The role of distress tolerance, social support, and cognitive flexibility in predicting pain catastrophizing in patients with chronic low back pain

Document Type : Original Article

Authors

1 Ph.D. Student, Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

2 Assistant Professor of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

3 M.A in Clinical Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran

4 M.A in Clinical Psychology, Islamic Azad University of Ardabil Branch, Ardabil, Iran

Abstract

The present study aimed to investigate the roles of distress tolerance, social support, and cognitive flexibility in predicting pain catastrophizing in patients with chronic low back pain (CLBP). The research design was descriptive and correlational. The study's population included all patients with CLBP in the 7th district in Tehran in 2022. The sample included 180 patients selected through the availability sampling. The participants completed questionnaires on distress tolerance, social support, cognitive flexibility, and pain catastrophizing. Data analysis was conducted using the Pearson correlation and multiple regression analysis with SPSS 24 software. The results of this research indicated that distress tolerance, social support, and cognitive flexibility had a significant negative correlation with pain catastrophizing (p < 0.05). The correlation coefficient of predictor variables with pain catastrophizing in patients with CLBP was 0.68. These variables could significantly predict 61% of the changes in pain catastrophizing in patients suffering from CLBP. In general, the obtained results demonstrate the relationship and the possibility of predicting pain catastrophizing through distress tolerance, social support, and cognitive flexibility in patients with CLBP. According to the findings of the research, increasing distress tolerance, social support, and cognitive flexibility can help control the extent of pain catastrophizing in CLBP patients.

Keywords

References

Alshelh, Z., Brusaferri, L., Saha, A., Morrissey, E., Knight, P., Kim, M., ... & Loggia, M. L. (2022). Neuroimmune signatures in chronic low back pain subtypes. Brain, 145(3), 1098-1110. doi:10.1093/brain/awab336
Andrés, M. L., del-Valle, M. V., Richaud de Minzi, M. C., Introzzi, I., Canet-Juric, L., & Navarro-Guzmán, J. I. (2021). Distress tolerance and executive functions: A systematic review. Psychology & Neuroscience, 14(3), 280. doi:10.1037/pne0000259
Anagnostopoulos, F., Paraponiari, A., & Kafetsios, K. (2022). The Role of Pain Catastrophizing, Emotional Intelligence, and Pain Intensity in the Quality of Life of Cancer Patients with Chronic Pain. Journal of Clinical Psychology in Medical Settings, 1-19. doi:10.1007/s10880-022-09921-5
Åkerblom, S., Perrin, S., Rivano Fischer, M., & McCracken, L. M. (2021). Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility. Journal of Behavioral Medicine, 44, 111-122. doi:10.1007/s10865-020-00168-9
Alhareeri, A. A., Archer, K. J., Fu, H., Lyon, D. E., Elswick, R. K., Kelly, D. L., ... & Jackson-Cook, C. K. (2020). Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study. Breast Cancer Research, 22(1), 1-18. doi:10.1186/s13058-020-01368-6
Bakhshaie, J., Storch PhD, E. A., & Zvolensky PhD, M. J. (2023). Pain-related disability and opioid use in a sample of young adults with current pain: The explanatory role of distress tolerance. Journal of American College Health, 71(4), 1206-1212. doi:10.1080/07448481.2021.1925677
Buruck, G., Tomaschek, A., Wendsche, J., Ochsmann, E., & Dörfel, D. (2019). Psychosocial areas of work life and chronic low back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders, 20, 1-16. doi:10.1186/s12891-019-2826-3
Bagheri Sheykhangafshe F, Shabahang R. (2020). Prediction of Psychological Wellbeing of Elderly People based on Spirituality, Social Support, and Optimism. JRH, 7(2), 22-32. http://jrh.mazums.ac.ir/article-1-716-en.html
Bagheri Sheykhangafshe, F., Sharifipour Choukami, Z., Tajbakhsh, K., Hamideh Moghadam, A., & Hajialiani, V. (2022). Relationship Between Social Networks, Cognitive Flexibility and Anxiety Sensitivity in Predicting Students' Corona Phobia. Psychological Achievements, 29(1), 209-228.
Carr, E. C., Norris, J. M., Alix Hayden, K., Pater, R., & Wallace, J. E. (2020). A scoping review of dog ownership's health and social benefits for people with chronic pain. Anthrozoös, 33(2), 207-224. doi:10.1080/08927936.2020.1719761
Cowen, S. L., Phelps, C. E., Navratilova, E., McKinzie, D. L., Okun, A., Husain, O., ... & Porreca, F. (2018). Chronic pain impairs cognitive flexibility and engages novel learning strategies in rats. Pain, 159(7), 1403. doi:10.1097/j.pain.0000000000001226
Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 34, 241-253. doi:10.1007/s10608-009-9276-4
Expósito‐Vizcaíno, S., Sánchez‐Rodríguez, E., & Miró, J. (2020). The role of physical, cognitive and social factors in pain interference with activities of daily living among individuals with chronic cancer pain. European Journal of Cancer Care, 29(2), e13203. doi:10.1111/ecc.13203
Esteve, R., Bernardes, S. F., López‐Martínez, A. E., Martín‐Delgado, C. E., & Ramírez‐Maestre, C. (2022). The informal social support for autonomy and dependence in pain inventory Spanish version. Health & Social Care in the Community, 30(5), e1991-e2002. doi:10.1111/hsc.13632
Écija, C., Luque-Reca, O., Suso-Ribera, C., Catala, P., & Peñacoba, C. (2020). Associations of cognitive fusion and pain catastrophizing with fibromyalgia impact through fatigue, pain severity, and depression: An exploratory study using structural equation modeling. Journal of Clinical Medicine, 9(6), 1763. doi:10.3390/jcm9061763
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175-191. doi:10.3758/BF03193146
Fernández-Peña, R., Molina, J. L., & Valero, O. (2018). Personal network analysis in the study of social support: the case of chronic pain. International journal of environmental research and public health, 15(12), 2695. doi:10.3390%2Fijerph15122695
Forgeron, P. A., Chambers, C. T., Cohen, J., Dick, B. D., Finley, G. A., & Lamontagne, C. (2018). Dyadic differences in friendships of adolescents with chronic pain compared with pain-free peers. Pain, 159(6), 1103-1111. doi:10.1097/j.pain.0000000000001191
Galvez-Sánchez, C. M., Reyes del Paso, G. A., & Duschek, S. (2018). Cognitive impairments in fibromyalgia syndrome: Associations with positive and negative affect, alexithymia, pain catastrophizing and self-esteem. Frontiers in Psychology, 377. doi:10.3389/fpsyg.2018.00377
Garland, E. L., Bryan, M. A., Priddy, S. E., Riquino, M. R., Froeliger, B., & Howard, M. O. (2019). Effects of mindfulness-oriented recovery enhancement versus social support on negative affective interference during inhibitory control among opioid-treated chronic pain patients: a pilot mechanistic study. Annals of behavioral medicine, 53(10), 865-876. doi:10.1093/abm/kay096
Gilpin, H. R., Keyes, A., Stahl, D. R., Greig, R., & McCracken, L. M. (2017). Predictors of treatment outcome in contextual cognitive and behavioral therapies for chronic pain: a systematic review. The Journal of Pain, 18(10), 1153-11 doi:10.1016/j.jpain.2017.04.003
Hruschak, V. J., Yuan, Y., Ringwald, W., Beaugard, C., Repine, M., Pacella-LaBarbara, M., ... & Cochran, G. (2021). Pain appraisals in patients with physical injury: assessing the role of distress tolerance in the relationship between depression and pain catastrophizing. Health & Social Work, 46(3), 187-198. doi:10.1093%2Fhsw%2Fhlab021
Hass-Cohen, N., Bokoch, R., Goodman, K., & McAnuff, J. (2022). Art therapy drawing protocols for chronic pain: Qualitative findings from a mixed-method pilot study. Art Therapy, 39(4), 182-193. doi:10.1080/07421656.2022.2085491
Kindt, S., Vansteenkiste, M., Josephy, H., Bernardes, S. F., & Goubert, L. (2019). Helping your partner with chronic pain: the importance of helping motivation, received social support, and Its timeliness. Pain Medicine, 20(1), 77-89. doi:10.1093/pm/pny006
Kline, R. B. (2023). Principles and practice of structural equation modeling. Guilford publications. https://www.researchgate.net/publication/361910413_Principles_and_Practice_of_Structural_Equation_Modeling
Kato, T., Kadota, M., & Shimoda, S. (2021). Effects of coping flexibility in young women on depressive symptoms during chronic pain. Behavioral Medicine, 47(3), 185-193. doi:10.1080/08964289.2019.1708250
Li, S. Y. (2021). The relationships among self-efficacy, social support, and self-care behavior in the elderly patients with chronic pain (a STROBE-compliant article). Medicine, 100(9). doi:10.1097/md.0000000000024554
Lackner, J. M., Gudleski, G. D., Radziwon, C. D., Krasner, S. S., Firth, R. S., Naliboff, B. D., ... & Mayer, E. A. (2022). Cognitive flexibility improves in cognitive behavioral therapy for irritable bowel syndrome but not nonspecific education/support. Behaviour Research and Therapy, 154, 104033. doi:10.1016/j.brat.2022.104033
López-Martínez, A. E., Sainero-Tirado, G., Esteve, R., Reyes-Pérez, Á., Ruiz-Párraga, G. T., de la Vega, R., ... & Ramírez-Maestre, C. (2023). Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain?. Psychological Trauma: Theory, Research, Practice, and Policy, 15(3), 394. doi:10.1037/tra0001269
Modares, M. (2011). Effectiveness of group dialectical behavior therapy (based on core mindfulness, distress tolerance and emotion regulation components) on depressive symptoms in university students. Journal of Fundamentals of Mental Health, 13(50), 35-124. doi:10.22038/jfmh.2011.881
Mohammadi, S., Dehghani, M., Heidari, M., Sedaghat, M., & Khatibi, A. (2013). The evaluation of pain-related psychological similarities among patients with musculoskeletal chronic pain and their spouses. International Journal of Behavioral Sciences, 7(1), 57-66. https://www.behavsci.ir/article_67812.html
Manning, K., Kauffman, B. Y., Rogers, A. H., Garey, L., & Zvolensky, M. J. (2022). Fatigue severity and fatigue sensitivity: relations to anxiety, depression, pain catastrophizing, and pain severity among adults with severe fatigue and chronic low back pain. Behavioral medicine, 48(3), 181-189. doi:10.1080/08964289.2020.1796572
Monticone, M., Portoghese, I., Rocca, B., Giordano, A., Campagna, M., & Franchignoni, F. (2021). Responsiveness and minimal important change of the Pain Catastrophizing Scale in people with chronic low back pain undergoing multidisciplinary rehabilitation. Eur J Phys Rehabil Med, 58, 68-75. doi:10.23736/s1973-9087.21.06729-0
Meints, S. M., Mawla, I., Napadow, V., Kong, J., Gerber, J., Chan, S. T., ... & Edwards, R. R. (2019). The relationship between catastrophizing and altered pain sensitivity in patients with chronic low back pain. Pain, 160(4), 833. doi:10.1097/j.pain.0000000000001461
McHugh, R. K., Kneeland, E. T., Edwards, R. R., Jamison, R., & Weiss, R. D. (2020). Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity. Journal of behavioral medicine, 43, 623-629. doi:10.1007/s10865-019-00086-5
McKillop, A. B., Carroll, L. J., Jones, C. A., & Battié, M. C. (2017). The relation of social support and depression in patients with chronic low back pain. Disability and rehabilitation, 39(15), 1482-1488. doi:10.1080/09638288.2016.1202335
Nagata, S., Seki, Y., Shibuya, T., Yokoo, M., Murata, T., Hiramatsu, Y., ... & Shimizu, E. (2018). Does cognitive behavioral therapy alter mental defeat and cognitive flexibility in patients with panic disorder?. BMC research notes, 11(1), 1-7. doi:/10.1186%2Fs13104-018-3130-2
Neumann, I., Käthner, I., Gromer, D., & Pauli, P. (2023). Impact of perceived social support on pain perception in virtual reality. Computers in Human Behavior, 139, 107490. doi:10.1016/j.chb.2022.107490
Nury, E., Schmucker, C., Nagavci, B., Motschall, E., Nitschke, K., Schulte, E., ... & Meerpohl, J. J. (2022). Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses. Pain, 163(4), 610-636. doi:10.1097/j.pain.0000000000002423
Oraison, H. M., & Kennedy, G. A. (2021). The effect of social support in chronic back pain: number of treatment sessions and reported level of disability. Disability and Rehabilitation, 43(11), 1526-1531. doi:10.1080/09638288.2019.1668969
Penn, T. M., Trost, Z., Parker, R., Wagner, W. P., Owens, M. A., Gonzalez, C. E., ... & Goodin, B. R. (2019). Social support buffers the negative influence of perceived injustice on pain interference in people living with HIV and chronic pain. Pain reports, 4(2). doi:10.1097%2FPR9.0000000000000710
Phelps, C. E., Navratilova, E., & Porreca, F. (2021). Cognition in the chronic pain experience: Preclinical insights. Trends in cognitive sciences, 25(5), 365-376. doi:10.1016/j.tics.2021.01.001
Rogers, A. H., Bakhshaie, J., Mayorga, N. A., Ditre, J. W., & Zvolensky, M. J. (2018). Distress tolerance and pain experience among young adults. Psychology, health & medicine, 23(10), 1231-1238. doi:10.1080/13548506.2018.1454598
Roseen, E. J., Pinheiro, A., Lemaster, C. M., Plumb, D., Wang, S., Elwy, A. R., ... & Saper, R. B. (2023). Yoga versus education for Veterans with chronic low back pain: A randomized controlled trial. Journal of General Internal Medicine, 1-10. doi:10.1007/s11606-023-08037-2
Russell, B. S., Lincoln, C. R., & Starkweather, A. R. (2019). Distress tolerance intervention for improving self-management of chronic conditions: A systematic review. Journal of Holistic Nursing, 37(1), 74-86. doi: 10.1177/0898010118777327
Shiers, S., Mwirigi, J., Pradhan, G., Kume, M., Black, B., Barragan-Iglesias, P., ... & Price, T. J. (2020). Reversal of peripheral nerve injury-induced neuropathic pain and cognitive dysfunction via genetic and tomivosertib targeting of MNK. Neuropsychopharmacology, 45(3), 524-533. doi:10.1038/s41386-019-0537-y
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social science & medicine, 32(6), 705-714. doi:10.1016/0277-9536(91)90150-b
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion, 29(2), 83-102. doi:10.1007/s11031-005-7955-3
Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological assessment, 7(4), 524. doi:10.1037/1040-3590.7.4.524
Semeru, G. M., & Halim, M. S. (2019). Acceptance versus catastrophizing in predicting quality of life in patients with chronic low back pain. The Korean journal of pain, 32(1), 22-29. doi:10.3344/kjp.2019.32.1.22
Schütze, R., Rees, C., Smith, A., Slater, H., Campbell, J. M., & O'Sullivan, P. (2018). How can we best reduce pain catastrophizing in adults with chronic noncancer pain? A systematic review and meta-analysis. The Journal of Pain, 19(3), 233-256. doi:10.1016/j.jpain.2017.09.010
Sainero-Tirado, G., Ramírez-Maestre, C., López-Martínez, A. E., & Esteve, R. (2023). Distress intolerance and pain catastrophizing as mediating variables in PTSD and chronic noncancer pain comorbidity. Scandinavian Journal of Pain, 23(2), 318-325. doi:10.1515/sjpain-2022-0041
Schiltenwolf, M., Akbar, M., Neubauer, E., Gantz, S., Flor, H., Hug, A., & Wang, H. (2017). The cognitive impact of chronic low back pain: positive effect of multidisciplinary pain therapy. Scandinavian journal of pain, 17(1), 273-278. doi:10.1016/j.sjpain.2017.07.019
Tapar, H., Özsoy, Z., Balta, M. G., Daşıran, F., Tapar, G. G., & Karaman, T. (2022). Associations between postoperative analgesic consumption and distress tolerance, anxiety, depression, and pain catastrophizing: a prospective observational study. Brazilian Journal of Anesthesiology, 72, 567-573. doi:10.1016/j.bjane.2021.07.007
Tsai, S., Crawford, E., & Strong, J. (2018). Seeking virtual social support through blogging: a content analysis of published blog posts written by people with chronic pain. Digital health, 4, 2055207618772669. doi:10.1177%2F2055207618772669
Tuna, E., & Gençöz, T. (2021). Pain perception, distress tolerance and self-compassion in Turkish young adults with and without a history of non-suicidal self-injury. Current psychology, 40, 4143-4155. doi;10.1007/s12144-020-00634-2
Tagliaferri, S. D., Miller, C. T., Owen, P. J., Mitchell, U. H., Brisby, H., Fitzgibbon, B., ... & Belavy, D. L. (2020). Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective. Pain Practice, 20(2), 211-225. doi:10.1111/papr.12846
Varallo, G., Giusti, E. M., Scarpina, F., Cattivelli, R., Capodaglio, P., & Castelnuovo, G. (2020). The association of kinesiophobia and pain catastrophizing with pain-related disability and pain intensity in obesity and chronic lower-back pain. Brain Sciences, 11(1), 11. doi:10.3390%2Fbrainsci11010011
World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. doi:10.1001/jama.2013.281053
Wilson, J. M., Colebaugh, C. A., Flowers, K. M., Meints, S. M., Edwards, R. R., & Schreiber, K. L. (2022). Social support and psychological distress among chronic pain patients: The mediating role of mindfulness. Personality and Individual Differences, 190, 111551. doi:10.1016/j.paid.2022.111551
Zegel, M., Rogers, A. H., Vujanovic, A. A., & Zvolensky, M. J. (2021). Alcohol use problems and opioid misuse and dependence among adults with chronic pain: The role of distress tolerance. Psychology of Addictive Behaviors, 35(1), 42. doi:10.1037/adb0000587

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