Depression and physical disability in chronic pain: The mediation role of emotional intelligence and acceptance

Emotional intelligence (EI) and acceptance have previously been identified as potential factors in the adjustment to chronic pain (CP). This study examined the associations between CP experiences, depression, and physical disability. It further investigated the mediating effect of EI and acceptance in the relationship between CP experiences, depression, and physical disability and how this changes with the duration of the CP. Method: A cross-sectional design, employing validated questionnaires, was used to measure pain experience, physical disability, depression, EI, and acceptance in 133 CP patients. Results: All variables were found to be significantly associated in theoretically predicted ways. The relationship between CP experiences and depression was mediated by both factors, as high EI and acceptance promoted a decreased influence of pain on depression. By contrast, the relationship between CP experiences and physical disability was mediated by acceptance, but not by EI. Further, the temporal stability analysis of this mediation model showed that long-term CP patients are better able to make use of these factors. Conclusions: The relationship between the experience of pain and depression or physical disability seems to be significantly mediated by factors such as EI and acceptance. This study lends further support to the development of more encompassing models that take both control and non-control variables into account when conceptualising the adjustment to CP. Theoretical and clinical implications are discussed.

Open-label placebo treatment in chronic low back pain: A randomized controlled trial

This randomized controlled trial was performed to investigate whether placebo effects in chronic low back pain could be harnessed ethically by adding open-label placebo (OLP) treatment to treatment as usual (TAU) for 3 weeks. Pain severity was assessed on three 0- to 10-point Numeric Rating Scales, scoring maximum pain, minimum pain, and usual pain, and a composite, primary outcome, total pain score. Our other primary outcome was back-related dysfunction, assessed on the Roland-Morris Disability Questionnaire. In an exploratory follow-up, participants on TAU received placebo pills for 3 additional weeks. We randomized 97 adults reporting persistent low back pain for more than 3 months' duration and diagnosed by a board-certified pain specialist. Eighty-three adults completed the trial. Compared to TAU, OLP elicited greater pain reduction on each of the three 0- to 10-point Numeric Rating Scales and on the 0- to 10-point composite pain scale (P < 0.001), with moderate to large effect sizes. Pain reduction on the composite Numeric Rating Scales was 1.5 (95% confidence interval: 1.0-2.0) in the OLP group and 0.2 (-0.3 to 0.8) in the TAU group. Open-label placebo treatment also reduced disability compared to TAU (P < 0.001), with a large effect size. Improvement in disability scores was 2.9 (1.7-4.0) in the OLP group and 0.0 (-1.1 to 1.2) in the TAU group. After being switched to OLP, the TAU group showed significant reductions in both pain (1.5, 0.8-2.3) and disability (3.4, 2.2-4.5). Our findings suggest that OLP pills presented in a positive context may be helpful in chronic low back pain.