Intolerance of Uncertainty, Anxiety Sensitivity and Health Distress Predicted Self-Reported and Clinician Rated Pain During Upper Endoscopy Though Pain Catastrophizing

CONTROL ID: 2910419 CURRENT CATEGORY: Clinical Practice CURRENT SUBCATEGORY/DESCRIPTORS: Patient Reported Outcomes: IBD, GERD, Functional Disorders, Other PRESENTATION TYPE: AGA Institute Oral or Poster PRESENTER: Rossella Palma PRESENTER (EMAIL ONLY): rossellapalma89@gmail.com Abstract TITLE: INTOLERANCE OF UNCERTAINTY, ANXIETY SENSITIVITY AND HEALTH DISTRESS PREDICTED SELFREPORTED AND CLINICIAN RATED PAIN DURING UPPER ENDOSCOPY THOUGH PAIN CATASTROPHIZING AUTHORS (LAST NAME, FIRST NAME): Palma, Rossella1 ; Pontone, Stefano1 ; Panetta, Cristina1 ; La Spina, Gaia3 ; Foglia, Anastasia3 ; Raniolo, Marilena1 ; Tomai, Manuela2 ; Lauriola, Marco3 INSTITUTIONS (ALL): 1. Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy. 2. Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Rome, Italy. 3. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy. ABSTRACT BODY: Abstract Body: Background: Endoscopic examination is stressful for patients, producing anxiety and fear, which increase pain and discomfort. According to the fear-anxiety-avoidance model1 pain perception is affected by catastrophizing thoughts. Other dispositions influence PC and pain perceptions. Intolerance of Uncertainty (IU) has been recognized as related to chronic pain and anxiety2 . Anxiety Sensitivity (AS) was associated with PC, chronic pain and accounted for the relationship of pain with anxious arousal3,4 . Methods: 39 patients referred for upper endoscopy at the Endoscopy Unit of SAPIENZA University of Rome participated in this study. Before endoscopy, patients completed the following scales: Anxiety Sensitivity Index (ASI); Intolerance of Uncertainty Index (IUI); Hospital Anxiety and Depression Scale (HADS), Penn State Worry Questionnaire (WQ). During endoscopy pain was rated by the Pain Assessment in Advanced Dementia Scale (PAINAD). After endoscopy, patients reported about pain during the procedure (SR-PAIN). The Pain Catastrophizing Scale (PCS) was also administered to assesses patient’s aptitude for catastrophic pain. Pain ratings were blinded as to psychological test results. The study was approved by the local ethical committee. Results: A non parametric mediation model for small samples (PLS-SEM, Fig. 1) was fitted to the data (R2 = .57 and .25 for SR-Pain and PAINAD, respectively). IU was associated with WQ, AS, and HADS. In turn, both AS and HADS predicted PC. In turn, PC was associated with SR-PAIN and with PAINAD. Indirect effects of IU on SR-PAIN and PAINAD were both significant. HADS but not WQ predicted SR-PAIN. AS was predictive of both pain variables and mediated the effect of IU (Tab. 1). Conclusion: IU affected pain and discomfort through increasing anxiety sensitivity, health distress, and pain catastrophizing. This model was consistent with the fear-anxiety-avoidance model1 and with recent evidence showing that affective dispositions affect one’s experience of pain2–4. This is the first study showing a relation between IU and AS with painduring a medical procedure. 1. Asmundson G, Norton P, Vlaeyen J. Fear-avoidance models of chronic pain: An overview. In: Press OU, ed. Understanding and Treating Fear of Pain. ; 2004:26-43. 2. Fischerauer SF, Talaei-Khoei M, Vissers FL, et al. Pain anxiety differentially mediates the association of pain intensity with function depending on level of intolerance of uncertainty. J Psychiatr Res. 2018;97(0):30-37. 3. Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, et al. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain. Int J Behav Med. 2017;24(2):239-248. 4. Zvolensky MJ, Bakhshaie J, Paulus DJ, et al. Exploring the Mechanism Underlying the Association Between Pain Intensity and Mental Health Among Latinos. J Nerv Ment Dis. 2017;205(4):300-307. TABLE: Note: The PDF table below is only an approximation of the HTML content and may not match formatting exactly. Tab 1. Indirect effects for independent variables in Partial Least Squares Structural Equation Modeling (PLS-SEM). Estimates are based on 5000 bootstrap resampings. Indirect Effect Original Sample Mean Bootstrap Samples Mean Bootstrap Samples SD t-value p-level WQ ---> SR Pain 0.123 0.121 0.133 0.929 0.353 AS ---> SR Pain 0.331 0.346 0.125 2.644 0.008 HADS ---> SR Pain 0.245 0.240 0.125 1.967 0.049 IU ---> PCS 0.416 0.445 0.116 3.574 0.000 WQ ---> PAINAD 0.081 0.088 0.099 0.816 0.415 AS ---> PAINAD 0.216 0.244 0.109 1.988 0.047 HADS ---> PAINAD 0.160 0.167 0.093 1.727 0.084 IU ---> PAINAD 0.205 0.246 0.102 2.010 0.045 IU ---> SR PAIN 0.314 0.342 0.093 3.359 0.001 WQ = Worry Questionnaire PSWQ-A SR Pain = Patient's Self-Reported Pain AS = Anxiety Sensitivity Index HADS = Hospital Anxiety and Depression Scale IU = Intolerance of Uncertainty PCS = Pain Catastrophizing Scale PAINAD = Physcian Rated Pain by Pain Assessment in Advanced Dementia Fig. 1. Partial Least Squares Structural Equations Modeling (PLS-SEM). Model fitted to upper endoscopy patient data. Blue circles represent latent variables. Yellow rectangles represent empirical indicators. Estimates are standardized regression path coefficients. Bold arrows connecting latent variables represent significant effects (p < .05).