A reduction in pain intensity ... associated with improved physical functioning in frustration tolerant... chronic pain patients, 2019, Ribera et al

A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients

Ribera et al,
Frontiers in Psycholology 2019
available for free here

Abstract

Objective: The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation).

Methods: The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female.

Results: Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R2 change = 0.177). This association was found to be moderated by frustration tolerance (β = -0.49, t = -2.80, p = 0.006, R2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41).

Conclusion: The results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain.

 

So people who are healthier tend to be in less chronic pain, and because of this they beat up less psychologists than people who are unhealthy and in severe pain, who have little tolerance for being asked stupid questions?

 

catastrophising or learned experience when will these idiots learn the difference between them.

 

It's a really bad look that so many psychologists and psychology-adjacent medical professionals have a cartoonishly bad understanding of human nature. They seem as inept in applying their knowledge as a tone-deaf and actual-deaf-from-birth person who has never heard music in their life yet feel confident in their superior understanding of music. Or like blind people who have never seen color condescendingly explaining to you that you are not seeing the color correctly.

Medicine needs adult supervision, this is embarrassing and extremely bad.

 

Again and again we are presented with research that shows clearly that psychologists impose their POV onto the people whose issues they are studying. They are very much stuck in the if this was me this is how I would fix it.

They come into the relationship fully blinkered so that they don't even see (to use a metaphor I've used before) the photograph (the person as they present in that moment) they only see some part of it through their blinkered state. When the person before them is a whole movie. You don't need to view the whole movie for this situation but you do need to stay still and listen long enough to get a grip on how this person is not you (the researcher) and has their own unique context and how that impacts how the researcher should start to consider (for a good while) how this makes the others experience of illness not amenable to the fix that the researcher has fixated on.

It also is horrifying to me how many of these fixes seem to be the product of a moment's consideration. If you went to a grade school class and as an exercise asked them to brainstorm some solutions for many of these problems psychology thinks it has answers for I bet the kids would hit on those same solutions after not too long. There is no nuance in any of this. No consideration that there might be more going on than just someone overreacting to something normal.

 

So what is Low Frustration Tolerance:

Doctor's view:
"Frustration tolerance is the ability to withstand obstacles and stressful situations. Decreased frustration tolerance is a common behavior problem of people who have brain injuries. Low frustration tolerance can be a direct result of brain damage as well as a secondary reaction to the lifestyle changes and losses which might accompany a brain injury. Typically conceptualized as an executive functioning impairment, low frustration tolerance is viewed as a problem with self-regulation. Behavioral manifestations include irritability, aggression, lability, and refusal to participate. As with other behavior problems, difficulties with frustration tolerance are often exacerbated by fatigue."
https://link.springer.com/referenceworkentry/10.1007/978-0-387-79948-3_2139

Psychologist view:
"The concept was originally developed by psychologist Albert Ellis who theorized that low frustration tolerance is an evaluative component in dysfunctional and irrational beliefs. His theory of REBT (Rational Emotive Behavior Therapy) proposes that irrational beliefs and the avoidance of stressful situations is the origin of behavioral and emotional problems. As humans, we tend to seek for instant gratification to avoid pain, ignoring the fact that evading a situation now, will make it more problematic later."
https://en.wikipedia.org/wiki/Low_frustration_tolerance


OK, so the latter is only from Wikipedia, but it doesn't really merit further time.

Thanks Trish, for your excellent summary.

 

Apologies folks, I did a Post-and-run on this one. Thanks for those who actually took the time to tease it apart.

As @Trish and others pointed out, they took many bites at the cherry, and got few hits.

They tested:
"demandingness"
"frustration tolerance"
"catastrophizing"
negative thoughts about self

The really bizarre thing is that the one significant result they do present hangs on a particular rather weird multiple regression analysis. Their analysis actually found that frustration tolerance did not affect how much people's physical functioning improved after medical treatment. (yes, that's right, it did not show that!).

All they found that was a significant interaction at a higher level (that the correspondence between changes in pain intensity and changes in physical functioning was slightly stronger for those who were more frustration tolerant... but there was still a correspondence for those who were "intolerant" as well!). This was probably the only interaction effect to come out as significant out of probably more than a dozen or interactions they tried.

I think this picture says it all (and I hope it soon acquires the same S4ME infamy as @arewenearlythereyet's famous tripe photo).

 

This is not just tripe...this is gently steeped and broiled tripe with carefully picked cherry ..tomatoes (couldn’t find a pic of actual,cherries)

 

Every research paper should have an obligatory @Wonko summary at the top. It would make for much more efficient, informative and entertaining reading and maybe, just maybe, some authors would realise the rest of their paper is nonsense.