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- (De)humanizing metaphors of people in pain and their association with the perceived quality of nurse-patient relationshipPublication . Diniz, Eva; Castro, Paula; Bernardes, Sónia F.Metaphors are central in communication and sense-making processes in health-related contexts. Yet how the metaphors used by health-care-professionals to make sense of their patients and their relations to them are associated to the perceived valence of their clinical encounters is underexplored. Drawing-upon the ABC Model of Dehumanization, this study investigated how the humanizing or dehumanizing metaphors nurses’ use for making sense of their pain patients are associated with how they perceived their relationships with them. Fifty female nurses undertook individual narrative-episodic interviews about easy/difficult cases in pain care. A content analysis classified the metaphors, identifying eight classes reflecting different types of patients (de)humanization. A multiple correspondence analysis extracted patterns of metaphors and their association with the perceived characteristics of the patient-nurse relationship. It showed how these patterns were not associated with patient sex or socioeconomic status (SES) but were related to the perceived valence of the clinical relationship. By uncovering how patient metaphors guide nurses’ sense-making and potentially modulate interactions in clinical encounters, these findings may contribute to improve quality of pain care.
- Social support for functional dependence, activity patterns, and chronic pain outcomes: A cross-lagged mediation panel studyPublication . Bernardes, Sónia F.; Brandão, Tânia; de Matos, Marta Osório; Ferreira-Valente, AlexandraObjective: Received social support undermining engagement in life activities of individuals with chronic pain (e.g., solicitousness, support for functional dependence) is consistently correlated with worse physical functioning, pain severity and disability. Whether such responses lead to worse pain outcomes (operant model of pain) or the latter lead to more supportive responses undermining activity engagement (social communication and empathy models of pain) is unknown, given the lack of crosslagged panel studies. Furthermore, the mediating role of activity patterns in such relationship over time is entirely unclear. This study aimed to bridge these gaps. Methods: This was a three-month prospective study with three waves of data collection (T1-T3; six-week lag in-between), including 130 older adults (71% women; Mage=78.26) with musculoskeletal chronic pain attending day-care centers. At every time point, participants filled out self-report measures of staff social support for functional dependence, activity patterns, physical functioning, pain severity and interference. Scales showed good/very good test-retest reliability (ICC=.74-.96) and internal consistency (all α>.90). Results: Parsimonious crosslagged panel mediation models showed the best fit (χ²/df<2.44; CFI>.96; GFI>.93; RMSEA<.09). Bidirectional effects were found over time, but poorer pain outcomes at T1 (higher pain severity/interference, lower physical functioning) more consistently predicted higher social support for functional dependence than vice versa. Poorer pain outcomes (T1) predicted more avoidance/less overdoing (T3), via increased received support for functional dependence (T2). Conclusion: Further research on the cyclical relationships between the study variables across chronic pain trajectories is needed to harness the power of interpersonal relationships in future self-management interventions.
- Pain-related beliefs, coping, and function: An observational study on the moderating influence of country of originPublication . Ferreira-Valente, Maria Alexandra; Sharma, Saurab; Chan, Joy; Bernardes, Sónia F.; Ribeiro, J.; Jensen, Mark P.Chronic pain is a multidimensional experience and pain treatments targeting psychosocial factors reduce pain and improve function. These treatments often overlook the sociocultural factors that influence pain and the psychological factors associated with function in people with chronic pain. Although preliminary findings suggest that cultural background may influence pain and function via their effects on beliefs and coping, no previous study has directly tested if the country of origin moderates the associations between these psychological factors and pain and function. This study sought to address this knowledge gap. Five hundred sixty-one adults with chronic pain, born and living in the USA (n = 273) or Portugal (n = 288), completed measures of pain, function, pain-related beliefs, and coping. Between-country similarities were found in the endorsement of beliefs related to disability, pain control, and emotion, and in asking for assistance, task persistence, and coping self-statement responses. Portuguese participants reported greater endorsement of harm, medication, solicitude, and medical cure beliefs, more frequent use of relaxation and support seeking, and less frequent use of guarding, resting, and exercising/stretching. In both countries, disability and harm beliefs and guarding responses were associated with worse outcomes; pain control and task persistence were associated with better outcomes. Six country-related small effect-size moderation effects emerged, such that task persistence and guarding are stronger predictors of pain and function in adults from the USA, but pain control, disability, emotion, and medication beliefs are more important in adults from Portugal. Some modifications may be needed when adapting multidisciplinary treatments from one country to another. Perspective: This article examines the similarities and differences in beliefs and coping endorsed by adults with chronic pain from 2 countries, and the potential moderation effects of country on the associations between these variables and pain and function. The findings suggest that some modifications may be needed when culturally customizing psychological pain treatments.