Pain Med. 2023 Aug 29:pnad119. doi: 10.1093/pm/pnad119. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state such as distress.

PURPOSE: This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and if psychological distress scores function as a mediation path.

METHODS: During routine visits to a single orthopedic clinic in East Los Angeles, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool, UPAT), mindful attention (Five-Facet Mindfulness Questionnaire, FFMQ) and psychological distress (Depression, Anxiety, and Stress Scale, DASS). We used Pearson correlation to examine relationships between FFMQ and UPAT scores, and mediation analyses to test indirect effects of DASS scores as a mediation path.

RESULTS: The average age of the sample was 54 years (range 18-98), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were shoulder (72%), elbow (21%) and clavicle or wrist (7%). 91% reported mild or greater pain in the past two weeks (M = 4.2 ± 2.5, range 0-10) and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (β = 0.-22, p < 0.01) mediated through DASS scores. DASS subscale scores for depression (β=-0.10, p = 0.02) and stress (β=-0.08, p = 0.04) but not anxiety (β=-0.03, p = 0.33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores.

CONCLUSIONS: We find statistical support to suggest distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention may counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

PMID:37643631 | DOI:10.1093/pm/pnad119