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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

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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

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Where it all began …

PAIN RESEARCH MEETING 2017 – 18.-19. September Antwerp, Belgium Nice little Caffe nearby

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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

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Theoretical background – resilience

4 Goubert and Trompetter (2017) Figure 1: A resilience approach to chronic pain.

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Theoretical background:

extreme body modification – skin suspension

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

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“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)

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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?

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Methods

International online survey

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Measurements Pain Coping strategies (CSQ) Pain-related anxiety (PASS-20) Psychological inflexibility (PIPS) Self-Compassion (SCS) Depression (PHQ-9) Disability (PDI)* Pain intensity and unpleasantness (NRS)* Suspendees (N = 55)

[n = 15 with chronic pain; n = 40 without pain]

Chronic pain (N = 34) Non-suspendees, healthy controls (N = 42)

*only chronic pain

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Results: (1) Coping strategies

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„Centering myself, conscious breathing, in through the nose, out through the mouth“ „Breathing; trying to perceive the pain 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 the pain, it is not enjoyable.“ „Listen to my chosen music or to nature sounds, if I am outside.“ „Breathing, almost meditation, distraction from a person you love.“ „Choosing a comfortable environment, positive and supportive company, and an empathic and experienced practioner are all important factors in managing the pain of suspension.“ „Breathing, relaxing, reminding myself that I‘m safe.“

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Results: (1) Coping strategies

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Reappraisal (self-statements) Breathing Mindfulness Acceptance Distraction Social Support

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Results: (2) Differentiation – Pain Control

Anja Carina Emmerich Pain Research Meeting 2019 10 1 2 3 4 5 6 Suspension Suspension + CP Chronic Pain Control Suspension Suspension + CP Chronic Pain Control

Kruskal-Wallis H (3) = 13.739 p = .003 ** **

*** p < .001; ** p < .01; * p < .05

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Results: (2) Differentiation – Pain Control

Anja Carina Emmerich Pain Research Meeting 2019 11 1 2 3 4 5 6 7 8 Suspension Suspension + CP Suspension General

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Results: (2) Differentiation – Pain-related anxiety

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Cognitive Anxiety Escape Fear Physiological Anxiety

Suspension Suspension + CP Chronic Pain Control

Kruskal-Wallis: CA: H(3) = 11.687; p = .009 E: H(3) = 5.876; P = .118 F: H(3) = 14.623; p = .002 PA: H(3) = 10.610; p = .014

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Results: (2) Differentiation – Psych. Inflexibility

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Kruskal-Wallis: Avoidance: H(3) = 20.140; p < .001 Defusion: H(3) = 10.259; p = .016

5 10 15 20 25 30 35 40 45 50 Avoidance Defusion Suspension Suspension + CP Chronic Pain Control

*** p < .001; ** p < .01; * p < .05

*** *** * **

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Conclusions

(1) Coping strategies used during suspension:

Breathing
Acceptance
Mindfulness
Distraction
Reappraisal/Self-statements
Social support

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well proven in pain research

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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.

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Conclusion: Non-interference/resilience

16 Goubert and Trompetter (2017) Figure 1: A resilience approach to chronic pain.

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Conclusions

Nevertheless, further investigation addressing

Body modification in pain
Resilience
Non-interfering pain

is needed.

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PAIN RESEARCH MEETING 2019 – 12.-13. September Groot Bijgaarden, Belgium

Th Thank ank yo you for for yo your r at atte tention! ntion!

Anja Carina Emmerich PhD-Student University Koblenz-Landau Pain & Psychotherapy Research Lab

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References

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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.

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Open Questions

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Other interesting/relevant aspects to look at in results?
Where to publish?
Next steps in research?

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PAIN RESEARCH MEETING 2019 – 12.-13. September Groot Bijgaarden, Belgium

Supplements & further analysis

Anja Carina Emmerich PhD-Student University Koblenz-Landau Pain & Psychotherapy Research Lab

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Common suspensions

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Results: Demographics

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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 male divers 50.9 43.6 5.5 88.2 11.8 73.8 26.2 Native tongue (English %) 50.9 47.1 Relationship status single married steady relationship divorced widowed 40.0 10.9 29.1 18.2 1.8 44.1 26.5 14.7 14.7 26.2 26.2 35.7 7.1 4.8 Education no degree secondary school grad. general qual. For university

ther

16.4 23.6 29.1 30.9 2.9 26.5 47.1 23.5 2.4 9.5 71.4 16.7

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Results: (A) Suspension-related fear

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„The pain, that the skin can rip, that I will not be able to myself up in the air, that I can‘t let go of the pain mentally. “ „Passing out or going into shock and needing to go to the hospital.“ „I‘m scared of the pain. For me pain is always quite unpleasant, but some kind of a border that need to be crossed to feel the power of the ritual. It‘s basically not about the pain, but what the pain does to you.“ „The pain, not being able to get up.“ „The pain being unbearable.“

10 20 30 40 50 60 No, I'm not scared Yes, I'm scared.

Fear of pain (%)

No, I'm not scared Yes, I'm scared.

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Results: (B) Differentiation – Depression PHQ-9

Anja Carina Emmerich Pain Research Meeting 2019 25 5 10 15 20 25 Suspension Suspension + CP Chronic Pain Control

PHQ-9

Suspension Suspension + CP Chronic Pain Control

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Results: (C) Differentiation – Non-suicidal self-injury

Anja Carina Emmerich Pain Research Meeting 2019 26 10 20 30 40 50 60 70 80 Suspension Suspension + CP Chronic Pain Control

NSSI (%)

Suspension Suspension + CP Chronic Pain Control

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Results: (D) Differentiation – Self-Compassion

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10 20 30 40 50 60

Self-Warmth Self-Coldness

Suspension Suspension + CP Chronic Pain Control