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Latest paper from Buchwald team: Reported Pain and Fatigue Behaviors Mediate the Relationship etc.

Dolphin

Senior Member
Messages
17,567
(Not a recommendation)

Reported Pain and Fatigue Behaviors Mediate the Relationship Between Catastrophizing and Perceptions of Solicitousness in Patients with Chronic Fatigue

Joan M. Romano, Ivan P. Molton, Kevin N. Alschuler, Karen B. Schmaling, Dedra S. Buchwald
1Mark P. Jensen, PhD, Department of Rehabilitation Medicine, University of Washington, Harborview Medical Cente, 325 Ninth Avenue, Seattle, WA 98104-2499.

DOI: http://dx.doi.org/10.1016/j.jpain.2015.10.020
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Article Info
Publication History
Published Online:November 29, 2015Accepted:October 30, 2015Received in revised form:October 13, 2015Received:June 4, 2015

Highlights


  • •Communal coping and behavioral models of catastrophizing make different predictions
  • •This study tested mediational paths from these models in chronic fatigue patients
  • •Catastrophizing’s effects on solicitousness occurred through pain/fatigue behavior
  • •Solicitousness did not mediate the path of catastrophizing to pain/fatigue behavior
  • •Results were more consistent with a cognitive behavioral than communal coping model


Abstract

Catastrophizing is associated with negative outcomes in chronic pain and illness.

The Communal Coping Model (CCM) and cognitive-behavioral (CB) formulations provide differing accounts of the function of catastrophizing in these contexts.

The present study examined predictions from CCM and CB theoretical models in a sample of 116 patients with chronic fatigue to test:

(1) whether patient-reported solicitous responses from significant others mediate the relationship of catastrophizing with patient-reported pain and fatigue behaviors, as predicted by the CCM,

and

(2) whether pain and fatigue behaviors mediate the relationship of catastrophizing with solicitous responses, consistent with a CB model.

This work is a secondary data analysis that examined the strength of the indirect (i.e., mediating) effects among study variables.

Consistent with CB models, pain and fatigue behaviors were associated with both catastrophizing and solicitous responses, and there was a significant indirect effect of catastrophizing on solicitous responses through pain and fatigue behaviors.

Results were inconsistent with the CCM; catastrophizing was not significantly associated with solicitous responses, nor did solicitous responses mediate the relationship between catastrophizing and pain/fatigue behaviors.

Findings highlight the importance of behavioral expressions of pain and fatigue in understanding the relationship of catastrophizing to solicitous responses in chronic fatigue.

Perspective

This study of chronic fatigue patients tested cognitive-behavioral and communal coping models of catastrophizing, pain and fatigue behaviors, and solicitous responses by significant others.

Results were more consistent with CB formulations, highlighting the importance of behavioral expressions of pain and fatigue in understanding the relationship of catastrophizing to solicitous responses.


Keywords:
Catastrophizing, chronic fatigue, solicitousness, partner responses, pain and fatigue behavior
 
Messages
13,774
Heads I win, tails you lose?

Would have to read the full paper, but it doesn't sound as if their results necessarily supported a cognitive-behavioural model for CFS either.
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
Who would want to participate in these sorts of studies, unless they are patients that 'believe' in the psychological model?

So we have a biased sample, and associations between a few different questionnaires, with no objective evidence of such behaviour. Sometimes what you think you are measuring might not be what you are actually measuring...

Buchwald et al. said:
Methods

Participants

Participants in the current study were originally recruited for an investigation of illness
behaviors and their relationship to partner responses.[35] The current study represents a
secondary data analysis of this sample.
[...]
Briefly, in that study 117 participants were recruited from patients aged 18-70 years who were evaluated at a referral clinic for CF and met the case definition for CFS (n=111) or idiopathic CF (n=6) established by the Centers for Disease Control and Prevention.

Buchwald et al. said:
Questionnaire Measures

Pain intensity. Average pain intensity over the previous two weeks, ranging from 0 (no pain) to 10 (pain as intense as it could be), was assessed by using an 11-point scale.

Fatigue severity. Fatigue at the time of evaluation was measured by using the fatigue severity rating from the Multidimensional Assessment of Fatigue,[4; 55] which is elicited by a single item: "How severe is the fatigue you are experiencing right now?" Responses range from 1 (mild) to 10 (severe).

Pain and fatigue behaviors. A modified form of the Pain Behavior Checklist (PBC)[24; 50] was used to assess pain and fatigue behaviors. The PBC consists of 17 items that assess pain behavior in four categories: distorted ambulation, facial or audible expressions, affective distress, and help-seeking, and has demonstrated good reliability and validity.[24; 36; 50] We modified the PBC by adding the word “fatigue” to items that mentioned pain.

Significant other responses. The Multidimensional Pain Inventory (MPI)[25] Spouse Response scale measures common SO responses (solicitous, punishing, and distracting) to patient pain behaviors.

Catastrophizing. The Pain Catastrophizing Scale (PCS)[45] measures dimensions of catastrophic thinking, including rumination, magnification, and helplessness. For study purposes, participants were directed to complete the measure with regard to their symptoms of CFS or CF, including pain, fatigue, and weakness.
 
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jimells

Senior Member
Messages
2,009
Location
northern Maine
Buchwald said:
The PBC consists of 17 items ... and has demonstrated good reliability and validity. We modified the PBC by adding the word “fatigue” to items that mentioned pain.

Is it still valid and reliable after modifying it? When I used to write software for a living, if I added an additional option for a user to select, I would have to, you know, test it.
 

dannybex

Senior Member
Messages
3,561
Location
Seattle
Dedra Buchwald is the Simon Wessley of the US.

If I had the energy I'd start a website where people could tell their horror stories regarding their (usually brief) experiences involving the Harborview CFS Clinic that she's headed for over 20 years here in Washington State.

In the 17 years I've been sick, and the 8 years I attended local CFS support group meetings, I've never heard of even ONE good experience coming from that place. Patients wait six months to get in, have to fill out probably 50 pages of questionnaire forms (no doubt for Buchwald's $$$Studies), then once they finally get in, basically no treatment is offered except 'go home and rest'.

It's quite telling as well, that when Dr. David Bell came to speak here last June, that Buchwald refused the invitation to attend.
 
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ballard

Senior Member
Messages
152
I agree with Dan. As far as I can tell, the clinic mainly collects data for Buchwald's psychologically oriented research. There is no appropriate treatment for ME/CFS at the Harbourview Clinic. I'm not even sure that Dr. Buchwald shows up at the clinic anymore. The last time I went (and it's definitely the last time), I was seen by a perfunctory physician's assistant.

I really don't understand why the U. of W. continues to associate itself with the Harbourview Clinic. Maybe it's because the U.of W. Medical School has recently relegated ME/CFS to the "Mind, Brain and Behavior" block of education for incoming medical students.

It's a shame, really.
 

dannybex

Senior Member
Messages
3,561
Location
Seattle
I really don't understand why the U. of W. continues to associate itself with the Harbourview Clinic. Maybe it's because the U.of W. Medical School has recently relegated ME/CFS to the "Mind, Brain and Behavior" block of education for incoming medical students.

Hi there @ballard :)

Actually, I think it's the other way around, which is even worse; I have a feeling the U.W. Medical School relegated ME/CFS to the 'Mind, Brain and Behavior' department precisely because of the influence of 20-25 years of Buchwald's self-serving "work".

And the fact that she hasn't seen patients in years is IMO a testament to her cowardice. Sorry, that just slipped out.
 

Kati

Patient in training
Messages
5,497
Buchwald is part of the MAPP collaborative for pelvic pain. She has been working hard for diseases such as pelvic chronic pain and interstitial cystitis remain in the psychological domain.
 
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SOC

Senior Member
Messages
7,849
Buchwaldmis part of the MAPP collaborative for pelvic pain. She has been working hard for diseases such as pelvic chronic pain and interstitial cystitis remain in the psychological domain.
It's really hard not to wish these illnesses on people like Buchwald and SW. I can't really, because no one deserves ME or any chronic pain condition, but if anyone did deserve this kind of suffering, psychogenic theory pushers would be on the list.
 

Sean

Senior Member
Messages
7,378
Perfectly legitimate to wish it on them for as long as it takes for them to understand how wrong they are.

I have been wishing it for years, and the gods have not struck me down yet. :p

Mind you, they haven't granted my wish yet either. Maybe I haven't sacrificed enough chickens. :rolleyes:

:whistle:
 
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