Sherman, KB, Goldberg M, Bell KR. Traumatic Brain Injury and Pain. Phys Med Rehabil Clin N Am. 2006;17(2);473–90. doi: 10.1016/j.pmr.2005.11.007.
14. Jamora CW, Schroeder SC, Ruff RM. Pain and mild traumatic brain injury: The implications of pain severity on emotional and cognitive functioning. Brain Injury. 2013; 27(10);1134–40. doi: 10.3109/02699052.2013.804196.
15. Fedoroff JP, Starkstein SE, Forrester AW, Geisler FH, Jorge RE, Arndt SV, Robinson RG. Depression in patients with acute traumatic brain injury. Am J Psychiatry. 1992;149(7);918–23. doi: 10.1176/ajp.149.7.918.
16. Mallya S, Sutherland J, Pongracic S, Mainland B, Ornstein TJ. The manifestation of anxiety disorders after traumatic brain injury: a review. J Neurotrauma. 2015;32(7):411-421. doi:10.1089/neu.2014.3504
17. Seel RT, Kreutzer JS, Rosenthal M, Hammond FM, Corrigan JD, Black K. Depression after traumatic brain injury: A National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation. Arch Phys Med Rehabil. 2003;84(2);177–84. doi: 10.1053/apmr.2003.50106.
18. Silver J, Yudofsky S, Hales R. Neuropsychiatry of Traumatic Brain Injury. Washington: American Psychological Association; 1994.
19. van der Naalt J, Timmerman ME, de Koning ME, van der Horn HJ, Scheenen ME, Jacobs B, Hageman G, Yilmaz T, Roks G, Spikman JM. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7);532–40. doi: 10.1016/S1474-4422(17)30117-5
20. Beck A. Cognitive therapy and the emotional disorders. Connecticut: International Universities Press; 1976.
21. Sullivan MJL, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17(1);52–64. doi: 10.1097/00002508-200103000-00008
22. Ullrich P, Jensen M, Loeser J, Cardenas D. Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury. Rehabil Psychol. 2007;52(4);390–8. doi: 10.1037/0090-5550.52.4.390
23. Vlaeyen JWS, Morley S. Active despite pain: the putative role of stop-rules and current mood. Pain. 2004;110(3);512–6. doi: 10.1016/j.pain.2004.04.037.
24. Kim JH, Park H, Juon HS. The mediating role of pain catastrophizing on the association between depression and pain severity and interference among elderly Asian immigrants with chronic pain. J Pain Res. 2021; 14;737-745. doi: 10.2147/JPR.S304440
25. Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. J Behav Med. 2007;30(1);77–94. doi: 10.1007/s10865-006-9085-0.
26. Spanos NP, Radtke-Bodorik HL, Ferguson JD, Jones B. The effects of hypnotic susceptibility, suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain. J Abnorm Psychol. 1979;88(3);282–92. doi: 10.1037//0021-843x.88.3.282.
27. Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6);1144–7. doi: 10.1016/j.pain.2011.12.009
28. Pincus T, Smeets RJEM, Simmonds MJ, Sullivan MJL. The fear avoidance model disentangled: Improving the clinical utility of the fear avoidance model. Clin J Pain. 2010;26(9);739–46. doi: 10.1097/AJP.0b013e3181f15d45
29. Kay T, Harrington D, Adams R, Anderson T, Berrol S, Cicerone K, Dahlberg C, Gerber D, Goka R, Harley P, Hilt J, Horn L, Lehmkuhl D, Malec J; Mild Traumatic Brain Injury Committee, American Congress of Rehabilitation Medicine, Head Injury Interdisciplinary Special Interest Group. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993;8;86–7. doi:10.1097/00001199-199309000-00010
30. Heilbronner RL, Sweet JJ, Morgan JE, Larrabee GJ, Millis SR; Conference Participants. American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering. Clin Neuropsychol. 2009;23(7):1093-1129. doi:10.1080/13854040903155063
31. Martin MY, Bradley LA, Alexander RW, Alarcon GS, Triana-Alexander M, Aaron LA, Alberts KR. Coping strategies predict disability in patients with primary fibromyalgia. Pain. 1996;68(1);45–53. doi: 10.1016/S0304-3959(96)03179-X.
32. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess. 1995;7(4);524–32. doi: 10.1037/1040-3590.7.4.524
33. Chaput G, Lajoie SP, Naismith LM, Lavigne G. Pain Catastrophizing correlates with early mild traumatic brain injury outcome. Pain Res Manag. 2016;1–7. doi: 10.1155/2016/2825856
34. Kremer R, Granot M, Yarnitsky D, Crispel Y, Fadel S, Anson Best LA, Nir RR. The role of pain catastrophizing in the prediction of acute and chronic postoperative pain. Open Pain J. 2013;6(1);176–82. doi: 10.2174/1876386301306010176
35. Beck A, Steer R. Beck Anxiety Inventory Manual. Psychological Corporation; 1993.
36. Wilson KA, De Beurs E, Palmer CA, Chambless DL. Beck Anxiety Inventory. In: Maruish ME (Ed.), The use of psychological testing for treatment planning and outcomes assessment. 2nd ed. Lawrence Erlbaum; 1999:971-1992.
37. Creamer M, Foran J, Bell R. The Beck Anxiety Inventory in a non-clinical sample. Behav Res Ther. 1995;33(4):477-85. doi:10.1016/0005-7967(94)00082-u
38. Beck A, Steer R, Brown G. Manual for the Beck Depression Inventory-II. Psychological Corporation; 1996.
39. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013.
40. Wang Y-P, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria. 2013;35(4):416-431. doi:10.1590/1516-4446-2012-1048
41. Knaster P, Estlander AM, Karlsson H, Kaprio J, Kalso E. Diagnosing depression in chronic pain patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI). PLoS One. 2016;11(3);e0151982. doi: 10.1371/journal.pone.0151982
42. Huskisson E. Measurement of pain. The Lancet. 1974;304(7889);1127–31. doi: 10.1016/s0140-6736(74)90884-8.
43. Sindhu BS, Shechtman O, Tuckey L. Validity, reliability, and responsiveness of a digital version of the visual analog scale for measuring pain intensity. J Hand Ther. 2011;24(4);384. doi: 10.1016/j.jht.2011.06.003
44. Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain. 1990;40(2);171–82. doi: 10.1016/0304-3959(90)90068-O.
45. Jerome A, Gross RT.. Pain Disability Index: Construct and discriminant validity. Arch Phys Med Rehabil. 1991;72(11);920–2. doi: 10.1016/0003-9993(91)90012-8.
46. Smith GP, Burger GK. Detection of malingering: validation of the Structured Inventory of Malingered Symptomatology (SIMS). J Am Acad Psychiatry Law. 1997;25(2);183–9.
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