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Cited by 2Mindfulness and Compassion InterventionsMusculoskeletal pain and rehabilitationPediatric Pain Management Techniques

Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients.

Open access
Lam, Chun Nok, Larach, Daniel B, Chou, Chih-Ping, Black, David S·2024·Pain Medicine
DOI 10.1093/pm/pnad119PMC PMC10765158
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Abstract

Background Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress. Purpose This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path. Methods During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path. Results The average age of the sample was 54 years (range 18–98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0–10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (β = –0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (β = –0.10, P = .02) and stress (β = –0.08, P = .04) but not anxiety (β = –0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores. Conclusions We find statistical support to suggest that distress—particularly depressed mood and stress—mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

Integrity signals

Registry

Crossref · 10.1093/pm/pnad119

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 33 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Studies have demonstrated links between mindfulness and psychological processes involved in pain-related distress, including pain catastrophizing, depression, and anxiety.

    “Other studies have demonstrated the links between mindfulness and psychological processes involved in pain-related distress, including pain catastrophizing, 19,20,23 depression, 16,22 and anxiety.11,16”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [19] Schutze, 2010, Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain, Pain. source
    • cites [20] Komandur, 2018, Mindfulness and chronic headache/migraine: mechanisms explored through the fear-avoidance model of chronic pain, Clin J Pain source
    • cites [23] Brooks, 2018, Perceived mindfulness and depressive symptoms among people with chronic pain, J Rehabil
    • cites [16] McCracken, 2007, The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability, Pain. source
    • cites [22] Elvery, 2017, Pain catastrophizing, mindfulness, and pain acceptance: what’s the difference?, Clin J Pain source
    • cites [11] Curtin, 2017, The relationship between chronic musculoskeletal pain, anxiety and mindfulness: adjustments to the fear-avoidance model of chronic pain, Scand J Pain source
  • Interpretationreasoning

    The findings are in accordance with the theory that being mindful helps one encounter the pain experience without unnecessary elaboration, catastrophizing, or reactivity.

    “As such, our findings are in accordance with the theory that being mindful helps one encounter the pain experience without unnecessary elaboration, catastrophizing, or reactivity.10,15,50”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [10] Keefe, 2004, Psychological aspects of persistent pain: current state of the science, J Pain source

      The Acceptance discussion (page unavailable in our copy) describes acceptance as a way to avoid repeated struggles with pain and reports a meditation-based protocol designed to enhance acceptance. It does not say that mindfulness prevents elaboration, catastrophizing, or reactivity to pain; its discussion of catastrophizing is separate. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [15] Day, 2014, Toward a theoretical model for mindfulness-based pain management, J Pain source
    • cites [50] Veehof, 2016, Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review, Cogn Behav Ther source

      The KEYWORDS section defines mindfulness in terms of nonjudgmental awareness and nonreactivity, and Main findings suggests that acceptance may help people experience pain without treating it as something to avoid immediately. The paper does not describe mindfulness as preventing unnecessary elaboration or catastrophizing; Conclusions and recommendations discusses catastrophizing chiefly as a proposed CBT mechanism. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • The authors state this as an assumption: Mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.
  • Interpretationcitation

    Mindfulness's role as a buffer against negative affect associated with pain could provide a positive psychological adjustment to patients experiencing these types of pain-associated psychological symptoms.

    “Mindfulness's role as a buffer against negative affect (ie, distress or catastrophizing) associated with pain could provide a positive psychological adjustment to patients experiencing these types of painassociated psychological symptoms.48,49”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [48] Poulin, 2016, The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain, Support Care Cancer source
    • cites [49] Dorado, 2018, Interactive effects of pain catastrophizing and mindfulness on pain intensity in women with fibromyalgia, Health Psychol Open source

      The Discussion reports that the Observe facet of mindfulness reduced the association between catastrophizing and pain intensity in women with fibromyalgia. But it also reports that non-judgment and awareness may amplify that association. The paper therefore supports a possible buffering role for some mindfulness facets, not mindfulness generally; it did not establish positive psychological adjustment as an outcome. Page numbers were not supplied. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • The authors state this as an assumption: Mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.
  • Premisecitation

    A negative cycle can develop between distress and pain, causing further deterioration in one's health and ability to seek proper treatment.

    “As has been noted, 53 a negative cycle can develop between distress and pain, causing further deterioration in one's health and ability to seek proper treatment.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [53] Duffield, 2017, The contribution of musculoskeletal disorders in multimorbidity: implications for practice and policy, Best Pract Res Clin Rheumatol source
  • Findingown data

    UPAT was moderately negatively correlated with FFMQ non-judging (r = -0.21).

    “UPAT was moderately correlated with all 3 domains of DASS (depression: r ¼ 0.39; anxiety: r ¼ 0.35; stress: r ¼ 0.38), was weakly and negatively correlated with FFMQ describing (r ¼ -0.14) and non-reactivity (r ¼ -0.13), and was moderately correlated with non-judging (r ¼ -0.21).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 41
  • May combine two claims. 17

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The survey design relied on self-report metrics, which could introduce biases in the reporting of psychological distress and physical pain, given their known association, and can be dependent on the time of survey response.

    “Our survey design relied on self-report metrics, which could introduce biases in the reporting of psychological distress and physical pain, given their known association, and can be dependent on the time of survey response.56”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [56] Linton, 2011, Impact of psychological factors in the experience of pain, Phys Ther source

      The “Emotions and their regulation” section links psychological distress with pain, reporting that depression is associated with higher pain intensity. The paper does not address whether self-report surveys introduce reporting bias or whether responses depend on the time of survey completion. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Item-level imputation is often the preferred method, but a simplified approach using the subscale total for imputation has been suggested.

    “Although we were fully aware that item-level imputation is often the preferred method, 45,55 a simplified approach using the subscale total for imputation has been suggested, 45 which we used.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [45] Plumpton, 2016, Multiple imputation of multiple multi-item scales when a full imputation model is infeasible, BMC Res Notes source
    • cites [55] Gottschall, 2012, A comparison of item-level and scale-level multiple imputation for questionnaire batteries, Multivariate Behav Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The presence of psychological conditions such as depression is well established in patients experiencing musculoskeletal pain.

    “The presence of psychological conditions such as depression is well established in patients experiencing musculoskeletal pain.2,53”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Yelin, 2016, The burden of musculoskeletal diseases in the United States, Semin Arthritis Rheum source
    • cites [53] Duffield, 2017, The contribution of musculoskeletal disorders in multimorbidity: implications for practice and policy, Best Pract Res Clin Rheumatol source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The sum mediated proportion exceeding 100% could be due to mediators affecting one another, interaction between mediators affecting the outcome, or other mediators with a negative proportion being unaccounted for in the model.

    “This observation is possible and could be due to 3 factors: (1) mediators affecting one another, (2) interaction between mediators affecting the outcome, or (3) other mediators with a”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [52] VanderWeele, 2014, Mediation analysis with multiple mediators, Epidemiol Methods source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The analysis included 525 unique adult orthopedic patients who returned the survey.

    “Our analysis included 525 unique adult orthopedic patients who returned the survey.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants reported the presence of distress (DASS sum score mean 13.0, SD 11.5), with 49% overall reporting at least a mild level of depression, anxiety, or stress.

    “Participants also reported the presence of distress (DASS sum score: mean 6 SD ¼ 13.0 6 11.5), with 49% overall reporting at least a mild level of depression (subscale score !5; 30.5%), anxiety (subscale score !4; 34.5%), or stress (subscale score !8; 30.0%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    UPAT was weakly negatively correlated with FFMQ non-reactivity (r = -0.13).

    “UPAT was moderately correlated with all 3 domains of DASS (depression: r ¼ 0.39; anxiety: r ¼ 0.35; stress: r ¼ 0.38), was weakly and negatively correlated with FFMQ describing (r ¼ -0.14) and non-reactivity (r ¼ -0.13), and was moderately correlated with non-judging (r ¼ -0.21).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    UPAT was weakly negatively correlated with FFMQ describing (r = -0.14).

    “UPAT was moderately correlated with all 3 domains of DASS (depression: r ¼ 0.39; anxiety: r ¼ 0.35; stress: r ¼ 0.38), was weakly and negatively correlated with FFMQ describing (r ¼ -0.14) and non-reactivity (r ¼ -0.13), and was moderately correlated with non-judging (r ¼ -0.21).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Ninety-one percent of participants who responded to the pain item reported at least a mild level of pain in the prior 2 weeks, with UPAT scoring of 1 or greater (mean 4.2, SD 2.5).

    “Ninety-one percent of participants who responded to the pain item reported at least a mild level of pain in the prior 2 weeks, with UPAT scoring of 1 or greater (UPAT: mean 6 SD ¼ 4.2 6 2.5).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Male sex was correlated with lower levels of pain (r = -0.15).

    “For other covariates, male sex was correlated with lower levels of pain (r ¼ -0.15), while age was positively correlated with FFMQ sum score (r ¼ 0.15) and FFMQ act-with-awareness (r ¼ 0.11) and was negatively correlated with male sex (r ¼ -0.15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age was positively correlated with FFMQ sum score (r = 0.15).

    “For other covariates, male sex was correlated with lower levels of pain (r ¼ -0.15), while age was positively correlated with FFMQ sum score (r ¼ 0.15) and FFMQ act-with-awareness (r ¼ 0.11) and was negatively correlated with male sex (r ¼ -0.15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sensitivity analysis including primary injury location and race/ethnicity produced results not different from the primary findings.

    “The results were not different from the primary findings in Figure 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Model fit statistics showed low non-normalized RMSE (depression 0.75, anxiety 0.80, stress 0.79) and moderate R-squared values (depression 0.38, anxiety 0.30, stress 0.34), indicating good model fit for the multiple-mediation analysis.

    “The analysis showed that all 3 mediation pathways had low non- normalized Root Mean Square Error (depression ¼ 0.75, anxiety ¼ 0.80, stress ¼ 0.79) and moderate R-squared values (depression ¼ 0.38, anxiety ¼ 0.30, stress ¼ 0.34), which indicated a good model fit for our multiple-mediation analysis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The proportion mediated by different distress domains between mindfulness disposition and pain was estimated in a multiple-mediation model.

    “Proportion mediated by different distress domains between mindfulness disposition and pain in a multiple-mediation model.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age was negatively correlated with male sex (r = -0.15).

    “For other covariates, male sex was correlated with lower levels of pain (r ¼ -0.15), while age was positively correlated with FFMQ sum score (r ¼ 0.15) and FFMQ act-with-awareness (r ¼ 0.11) and was negatively correlated with male sex (r ¼ -0.15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age was positively correlated with FFMQ act-with-awareness (r = 0.11).

    “For other covariates, male sex was correlated with lower levels of pain (r ¼ -0.15), while age was positively correlated with FFMQ sum score (r ¼ 0.15) and FFMQ act-with-awareness (r ¼ 0.11) and was negatively correlated with male sex (r ¼ -0.15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The DASS showed high internal consistency in the sample (Cronbach's alpha = 0.89).

    “We observed high internal consistency in our sample (Cronbach's a ¼ 0.89).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The FFMQ showed high internal consistency in the sample (Cronbach's alpha = 0.87).

    “We observed high internal consistency in our sample (Cronbach's a ¼ 0.87).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Age and sex were controlled for in the analytic models.

    “We controlled for age and sex in the analytic models.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A sensitivity analysis using complete cases was conducted and compared with the imputed data.

    “Finally, we conducted a sensitivity analysis using complete cases and compared results with the imputed data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Psychological distress is common among orthopedic patients.

    “Psychological distress, defined as a discomforting emotional state experienced in response to a stressor like pain, 5 is common among orthopedic patients 6 and plays an important role in modulating the affective experience of pain.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Castillo, 2016, Pain and psychological distress following orthopedic trauma: a call for collaborative models of care, Tech Orthop source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mindfulness facets, including observing and describing, predicted pain intensity, while non-reactivity and non-judging predicted depression.

    “Another study found that mindfulness facets, including observing and describing, predicted pain intensity, while non-reactivity and non-judging predicted depression.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Elvery, 2017, Pain catastrophizing, mindfulness, and pain acceptance: what’s the difference?, Clin J Pain source

  • Classified as probably not a substantial claim.

    Premisecitation

    Mindfulness facets, including non-judgment, non-reactivity, and describing, influence pain severity through their effects on depression.

    “One proposed path model is based on data showing that mindfulness facets, including non-judgment, non-reactivity, and describing, influence pain severity through their effects on depression.21”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Nigol, 2020, The relationship between mindfulness facets, depression, pain severity and pain interference, Psychol Health Med source

  • Classified as probably not a substantial claim.

    Premisecitation

    Being mindful might help a patient experience the basic sensory elements of physical pain without unnecessary cognitive elaboration, catastrophizing, or reactivity.

    “This attentional stance is relevant to the pain experience, as being mindful might help a patient experience the basic sensory elements of physical pain without unnecessary cognitive elaboration, catastrophizing, or reactivity.10,[15][16][17]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 10,[15][16][17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The underlying mechanisms of change for mindfulness as a protective factor against pain remain to be determined.

    “Although studies have examined mindfulness as a protective factor against the experience of pain, 11,[18][19][20] the underlying mechanisms of change remain to be determined.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 11,[18][19][20]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most orthopedic patients present with a chief complaint of pain.

    “Most orthopedic patients present with a chief complaint of pain.[1][2][3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1][2][3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Convenience sampling might have introduced self-selection bias, yielding a sample that could have been healthier or had greater levels of trust in medical care and research.

    “Convenience sampling might have introduced selfselection bias, yielding a sample that could have been healthier or had greater levels of trust in medical care and research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The process of reperceiving could disrupt the distress-pain cycle or compete against rumination from pain catastrophizing.

    “This process could disrupt the distress-pain cycle or compete against rumination from pain catastrophizing.48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Poulin, 2016, The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain, Support Care Cancer source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Imputing FFMQ and DASS scales at the domain level did not fully utilize the information available at the item level.

    “Although imputing FFMQ and DASS scales at the domain level did not fully utilize the information that was available at the item level (ie, any item missing was treated as the domain missing)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    They encountered issues with missing data, including the primary outcome.

    “For data validity, we encountered issues with missing data, including the primary outcome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Our results offer additional mechanistic details to the design of specific mindfulness-facet-by-distress-type interventions for orthopedic populations.

    “As more mind-body therapies target psychological symptoms for pain management, 54 our results offer additional mechanistic details to the design of specific mindfulness-facet-by-distress-type interventions for orthopedic populations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Rajguru, 2015, Use of mindfulness meditation in the management of chronic pain a systematic review of randomized controlled trials, Am J Lifestyle Med source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Individuals with higher mindful awareness and less judgmental affect might be able to shift their thoughts and observe their emotions toward pain differently (reperceiving).

    “Individuals with higher mindful awareness and less judgmental affect might be able to shift their thoughts and observe their emotions toward pain differently, a notion of reperceiving suggested by Day et al. 15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Day et al. 15

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The inclusion of years since diagnosis and years of pain patients experienced would be important clinical factors to consider.

    “Though not available in the present data, the inclusion of years since diagnosis and years of pain patients experienced would be important clinical factors to consider.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    Our findings support mindfulness as a positive psychological disposition varying in orthopedic patients that can possibly be targeted to ameliorate distress and subjective pain levels.

    “Our findings support mindfulness as a positive psychological disposition varying in orthopedic patients that can possibly be targeted to ameliorate distress and subjective pain levels.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    They recruited a large study sample to increase the variance of the subject pool and diversify the responses.

    “To address some of these potential issues, we recruited a large study sample to increase the variance of the subject pool and diversify the responses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    It is possible that the DASS stress and depression mediators affected one another or interacted to affect the outcome pain.

    “it is possible that these mediators affected one another or interacted to affect the outcome pain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Mindfulness disposition might change the psychological processes of pain perception, which warrants the mediation analysis approach.

    “However, mindfulness disposition might change the psychological processes of pain perception, which warrants the mediation analysis approach.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.

  • May combine two claims.

    Interpretationown data

    Our results confirm the observation of a negative cycle and identify that mindfulness disposition could affect the distress-pain relation.

    “Our results confirm this observation and identify that mindfulness disposition could affect the distress-pain relation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

    “A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.
    • Rests on an assumption: The mediation model's assumed causal ordering (mindful attention → psychological distress → pain) is valid despite the cross-sectional design.
    • Rests on an assumption: There is no unmeasured confounding of the FFMQ–DASS, DASS–UPAT, and FFMQ–UPAT relationships.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study recruited from a single nonprofit teaching hospital.

    “The study recruited from a single nonprofit teaching hospital.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    They tested the mediation analysis using cross-sectional data, which is controversial and can limit the ability to infer causality for the observed effects.

    “In addition, we tested the mediation analysis using cross-sectional data, which is controversial and can limit our ability infer causality for the observed effects 57 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] Maxwell, 2007, Bias in cross-sectional analyses of longitudinal mediation, Psychol Methods source

  • May combine two claims.

    Interpretationown data

    Higher mindfulness disposition correlates with lower pain levels, with psychological distress as the statistical mediator.

    “Our findings showed that higher mindfulness disposition correlates with lower pain levels, with psychological distress as the statistical mediator.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The mediation model's assumed causal ordering (mindful attention → psychological distress → pain) is valid despite the cross-sectional design.
    • Rests on an assumption: There is no unmeasured confounding of the FFMQ–DASS, DASS–UPAT, and FFMQ–UPAT relationships.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Using the subscale total for imputation reduced the imputation model size, with the potential tradeoff of losing the ability to further explore individual items.

    “This allowed us to reduce the imputation model size, with the potential tradeoff of losing the ability to further explore individual items.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Examining the presence of distress among patients with pain conditions, and the associated mechanisms of action, are among the nation's top research priorities.

    “Examining the presence of distress among patients with pain conditions, and the associated mechanisms of action, are among the nation's top research priorities.60”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Interagency Pain Research Coordinating Committee, 2017

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    They performed multiple imputation to produce an estimation of the full sample.

    “To remedy, we performed multiple imputation so that we could produce an estimation of the full sample.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Their initial attempt using individual items failed to converge because of a large volume of scale items (FFMQ: 24 items; DASS: 21 items).

    “our initial attempt using individual items failed to converge because of a large volume of scale items (FFMQ: 24 items; DASS: 21 items).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The selective patient cohort and the undifferentiated nature of the orthopedic sample could limit the external validity and generalizability of the findings.

    “The selective patient cohort and the undifferentiated nature of the orthopedic sample could limit the external validity and generalizability of the findings.”
    Quote in the paperNot a substantial claim
47 of 47

  • The authors state this as an assumption.

    Mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.

    “This is under the premise that mindfulness could modify pain perception and the elaboration of emotions surrounding the experience of pain.”

  • The paper relies on this without support.

    The mediation model's assumed causal ordering (mindful attention → psychological distress → pain) is valid despite the cross-sectional design.

    “Our model proposes that psychological distress mediates an association between mindful attention and experienced pain.”

  • The paper relies on this without support.

    There is no unmeasured confounding of the FFMQ–DASS, DASS–UPAT, and FFMQ–UPAT relationships.

    “We controlled for age and sex in the analytic models.”

  • The paper relies on this without support.

    Missing data for the imputed variables are missing at random (MAR) or missing completely at random (MCAR).

    “We performed multiple imputation and ran all mediation analyses using the imputed datasets.”

  • The paper relies on this without support.

    The single-site sample is representative of orthopedic patients generally.

    “We conducted a single-site cross-sectional survey in 2015.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The imputation description conflicts on excluded fields

    Minor

    The methods say all data fields were imputed, whereas the results say injury location and race/ethnicity were initially excluded from imputation.

1 of 1

Cites

Flagged first, then by citations

2 of the 63 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. StataCorp, 2017, Stata Statistical Software: Release 15
  2. Interagency Pain Research Coordinating Committee, 2017, Federal Pain Research Strategy

Cited by

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Authors
Lam, C. N., Larach, D. B., Chou, C.-P., & Black, D. S.
Affiliations
  • University of Southern California (US)
  • Vanderbilt University Medical Center (US)
Corresponding author
Lam, Chun Nok
ORCID
Venue
Pain Medicine
Publisher
Oxford University Press (OUP)
Published
2023-08-29
Volume
25
Issue
1
Pages
63-70
ISSN
  • 1526-2375 (ISSN-L)
  • 1526-4637
DOI
10.1093/pm/pnad119
PMC
PMC10765158
OpenAlex
W4386241078
Cited by
2
References
63
Citations by year
2026: 1 · 2025: 1
FWCI
0.58
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Pain Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Southern California Zumberge Interdisciplinary Grant
  • American Mindfulness Research Association
  • National Institute on Drug Abuse (K23DA057387)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
mindful attention, pain intensity, psychological distress, depression, stress, orthopedic patients, mediation, mindfulness training, musculoskeletal pain, shoulder pain
MeSH terms
Psychological Distress, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Attention, Female, Humans, Male, Middle Aged, Pain, Stress, Psychological, Young Adult, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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