Personalized behavior management as a replacement for medications for pain control and mood regulation

Abstract

A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a 'resource matching' hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual ('out-of-touch-with-reality') behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational ('in-touch-with-reality') behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual 'resource' of the pain experience from its 'feeding' to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.

Figure 1

A schema of main direct, interaction, and indirect (mediation and moderated mediation) effects indicated in the study and associated with experienced intensity of occasional acute pain incidences in the healthy group (assessed retrospectively) and chronic pain severity along with drug use in the FMS group. Signs indicate direction of the effects. Experience of acute pain intensity and chronic pain severity were assessed by general and specific to disease scales and inventories such as McGill Pain Questionnaire, Visual Analogue Scale, Body Pain Scale of the Short-Form Health Survey, the Fibromyalgia Impact Questionnaire, analgesics, antidepressants and anxiolytics use. Catastrophizing and situational cognitive distraction were assessed by Coping Strategies Questionnaire. Depressive rumination was assessed by its proxy measure—depression severity obtained from the Beck Depression Inventory. Trait Anxiety was assessed by the State-Trait Anxiety Inventory. Habitual cognitive distraction strategy, capabilities for differentiation, and description of emotions were assessed by the Externally Oriented Thinking, the Difficulty Identifying Feelings, and the Difficulty Describing Feelings subscales of the Toronto Alexithymia Scale, respectively.

Figure 2

A schema of situational and habitual cognitive distraction mechanisms redirecting attention from the pain experience with a high psychotic-like or high affective component to other dominant, real or unreal events in individuals with tendencies to concentrate attention on internal or external objects, respectively, thus reducing pain severity and need for pain medication.