Our group in conjunction with the Pain Clinic and rheumatologists at St. Joseph’s Health Care have developed a large comprehensive 700 patient data base examining the role of psychological factors in pain-related disability in chronic pain and rheumatoid arthritis patients.  We recently published 8 influential peer-review papers looking at the role of personality traits on long term chronic pain disability.  This work has been highlighted by two external professional newsletters, one for musculoskeletal practitioners and the other for psychiatry practitioners, demonstrating yet another example of crosscutting research. It is important research, highlighting the prominent role anxiety and avoidance of psychological issues play in disabling chronic pain and fits well with my treatment program which has long centered on managing the high risk APS highly active, perfectionistic, high standards) patients (i.e., type A individuals) who seem to cope poorly with the activity dampening effect of chronic pain.

 

Personality Trait Measures

  • Acceptance and Action Questionnaire (AAQ) – environmental avoidance
  • Anxiety Sensitivity Index (ASI) – anxiety sensitivity
  • Frost Multidimensional Perfectionism Scale (FMPS) – perfectionism
  • Penn State Worry Questionnaire (PSWQ) – excessive worrying
  • Sexual-Physical Abuse History Questionnaire (SPAHQ)) -sexual abuse
  • Reactions to Relaxation and Arousal Questionnaire (RRAQ) – inability to relax

 

Dependent Outcome Measures

  • Brief Pain Inventory Short Form (BPI-SF)
  • Depression Anxiety Stress Scale Short Form (DASS-SF)
  • Health Assessment Questionnaire Disability Index (HAQ-DI)
  • Pain Anxiety Symptoms Scale –Short Form
  • Pain Catastrophizing Scale (PCS)
  • Pain Disability Index (PDI)
  • 36-Item Short-Form Health Survey

 

Published Articles for Personality and Pain Research

 

High Risk Chronic Pain Patients

 

Article showing a subgroup of chronic pain individuals with high levels of experiential avoidance/anxiety sensitivity may be at risk for greater levels of mood and disability issues compared to those in moderate and low groups. EA was shown to have a greater impact on mood disorders.

Mehta S, Rice D, Janzen S, Serrato J, Getty H, Shapiro AP, Morley-Forster P, Sequeira K, Teasell R.  The long-term role of anxiety sensitivity and experiential avoidance on pain intensity, mood and disability among patients in a specialist pain clinic.  Journal of Pain Research and Management vol. 2016, Article 6954896, 7 pages, 2016. doi:10.1155/2016/6954846.

 

Article identified a high-risk group of individuals with chronic pain whose level of obsessive traits significantly correlated with impaired mood and coping, anxiety sensitivity and experiential avoidance.

Mehta S, Rice D, McIntyre A, Getty H, Speechley M, Sequeira K, Shapiro AP, Morley-Forster P, Teasell R.  Identification and characterization of unique subgroups of chronic pain individuals with dispositional personality traits.  Journal of Pain Research and Management 2016; Article 5187631, 7 pages, 2016. doi.10.115/2016/5187631.

 

Similar High-Risk Patients with Rheumatoid Arthritis

 

Article reported the maladaptive effects of anxiety sensitivity and experiential avoidance may also effect outcomes among those with rheumatoid arthritis with the effects not limited to mood but also related to greater disability and lower quality of life among those with rheumatoid arthritis.

Mehta S, Rice D, Janzen S, Pope J, Harth M, Shapiro A, Teasell R.  Mood, disability, and quality of life among a subgroup of rheumatoid arthritis individuals with experiential avoidance and anxiety sensitivity.  Journal of Pain Research and Management 2016, Article 7241856, 7 pages, 2016.doi:101155/2016/7241856.

 

This study identified a high-risk group of individuals with rheumatoid arthritis whose level of obsessive traits significantly correlated with impaired mood and coping, anxiety sensitivity and experiential avoidance.

Rice D, Mehta S, Pope JE, Harth M, Shapiro A, Teasell R. Dispositional affect in unique subgroups of patients with rheumatoid arthritis.  Journal of Pain Research and Management 2016, Article ID 1024985, 9 pages, 2016. doi:10.1155/2016/1024985.

 

Comparing Role of Personality Factors in Chronic Pain and Rheumatoid Arthritis

 

This study established the importance that personality traits and coping factors have on well-being of individuals with rheumatoid arthritis and chronic pain. In rheumatoid arthritis participants, excessive worrying (PSWQ), anxiety sensitivity (ASI) and pain catastrophizing (PCS; helplessness subscale) were independently associated with increased reports of stress (p<0.001) and explained 29% of the variance in stress scores (p<0.001), after adjusting for age, gender, years of education and average pain intensity. In participants with chronic pain, fear of relaxation (RRAQ), anxiety sensitivity (ASI) and pain catastrophizing (PCS; rumination and helplessness subscales) were independently associated with increased stress scores (p<0.001) and explained 31% of variance in stress after adjusting for age, gender, years of education and average pain intensity.

Rice D, Mehta S, Shapiro A, Pope J, Harth M, Morley-Forster P, Sequeira K, Teasell R.  Psychological distress in outpatients assessed for chronic pain compared to those with rheumatoid arthritis clinic.  Journal of Pain Research and Management vol. 2016, Article 7071907, 7 pages, 2016. doi:10.1155/2016/7071907.

 

Greater levels of psychological distress were found among chronic pain individuals referred to academic pain clinic when compared to rheumatoid arthritis patients referred to academic rheumatology clinic even after controlling for average pain intensity.

 

Rice D, Mehta S, Serrato J, Pope J, Harth J, Sequeira K, Morley-Forster P, Shapiro A, Teasell R.  Stress in patients diagnosed with rheumatoid arthritis compared to chronic pain. Rehabilitation Psychology 2017; 62(4):571-579.

 

Personality Factors and Childhood Sexual Abuse in Chronic Pain Coping

 

Article described model demonstrating the direct and indirect effects of childhood sexual abuse on state and trait psychosocial factors among individuals with chronic pain. Pain anxiety, maladaptive worrying, and pain intensity were the main determinants of pain-related disability. Sexual abuse did not have a direct effect on pain-related disability. However, indirect effects through other psychosocial factors were demonstrated.

Mehta S, Rice D, Shapiro A, Chan A, Sequeira K, Teasell R.  Impact of abuse on adjustment and chronic pain disability: A structural equation model.  Clinical Journal of Pain 2017: 33(8):687-693.

 

High Risk Acquired Brain Injury Patients

 

There exists a subgroup of individuals with ABI that have high levels of AS and EA; this was associated with greater symptoms of anxiety and depression, and poorer QoL. Interventions to address AS and EA may improve mood and QoL in this population.

McIntyre A, Rice D, Janzen S, Mehta S, Harnett A, Caughlin S, Sequeira K, Teasell R. Anxiety, depression and quality of life among subgroups of individuals with acquired brain injury: The role of anxiety sensitivity and experiential avoidance. Neurorehabilitation 2020; 47(1):45-53.

 

The use of passive coping strategies combined with increased EA behaviours among severely depressed individuals with ABI may lead to long-term negative outcomes. Programs that promote problem-based coping and reduce EA behaviours may be beneficial in reducing disability and impaired quality of life associated with depression symptoms in individuals with ABI.

 McIntyre A, Mehta S, Janzen S, Rice D, Harnett A, MacKenzie HM, Van derLaan D, Teasell R.  Coping strategies and personality traits among individuals with brain injury and depressive symptoms. Neurorehabilitation 2020; 47(1):25-34.

 

The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain

McIntyre A, Mehta S, Vanderlaan D, Sequeira K, Loh E, Teasell R. The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain.  Pain Research and Management Volume 2021, Article ID 9946067, 9 pages

https://doi.org/10.1155/2021/9946067.

 

This study examined the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Despite management with recommended nonpharmacologic and pharmacologic treatments, many individuals with chronic pain struggle to try to reestablish their premorbid level of activity and productivity. Individuals in these circumstances may experience high levels of stress and dysphoria when faced with pain-related limitations and may more aggressively pursue treatment for unrelenting chronic pain including opioids.  We were interested in whether the same personality factors (anxiety sensitivity and experiential avoidance) that significantly influenced chronic pain disability and mood are also related to opioid analgesic dosage.  Therefore, the purpose was to evaluate the relationship between opioid dosage and these same problematic personality traits as well as psychosocial variables among individuals with chronic pain stratified by morphine equivalent doses (i.e., 0 mg, 1–89 mg, and 90+ mg MEQ).

 

215 individuals (64.2% female) were recruited from a chronic pain clinic with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1–45).  After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to reports of increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1–89 mg or MEQ 0 mg.  These maladaptive personality traits may help to explain why and how individuals with chronic pain utilize higher doses of opioid analgesics in that these individuals have trouble coping, not so much with the pain intensity, but rather with how the pain is interfering with their lives, i.e. slowing them down and interfering with goals and tasks.  It should come as no surprise that narcotic analgesics are more likely to be used in a higher dose in an attempt to overcome the pain and reestablish a more “normal” lifestyle; these are patients who are going to have trouble coping, experience greater pain interference, a perception of lower quality of life and higher levels of anxiety and depression with chronic pain.