Ext xtre reme me bo body y mo modif ificatio ication n – ne new w in insid sides es in in no noni ninte nterfe rfering ring pai ain Anja Carina Emmerich PhD-Student University Koblenz-Landau Pain & Psychotherapy Research Lab
Where it all began … Nice little Caffe nearby PAIN RESEARCH MEETING 2017 – 18.-19. September Antwerp , Belgium
Theoretical background – non-interfering pain Pain-related interference: “perceived disruption in daily activities, relationships, roles, and employment resulting from pain.” (Barry et al., 2017) prevalence for non-interfering pain: 4-28% (Hairi et al., 2013; Reitsma et al., 2011; Shi et al., 2010; Thomas et al, 2004) lower levels of anxiety, depression, and comorbidity (Jordan et al., 2012) disability paradox (Albrecht & Devlieger, 1999) understudied sample, therefore proposed shift in pain research (Jordan et al., 2019) Resilience (pain): “the ability to restore and sustain living a fulfilling life in the presence of pain.” (Goubert & Trompetter, 2017) Anja Carina Emmerich Pain Research Meeting 2019 3
Theoretical background – resilience Goubert and Trompetter (2017) Figure 1: A resilience approach to chronic pain. 4
Theoretical background: extreme body modification – skin suspension “Suspension is a ritual, ordeal, form of body play, or rite in where a person hangs from flesh hooks put through (normally) temporary piercings .“ (Larratt, 2006) • Been practiced for thousands of years (e.g. Hindu culture or Native Americans) (Laratt, 2006; Stirn, 2003) • Several types of suspension (e.g. suicide, scarecrow, superman, …) (DeBoer et al., 2008) • Duration: few seconds to several hours (DeBoer et al., 2008) Extremely limited pain research on body modification Anja Carina Emmerich Pain Research Meeting 2019 5
Research Questions (1) Which pain coping strategies do suspenders use during a suspension? (2) How do suspenders differ from people suffering from chronic pain in a) pain control? b) pain-related anxiety? c) psychological inflexibility? Anja Carina Emmerich Pain Research Meeting 2019 6
Methods International online survey Measurements Pain Coping strategies (CSQ) Non-suspendees, Suspendees (N = 55) Pain-related anxiety (PASS-20) healthy controls [n = 15 with chronic pain; (N = 42) Psychological inflexibility (PIPS) n = 40 without pain] Chronic pain (N = 34) Self-Compassion (SCS) Depression (PHQ-9) Disability (PDI)* Pain intensity and unpleasantness (NRS)* *only chronic pain Anja Carina Emmerich Pain Research Meeting 2019 7
Results: (1) Coping strategies „Centering myself, conscious breathing, in „Breathing; trying to perceive the pain through the nose, out through the mouth“ as a physical sensation and removing the typical association with pain as a negative experience.“ „It helps to „not control“; to let go, to just accept it. If I fight against „Listen to my chosen music or to the pain, it is not enjoyable.“ nature sounds, if I am outside.“ „Breathing, almost meditation, „Choosing a comfortable environment, distraction from a person you positive and supportive company, and „Breathing, relaxing, love.“ an empathic and experienced practioner reminding myself that I‘m are all important factors in managing safe.“ the pain of suspension.“ Anja Carina Emmerich Pain Research Meeting 2019 8
Results: (1) Coping strategies Breathing Distraction Acceptance Reappraisal (self-statements) Mindfulness Social Support Anja Carina Emmerich Pain Research Meeting 2019 9
Results: (2) Differentiation – Pain Control ** 6 Kruskal-Wallis H (3) = 13.739 ** 5 p = .003 4 3 2 1 0 Suspension Suspension + CP Chronic Pain Control Suspension Suspension + CP Chronic Pain Control *** p < .001; ** p < .01; * p < .05 Anja Carina Emmerich Pain Research Meeting 2019 10
Results: (2) Differentiation – Pain Control ** 8 7 6 5 4 3 2 1 0 Suspension Suspension + CP Suspension General Anja Carina Emmerich Pain Research Meeting 2019 11
Results: (2) Differentiation – Pain-related anxiety 25 Kruskal-Wallis: CA: H(3) = 11.687; 20 p = .009 E: H(3) = 5.876; 15 P = .118 F: H(3) = 14.623; 10 p = .002 5 PA: H(3) = 10.610; p = .014 0 Cognitive Anxiety Escape Fear Physiological Anxiety Suspension Suspension + CP Chronic Pain Control Anja Carina Emmerich Pain Research Meeting 2019 12
Results: (2) Differentiation – Psych. Inflexibility 50 *** Kruskal-Wallis: 45 Avoidance: *** H(3) = 20.140; 40 ** * p < .001 35 30 Defusion: H(3) = 10.259; 25 p = .016 20 15 10 5 0 Avoidance Defusion Suspension Suspension + CP Chronic Pain Control *** p < .001; ** p < .01; * p < .05 Anja Carina Emmerich Pain Research Meeting 2019 13
Conclusions (1) Coping strategies used during suspension: Breathing well proven Acceptance in pain Mindfulness research Distraction Reappraisal/Self-statements Social support Anja Carina Emmerich Pain Research Meeting 2019 14
Conclusions (2) Differentiation: a) Pain control differs between suspenders with and without pain as well as people suffering from chronic pain. b) Cognitive anxiety, fear and physiological anxiety differs between suspenders and people suffering from chronic pain. c) Psychological Inflexibility: avoidance and defusion differs between groups. Anja Carina Emmerich Pain Research Meeting 2019 15
Conclusion: Non-interference/resilience Goubert and Trompetter (2017) Figure 1: A resilience approach to chronic pain. 16
Conclusions Nevertheless, further investigation addressing • Body modification in pain • Resilience • Non-interfering pain is needed. Anja Carina Emmerich Pain Research Meeting 2019 17
Th Thank ank yo you for for yo your r at atte tention! ntion! Anja Carina Emmerich PhD-Student PAIN RESEARCH MEETING 2019 – University Koblenz-Landau 12.-13. September Groot Bijgaarden , Belgium Pain & Psychotherapy Research Lab
References Albrecht & Devlieger, (1999). The disability paradox: high quality of life against all odds. Social Science Medicine, 48, 977-88. Barry, D.T., Pilver Glenn, C.E., Hoff, R.A., & Potenza, M.N. (2017). Pain interference and incident medical disorders in the general population . Pain Medicine, 18, 1209-17. DeBoer, S., Falkner, A., Amundson, T., Armstrong, M., Seaver, M., Joyner, S. & Rapoport, L., (2008). Just hanging around: Questions and answers about body suspensions. Journal of Emergency Nursing, 34 (6), 523-529. Goubert, L. & Trompetter, H. (2017). Towards a science and practice of resilience in the face of pain. European Journal of Pain, 21, 1301-15. Hairi, N.N., Cumming, R.G., Blyth, F.M., Naganathan, V. (2013). Chronic pain, impact of pain and pain severity with physical disability in older people – is there a gender difference? Maturitas, 74, 68-73. Jordan, K.P., Sim, J., Croft, P. & Blyth, F. (2019 ). Pain that does not interfere with daily life – a new focus for population epidemiology and public health? PAIN, 160 (2), 281-285. Jordan, K.P., Sim, J., Moore, A., Bernard, M. & Richardson, J. (2012). Distinctiveness of long-term pain that does not interfere with life: an observational cohort study. European Journal of Pain, 16, 1185-94. Laratt, S. (2006). Suspension: From BME Encyclopedia. Reitsma, M.L:, Tranmer, J.E., Buchanan, D.M. & Vandenkerkhof, E.G. (2011). The prevalence of chronic pain and pain-related interference in the Canadian population from 1994-2008. Chronic Diseases and Injuries in Canada, 31, 157-64. Shi, Y., Hooten, W.M., Roberts, R.O. & Warner, D.O. (2010). Modifiable risk factors for incidence of pain in older adults. PAIN, 151, 366-71. Stirn, A. (2003). Body piercing: medical consequences and psychological motivations . Lancet, 361, 1205-15. Thomas, E., Peat, G., Harris, L., Wilkie, R. & Croft, P.R. (2004). The prevalence of pain and pain interference in a general population of older adults: cross- sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). PAIN, 110, 361-8. Anja Carina Emmerich Pain Research Meeting 2019 19
Open Questions • Other interesting/relevant aspects to look at in results? • Where to publish? • Next steps in research? Anja Carina Emmerich Pain Research Meeting 2019 20
Supplements & further analysis Anja Carina Emmerich PhD-Student PAIN RESEARCH MEETING 2019 – University Koblenz-Landau 12.-13. September Groot Bijgaarden , Belgium Pain & Psychotherapy Research Lab
Common suspensions Anja Carina Emmerich Pain Research Meeting 2019 22
Results: Demographics Suspension (N = 55) Chronic Pain (N = 34) Control (N = 42) Age M (SD) 33.73 (7.646) 37.91 (12.831) 38.81 (16.873) Gender female 50.9 88.2 73.8 male 43.6 11.8 26.2 divers 5.5 0 0 Native tongue (English %) 50.9 47.1 0 Relationship status single 40.0 44.1 26.2 married 10.9 26.5 26.2 steady relationship 29.1 14.7 35.7 divorced 18.2 14.7 7.1 widowed 1.8 0 4.8 Education no degree 16.4 2.9 2.4 secondary school grad. 23.6 26.5 9.5 general qual. For university 29.1 47.1 71.4 other 30.9 23.5 16.7 Anja Carina Emmerich Pain Research Meeting 2019 23
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