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Published in: Journal of Behavioral Medicine 4/2017

Open Access 01-08-2017

The relationship between pain, disability, guilt and acceptance in low back pain: a mediation analysis

Published in: Journal of Behavioral Medicine | Issue 4/2017

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Abstract

Pain-related guilt is a common yet unexplored psychological factor in low back pain (LBP). It has recently been linked to greater depression, anxiety and disability in LBP, hence an understanding of how it can be managed in the presence of pain and disability is necessary. Since acceptance of pain has been shown to be associated with improved outcomes in chronic pain, we examined whether it might also help reduce guilt in people with LBP. To this end, a series of mediation analyses were conducted on data from 287 patients with chronic LBP, in which acceptance of pain was tested as a mediator of the relationship between pain/disability and guilt. Results showed that acceptance of pain reduced the impact of pain/disability on pain-related guilt in all mediation analyses. Pain-related guilt might be a potential target for acceptance based interventions, thus this relationship should be further tested using longitudinal designs.
Literature
go back to reference Bedford, O., & Hwang, K. K. (2003). Guilt and shame in Chinese culture: A cross-cultural framework from the perspective of morality and identity. Journal for the Theory of Social Behaviour, 33, 127. doi:10.1111/1468-5914.00210 CrossRef Bedford, O., & Hwang, K. K. (2003). Guilt and shame in Chinese culture: A cross-cultural framework from the perspective of morality and identity. Journal for the Theory of Social Behaviour, 33, 127. doi:10.​1111/​1468-5914.​00210 CrossRef
go back to reference Bennett, D. A. (2001). How can I deal with missing data in my study? Australian and New Zealand Journal of Public Health, 25, 464–469.CrossRefPubMed Bennett, D. A. (2001). How can I deal with missing data in my study? Australian and New Zealand Journal of Public Health, 25, 464–469.CrossRefPubMed
go back to reference Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: global use of the brief pain inventory. Annals of the Academy of Medicine, Singapore, 23, 129–138.PubMed Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: global use of the brief pain inventory. Annals of the Academy of Medicine, Singapore, 23, 129–138.PubMed
go back to reference Field, A. P. (2013). Discovering statistics using IBM SPSS statistics : and sex and drugs and rock ‘n’ roll (4th ed.). Los Angeles: Sage. Field, A. P. (2013). Discovering statistics using IBM SPSS statistics : and sex and drugs and rock ‘n’ roll (4th ed.). Los Angeles: Sage.
go back to reference Harris, S., Morley, S., & Barton, S. B. (2003). Role loss and emotional adjustment in chronic pain. Pain, 105, 363–370.CrossRefPubMed Harris, S., Morley, S., & Barton, S. B. (2003). Role loss and emotional adjustment in chronic pain. Pain, 105, 363–370.CrossRefPubMed
go back to reference Hayes, A. (2013). Introduction to mediation, moderation and conditional process analysis. New York: Guilford Press. Hayes, A. (2013). Introduction to mediation, moderation and conditional process analysis. New York: Guilford Press.
go back to reference Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy : an experiential approach to behavior change. New York: Guilford Press. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy : an experiential approach to behavior change. New York: Guilford Press.
go back to reference IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 21.0.. IBM Corp: Armonk. IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 21.0.. IBM Corp: Armonk.
go back to reference Kubany, E. S., & Watson, S. B. (2003). Guilt: Elaboration of a multidimensional model. Psychological Record, 53, 51–90. Kubany, E. S., & Watson, S. B. (2003). Guilt: Elaboration of a multidimensional model. Psychological Record, 53, 51–90.
go back to reference Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2224–2260.CrossRefPubMedPubMedCentral Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2224–2260.CrossRefPubMedPubMedCentral
go back to reference McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27.CrossRefPubMed McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27.CrossRefPubMed
go back to reference McCracken, L. M., & Gutiérrez-Martínez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274. doi:10.1016/j.brat.2011.02.004 McCracken, L. M., & Gutiérrez-Martínez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274. doi:10.​1016/​j.​brat.​2011.​02.​004
go back to reference McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain, 80, 283–289.CrossRefPubMed McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain, 80, 283–289.CrossRefPubMed
go back to reference McCracken, L. M., & Vowles, K. E. (2006). Acceptance of chronic pain. Current Pain and Headache Reports, 10, 90–94.CrossRefPubMed McCracken, L. M., & Vowles, K. E. (2006). Acceptance of chronic pain. Current Pain and Headache Reports, 10, 90–94.CrossRefPubMed
go back to reference McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain model, process, and progress. American Psychologist, 69, 178–187. doi:10.1037/a0035623 CrossRefPubMed McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain model, process, and progress. American Psychologist, 69, 178–187. doi:10.​1037/​a0035623 CrossRefPubMed
go back to reference Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16, 93–115. doi:10.1037/a0022658 CrossRefPubMed Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16, 93–115. doi:10.​1037/​a0022658 CrossRefPubMed
go back to reference Rovner, G. S., Arestedt, K., Gerdle, B., Borsbo, B., & McCracken, L. M. (2014). Psychometric properties of the 8-item chronic pain acceptance questionnaire (Cpaq-8) in a Swedish chronic pain cohort. Journal of Rehabilitation Medicine, 46, 73–80. doi:10.2340/16501977-1227 CrossRefPubMed Rovner, G. S., Arestedt, K., Gerdle, B., Borsbo, B., & McCracken, L. M. (2014). Psychometric properties of the 8-item chronic pain acceptance questionnaire (Cpaq-8) in a Swedish chronic pain cohort. Journal of Rehabilitation Medicine, 46, 73–80. doi:10.​2340/​16501977-1227 CrossRefPubMed
go back to reference Serbic, D., & Pincus, T. (2013). Chasing the ghosts: The impact of diagnostic labelling on self-management and pain-related guilt in chronic low back pain patients. Journal of Pain Management, 6, 25–35. Serbic, D., & Pincus, T. (2013). Chasing the ghosts: The impact of diagnostic labelling on self-management and pain-related guilt in chronic low back pain patients. Journal of Pain Management, 6, 25–35.
go back to reference Stangor, C. (1998). Research methods for the behavioral sciences. Boston: Houghton Mifflin. Stangor, C. (1998). Research methods for the behavioral sciences. Boston: Houghton Mifflin.
go back to reference Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., et al. (2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain, 106, 65–72. doi:10.1016/S0304-3959(03)00291-4 CrossRefPubMed Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., et al. (2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain, 106, 65–72. doi:10.​1016/​S0304-3959(03)00291-4 CrossRefPubMed
go back to reference Waddell, G. (2004). The back pain revolution (2nd ed.). Edinburgh: Churchill Livingstone. Waddell, G. (2004). The back pain revolution (2nd ed.). Edinburgh: Churchill Livingstone.
Metadata
Title
The relationship between pain, disability, guilt and acceptance in low back pain: a mediation analysis
Publication date
01-08-2017
Published in
Journal of Behavioral Medicine / Issue 4/2017
Print ISSN: 0160-7715
Electronic ISSN: 1573-3521
DOI
https://doi.org/10.1007/s10865-017-9826-2

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