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      Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review

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          Abstract

          It has been speculated that there is an association between pain area and psychological factors in chronic musculoskeletal pain conditions; however, this relation is not well established.

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          Most cited references 36

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          A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.

          A systematic review of prospective cohort studies in low back pain. To evaluate the evidence implicating psychological factors in the development of chronicity in low back pain. The biopsychosocial model is gaining acceptance in low back pain, and has provided a basis for screening measurements, guidelines and interventions; however, to date, the unique contribution of psychological factors in the transition from an acute presentation to chronicity has not been rigorously assessed. A systematic literature search was followed by the application of three sets of criteria to each study: methodologic quality, quality of measurement of psychological factors, and quality of statistical analysis. Two reviewers blindly coded each study, followed by independent assessment by a statistician. Studies were divided into three environments: primary care settings, pain clinics, and workplace. Twenty-five publications (18 cohorts) included psychological factors at baseline. Six of these met acceptability criteria for methodology, psychological measurement, and statistical analysis. Increased risk of chronicity (persisting symptoms and/or disability) from psychological distress/depressive mood and, to a lesser extent, somatization emerged as the main findings. Acceptable evidence generally was not found for other psychological factors, although weak support emerged for the role of catastrophizing as a coping strategy. Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.
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            Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample.

            Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude of these associations have been biased by the use of select clinical samples. The present study utilized the National Comorbidity Survey [Arch. Gen. Psychiatry 51 (1994) 8-19] Part II data set to investigate the associations between a chronic pain condition (i.e. arthritis) and common mood and anxiety disorders in a sample representative of the general US civilian population. Participants (N=5877) completed the Composite International Diagnostic Interview [World Health Organization (1990)], a structured interview for trained non-clinician interviewers based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association (1987)], and provided self-reports of pain and disability associated with a variety of medical conditions. Significant positive associations were found between chronic pain and individual 12-month mood and anxiety disorders [odds ratios (OR) ranged from 1.92 to 4.27]. The strongest associations were observed with panic disorder (OR=4.27) and post-traumatic stress disorder (OR=3.69). The presence of one psychiatric disorder was not significantly associated with pain-related disability, but the presence of multiple psychiatric disorders was significantly associated with increased disability. The findings of the present study raise the possibility that improved efforts regarding the detection and treatment of anxiety disorders may be required in pain treatment settings.
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              Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art.

              The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.
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                Author and article information

                Journal
                Physiotherapy Theory and Practice
                Physiotherapy Theory and Practice
                Informa UK Limited
                0959-3985
                1532-5040
                March 28 2018
                June 03 2019
                April 16 2018
                June 03 2019
                : 35
                : 6
                : 533-542
                Affiliations
                [1 ] Department of Physiotherapy, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
                [2 ] Postgraduation Progam, Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
                [3 ] Postgraduation Progam in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
                [4 ] Department of Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
                [5 ] Physical Therapy Department, McGill University, Montreal, Canada
                Article
                10.1080/09593985.2018.1455122
                29659315
                © 2019

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