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      Pain behavior mediates the relationship between perceived injustice and opioid prescription for chronic pain: a Collaborative Health Outcomes Information Registry study

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          Abstract

          Background and purpose

          Perceived injustice has been defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame and a sense of unfairness. Recent findings have identified perceived injustice as an important risk factor for pain-related outcomes. Studies suggest that perceived injustice is associated with opioid prescription in patients with pain conditions. However, the mechanisms by which perceived injustice is linked to opioid prescription are not well understood. The primary objective of this study was to examine the potential mediating roles of pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription among patients with chronic pain.

          Methods

          This cross-sectional study used a sample of 344 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of perceived injustice, pain intensity, depressive symptoms, pain behavior and opioid prescription. Bootstrapped multiple mediation analyses were used to examine the mediating role of patients’ pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription.

          Results

          Consistent with previous research, we found a significant association between perceived injustice and opioid prescription. Interestingly, results revealed that pain behavior was the only variable that mediated the association between perceived injustice and opioid prescription.

          Conclusion

          This study was the first to examine the mechanisms by which perceived injustice is associated with opioid prescription in patients with chronic pain. We found that pain behavior, rather than pain intensity and depressive symptoms, mediated the association between perceived injustice and opioid prescription. Future research in this area should employ a longitudinal research design in order to arrive at clearer causal conclusions about the relationships between pain behavior, perceived injustice and opioid prescription.

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          Most cited references 51

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          SPSS and SAS procedures for estimating indirect effects in simple mediation models.

          Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.
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            Epidemiology and treatment of depression in patients with chronic medical illness

            There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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              A theoretical framework for understanding self-report and observational measures of pain: a communications model.

              Self-report and observational measures of pain are examined from the perspective of a model of human communication. This model examines the experience of pain as affected by intrapersonal and contextual factors, the process whereby it is encoded into expressive behaviour, and the process of decoding by observers prior to their engaging in action. Self-report measures primarily capture expressive pain behaviour that is under the control of higher mental processes, whereas observational measures capture behaviour that is less subject to voluntary control and more automatic. Automatic expressive behaviours are subject to less purposeful distortion than are behaviours dependent upon higher mental processes. Consequently, observational measures can be used and have clinical utility as indices of pain when self-report is not available, for example, in infants, young children, people with intellectual disabilities or brain damage, and seniors with dementia. These measures are also useful when the credibility of self-report is questioned and even when credible self-report is available. However, automatic behaviours may be more difficult for observers to decode. The model outlined herein takes into account the role of various human developmental stages in pain experience and expression and in understanding the utility of self-report and observational measures. We conclude that both observational and self-report measures are essential in the assessment of pain because of the unique information that each type contributes.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                07 March 2017
                : 10
                : 557-566
                Affiliations
                [1 ]Department of Psychology
                [2 ]Faculty of Dentistry
                [3 ]Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada
                [4 ]Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
                [5 ]Faculty of Health and Behavioural Sciences, University of Queensland, Herston, QLD, Australia
                Author notes
                Correspondence: Junie S Carriere, Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC H3A 1B1, Canada, Tel +1 514 398 6127, Fax +1 514 398 4896, Email junie.carriere@ 123456mail.mcgill.ca
                Article
                jpr-10-557
                10.2147/JPR.S128184
                5349702
                © 2017 Carriere et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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