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Chronic neck pain (CNP) is a common and disabling condition, accounting for substantial healthcare and societal costs. Previous studies have demonstrated that certain cognitive factors are related to levels of adjustment (levels of disability, pain and depression) in chronic pain conditions. However, this association has not been adequately explored in patients with CNP. The aim of study one was to determine the relationship between specific cognitive factors and levels of adjustment in participants with CNP. Furthermore, study two explored whether the relationship between the cognitive factors and levels of adjustment differed between those patients with idiopathic CNP and those with Chronic Whiplash Associated Disorder (CWAD). Finally, study three compared the efficacy of a physiotherapy led intervention, specifically designed to modify cognitive factors to a conventional physiotherapy intervention.Study one: Hierarchical multiple regression analyses were performed. Greater catastrophizing and lower functional self-efficacy beliefs were associated with greater levels of pain and disability. Additionally, lower functional self-efficacy beliefs were also associated with greater levels of depression. Study two: Data were dichotomised into two groups: those with CWAD and those with idiopathic CNP. T-tests were performed to compare differences in the cognitive scores and the same regression analyses as study one were performed for each sub-group. No significant differences existed between the two groups in terms of levels of pain, disability, depression or the cognitive factors. In both groups greater catastrophizing and lower functional self-efficacy beliefs were related to levels of disability. Likewise, lower self-efficacy beliefs were related to levels of depression in those participants with idiopathic CNP and those with CWAD. However, amongst those with idiopathic CNP, greater levels of catastrophizing and lower levels of pain vigilance and awareness were related to greater pain intensity. In contrast, amongst those with CWAD, none of the cognitive measures were significantly related to levels of pain intensity.Study three: Participants were randomly allocated to either a progressive neck exercise programme or an intervention which specifically targeted the modification of cognitive factors. T-tests revealed that treatment targeting cognitive factors resulted in greater improvements in pain and pain-related fear. Moreover, Χ2 tests revealed that a greater proportion of patients made clinically meaningful reductions in pain and disability in the group targeting cognitive factors. This thesis highlights that cognitive factors play an important role in determining levels of adjustment in patients with CNP. Furthermore, treatments designed to specifically target these factors result in superior clinical outcomes when compared to conventional physiotherapy interventions.

Pain catastrophizing refers to an exaggerated negative mental set during the actual or anticipated experience of pain (Sullivan, Bishop, & Pivik, 1995). Interest in this construct, promising research findings, and greater attention to the role of psychological mechanisms in pain perception has led to a proliferation of self-report measures for assessing pain catastrophizing. Sullivan and colleagues’ (1995) three-factor Pain Catastrophizing Scale (PCS) is the most widely employed today. However, currently the construct is somewhat vaguely defined, different measures utilize different conceptual models, and many similar constructs exist. Similar to Brenan, Clark, and Shaver (1998) we gathered all available measures tapping pain catastrophizing and similar constructs, eliminated a small number of clearly redundant items, and had a sample of respondents (who regularly experience pain) complete a questionnaire containing the items. Items reflecting resilience were also included in the final questionnaire. This 70-item questionnaire was administered via the crowdsourcing platform: Mechanical Turk. This approach allowed us to assess the stability of the three-factor solution proposed by the PCS, to explore alternative models, and to develop a new measure based on these findings. Exploratory factor analyses (EFA) of just the items from the PCS did not yield a replication of the three-factor structure and instead found support for a one-factor model which accounted for 46.42% of the overall variance. EFA of the full item pool found support for a 45-item, five-factor model which accounted for 52.98% of the total variance and had no commonalities lower than 0.30. The following subscales were derived from this model: Catastrophizing, Disability, Resilience, Low Self-Efficacy, and Self-Directed Affect. Confirmatory factor analysis removed an additional seven redundant items. The five-factor model had adequate fit as the subscale and full model levels. The subscales were highly correlated with each other and had strong internal consistency. The seven-item Resilience subscale was dropped in favor of a four-factor model. The 31-item Negative Pain Cognitions Questionnaire (NPCQ) was derived from the four-factor model. The subscales of the NPCQ were sufficiently different to support a one-factor model of pain catastrophizing.

OBJECTIVES: This study aims to better understand the relationship between psychosocial factors and the development of chronic pelvic pain (CPP) in cases of adolescent endometriosis, specifically mood disorders, pain catastrophizing and quality of life, and to detect the development of central sensitization within this population. METHODS: Eligible candidates were patients between 14 and 22 years old with confirmed diagnosis of endometriosis and chronic pelvic pain who were enrolled in the Women’s Health Study: From Adolescence to Adulthood through the Boston Center for Endometriosis (BCE) and Boston Children’s Hospital. The administration of quantitative sensory testing (QST) to assess mechanical touch perception, pressure pain sensitivity and temporal summation was performed on 48 subjects. Pre-surgical baseline surveys, which included pain catastrophizing and quality of life measures, were obtained from the BCE. Record of diagnosed mood disorder (anxiety/depression) was obtained through medical chart review. Pearson correlations between QST measures, pain catastrophizing, presence of mood disorders or central sensitization and pre-surgical pain scores were conducted. One-way ANOVA calculations, and one sample and paired t-tests were conducted to gain further understanding of these variables as they relate to groups within the cohort. RESULTS: Regarding QST measures, 23 subjects (47.9%) produced a wind-up phenomenon from temporal summation during QST administration, which serves as a surrogate for the presence of central sensitization (+CS). Pressure sensation and pain scores correlated at all test sites (lower and upper abdomen, as well as finger control site) and wind-up phenomenon correlated in the lower and upper abdomen throughout the cohort. For the presence of mood disorders, anxiety and depression were equally distributed across the +CS and –CS groups. Review of pre-surgical pain scores and pain catastrophizing (PCS) within the cohort had significant correlations between pre-surgical pain and PCS subsets of rumination and magnification. PCS total and subset scores also correlated to +CS. One-way ANOVA calculations showed the cohort as a whole presented with clinically significant helplessness. CONCLUSIONS: Results encourage further investigation of the relationship between endometriosis, comorbid conditions, environmental factors and the development of CPP within the adolescent population. More detailed data regarding mental health and documentation of condition progression, as well as establishment of health control values and sample growth are encouraged for the continued progress of this project.

Children with chronic pain are vulnerable to adverse outcomes, such as impaired quality of life and poor functioning. Recent risk and resilience models for adult chronic pain have aimed to conceptualize the complexity of pain, which may prove useful for pediatric populations. The purpose of this study was to examine the unique predictive value of prominent pain-related risk factors, investigate optimism’s role as a resilience factor, and explore protective mechanisms through which optimism exerts its benefits. Participants included 58 8-17 year-old children and adolescents with chronic pain. Pain intensity remained the best predictor of disability, but pain-related fear and optimism were unique predictors of well-being. Optimism contributed to adaptation by reducing pain-related fear and catastrophizing. Findings suggest that the predictive value of related risk factors is inconsistent across functioning outcomes, and optimism is an applicable resilience factor in pediatric pain through its minimization of pain-related risk factors.

This study examined data from 63 adolescents with migraine (45 female) between the ages of 11 and 17 (mean age=14.4) to compare the relative impact of migraine severity, associated symptom severity, internalizing symptoms and catastrophizing on health-related quality of life (HRQL). Participants kept a 4-week diary about their headaches and completed 3 different quality of life scales, a psychological assessment scale and a catastrophizing questionnaire. A hierarchical regression analysis revealed that associated symptoms of migraine and internalizing symptoms predicted adolescent functioning. This is the first study of its kind designed specifically for adolescents with migraine. Its results suggest there is a need for further research exploring the impact of associated symptoms of migraine and internalizing on HRQL of adolescents.

Acceptance and chronic pain is an emerging topic both for research and intervention. Initial studies have demonstrated acceptance is correlated with higher quality of daily emotional, social, and physical functioning in various chronic pain populations. The purpose of the present study was to clarify the nature of the relationship between acceptance, appraisals that are common and relevant in chronic pain populations (i.e., control and catastrophizing), and coping among migraine headache sufferers, and to determine whether the relationships conform to the same pattern observed in other chronic pain populations. Seventy four participants with migraine headaches completed self report measures assessing appraisal, coping strategies, acceptance, and pain related disability. Sixty three participants also completed a 28-day daily dairy assessing headache activity, catastrophizing, control, acceptance, and coping strategies. Hierarchical regression and multilevel modeling were used to examine the relations between these variables. Overall, results indicate acceptance is a relevant construct in the experience of migraine pain. Higher levels of pain-related acceptance were associated with lower levels of catastrophizing and pain-related interference, and increased perceived control. Participants who endorsed higher levels of pain related acceptance reported engaging in a higher level of activity overall, and indicated they use fewer coping strategies. Though many of the primary hypotheses had partial support, it is clear that a different pattern of relationships was observed between acceptance, coping, and appraisal among migraine headache sufferers. Unlike previous studies with other chronic pain populations, pain severity was significantly related to many of the constructs tested. This could have important implications in developing appropriate acceptance-based treatment with headache sufferers. This highlights the importance of replicating and extending research with new populations. Acceptance continues to show promise as a way of viewing pain that lessens the detrimental impact of certain types of thoughts (i.e., catastrophizing), and leads to increased participation in daily life.