Aspects of life and pain
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Pekka Mäntyselkä
In this issue of the Scandinavian Journal of Pain, Nygaard Andersen and co-workers [1] report on the psychosocial aspects of everyday life with chronic musculoskeletal pain. Their article is based on a systematic review of studies focusing on adults’ psychosocial consequences related to clinical, everyday life or interpersonal aspects. In their review, the authors emphasize that in addition to experiencing pain, people with chronic pain are affected by depressive thoughts, disability, the low quality of life and severe disturbances in their family and other close relationships.
1 So many negative consequences of chronic pain on everyday life
In addition to depressive thoughts, anxiety, stress, disturbed interpersonal relationships and disability, there are several other psychological or social or psychosocial or societal consequences of pain. Among many consequences, Raspe lists the following ones: impaired handling of stress and psychological demands, limitation in activities of daily living, impaired leisure time activities, impaired social and sexual relations and activities and social isolation, the loss of household productivity, dependence on others, unmet health care needs, addictive behaviour, dissatisfaction with health care, adverse events, the impaired health related quality of life, the loss of income and increasing social gradients [2]. In one review like the present one – of course – it is reasonable to focus on common everyday life psychosocial factors affecting individual’s life instead of trying to capture all possible personal and societal consequences.
2 The most common and most important cause of disability and early retirement
Chronic pain is common and it affects people’s life seriously [3]. Pain epidemiology nowadays tends to focus more on risk factors and protective factors and consequences of pain. Verhaak and coworkers stated 16 years ago that “the important question is not precisely how many patients experience pain each day, but the extent to which pain leads to disability, to loss of working days, to premature incapacity, or to unnecessary medical treatment” [3]. Increasing numbers of studies related to impact of pain have been published during the recent years [4]. For example, chronic musculoskeletal pain has shown to cause or at least impact on work related problems, disability, early retirement and increased cost [5]. Chronic pain may have devastating impact on personal life and close relations with the most vulnerable people being most often affected by the psychosocial burden [6,7].
3 Chronic pain causes a dysfunctional everyday life
In this context Nygaard Andersen and co-workers analyse the findings of the studies published in the most recent years. The authors present a comprehensive synthesis of the main effects of chronic musculoskeletal pain on the everyday life of people. The synthesis states that living with chronic pain affects the quality of life and causes disability, depressive thoughts, interpersonal conflicts and further may in general have far-reaching consequences for everyday life [1]. They did not find any strong evidence for chronic pain related anxiety or stress which may appear as surprising. The authors conducted a very thorough data collection and review with a well-defined selection and eligibility criteria. Considering the quite enormous amount of studies involved with pain and psychosocial factors the number of selected studies was not big. Still, in many addressed outcomes, the studies were quite heterogeneous in their measurements and subjects and particular studies were quite inconsistent. Therefore it is understandable that it was not always possible to sum up the most relevant findings of studies or to pool the quantitative data. Therefore the review had to be based on a qualitative review of particular studies [1].
4 Chronic pain of unknown aetiology is more burdensome than specific chronic pain conditions
The authors of the present review conclude that there is an agreement on a relationship between pain and disability and the quality of life. However, the most solid ground exists only under the relationship between chronic pain and disability. Interestingly, psychosocial aspects – especially depressive symptoms – seemed to play a more significant role in the non-specific chronic pain than in the specific pain conditions. Besides being consequences of pain, these factors are involved in the aetiology of non-specific chronic pain and therefore some groups of people are more vulnerable to these psychosocial interferences. Psychosocial factors studied in the present review may be both risk factors and consequences of chronic pain with a barely distinguishable manifestation. However, as the authors stated, their review did not explore the potential interpersonal differences behind these findings.
5 With functions of everyday life preserved, pain tolerance is higher
At the population level, pain related behaviour with concomitant symptoms and comorbidities may have more significant impact than just the central impairment due to pain [2]. The findings of a recent study indicated that subjects with low back pain prefer the functional abilities of everyday life rather than the intensity of pain [8]. Further, a new systematic review or qualitative research suggested that patients’ everyday life preferences should be considered carefully in designing interventions of chronic musculoskeletal pain [9]. On the other hand, in the context of rehabilitation of chronic musculoskeletal pain, it seems to be that psychosocial risk factors (like yellow flags in low back pain) are known and can be assessed, but we do not yet know which interventions should be applied according to these assessments [10]. Out of this scope, it has been claimed that even social beliefs in general could be targets for preventive actions [2].
6 Vulnerable persons suffer the most negative consequences and need special attention
Everyday life aspects should be considered in the management and the prevention of chronic pain. Clinically relevant and useful variables are not always relevant from the point of view of the psychosocial aspects [2]. After all, it is evident that the everyday life aspects are important in the quality of life, functional capacity, rehabilitation, and in the recovery from chronic pain. In addition to the implication stated by authors, one implication of this study could be to address the importance of developing, testing and implementing reliable, valid and feasible instrument to measure the psychosocial aspects of everyday life and their change both in the clinical and population-based studies of people suffering from chronic pain. Beyond the aim of the present review the more far-reaching implication is to investigate the most effective interventions to improve the psychosocial outcomes among often the most vulnerable people suffering from longstanding pain.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2014.01.001.
References
[1] Nygaard Andersen L, Kohberg M, Juul-Kristensen B, Herborg LG, Søgaard K, Roessler K. Psychosocial aspects of everyday life with chronic musculoskeletal pain: a systematic review. Scand J Pain 2014;5:131–48.Search in Google Scholar
[2] Raspe H. Measuring the impact of chronic pain on populations: a narrative review. In: Croft P, Blyth FM, van der Windt D, editors. Chronic pain epidemiology. From aetiology to public health. New York: Oxford University Press Inc; 2010. p. 61–70.Search in Google Scholar
[3] Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain 1998;77:231–9.Search in Google Scholar
[4] O’Brien T, Breivik H. The impact of chronic pain – European patients’ perspective over 12 months. Scand J Pain 2012;3:23–9.Search in Google Scholar
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[8] Kemppi C, Laimi K, Salminen JJ, Tuominen R. Perceived relative importance of pain-related functions among patients with low back pain. J Rehabil Med 2012;44:158–62.Search in Google Scholar
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© 2014 Scandinavian Association for the Study of Pain
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Articles in the same Issue
- Editorial comment
- Central sensitization and visceral hypersensitivity: Facts and fictions
- Topical review
- Mechanisms of visceral pain in health and functional gastrointestinal disorders
- Editorial comment
- From patient observation to potential new therapies—Is old spironolactone a new analgesic?
- Observational study
- Long-term efficacy of spironolactone on pain, mood, and quality of life in women with fibromyalgia: An observational case series
- Editorial comment
- Combining an oral opioid-receptor agonist and the antagonist naloxone: A smart drug design that removes some but not all adverse effects of the opioid analgesic
- Observational study
- Effects of prolonged-release oxycodone/naloxone on pain control, bowel function and quality of life: A prospective observational study
- Editorial comment
- The swinging pendulum of oesophageal pain—Away from the centre back towards the periphery again
- Clinical pain research
- Do patients with functional chest pain have neuroplastic reorganization of the pain matrix? A diffusion tensor imaging study
- Editorial comment
- Female chronic pelvic pain is common and complex
- Observational study
- Female chronic pelvic pain is highly prevalent in Denmark. A cross-sectional population-based study with randomly selected participants
- Editorial comment
- Multiple chemical sensitivity and persistent pain states are related, may be treated with similar procedures?
- Educational case report
- Two of three patients with multiple chemical sensitivity had less symptoms and secondary hyperalgesia after transcranially applied pulsed electromagnetic fields
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- Evoked potentials through small-fiber pathways – For both clinical and research purposes?
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- GCH1 variants, tetrahydrobiopterin and their effects on pain sensitivity
- Editorial comment
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- Psychosocial aspects of everyday life with chronic musculoskeletal pain: A systematic review
