Startseite Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
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Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?

  • Christopher Sivert Nielsen EMAIL logo
Veröffentlicht/Copyright: 1. Oktober 2016
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Scandinavian Journal of Pain
Aus der Zeitschrift Scandinavian Journal of Pain Band 13 Heft 1

In this issue of the Scandinavian Journal of Pain (SJP) Whibley and colleagues report on how the relationship between neck and distal upper limb pain and disability is moderated by pain beliefs [1].

1 Persistent pain is the dominating cause of work disability

Persistent pain is severely disabling. The SJP has previously published data from two independent studies showing that around 50% of the work disability is attributable to persistent pain [2, 3]. The costs for society are immense, making this a public health issue of utmost importance.

2 Individual specific factors contribute to wide variation in pain from the same disease or injury

Prevention and treatment of persistent pain has traditionally focused on diagnosing and treating the peripheral pathology causing pain. Thus if the patient suffers from pain from osteoarthritis of the hip, hip arthroplasty may be indicated. Unfortunately this approach fails in very many cases. This is firstly, because there appears to be poor correlation between the degree of peripheral pathology and the degree of pain, and secondly, because the peripheral pathology is frequently not known [4]. Though these findings may in part be explained by inadequate diagnostic techniques, for instance that we lack imaging techniques for detecting pathology in soft tissues, there is substantial evidence suggesting that individual specific factors such as pain sensitivity contribute to the variation in pain among people suffering from the same disease or injury.

3 Socio-economic and psychological factors may increase risk of disability from pain

Just as the relationship between pathology and pain is tenuous, so is the relationship between pain and disability. While some patients function relatively well with moderate to strong pain, others become severely disabled. Some factors moderating the association between pain and disability have been identified. For instance, there is evidence that fibromyalgia patients with low socio-economic status experience greater functional impairment than high socio-economic status patients with similar levels of pain, depression and anxiety [5]. There is also evidence that a number of psychological factors including self-efficacy, psychological distress and fear of movement may affect the consequences of pain on functioning [6, 7]. Identifying these factors is of great importance for designing effective treatment strategies.

4 Pessimism about prognosis is associated with increased disability among individuals with mild or moderately strong pain

Whibley and coworkers approach this issue in a sample of 476 patients with arm pain [1]. They first performed exploratory factor analysis of a health beliefs questionnaire, identifying five constructs. Moderation analysis was then carried out to determine which of these constructs moderated the association between pain and disability. A moderation effect was found for beliefs about prognosis, with greater pessimism about prognosis being associated with greater disability among those with mild to moderate pain.

As the authors point out, the analysis is cross-sectional and the results should be interpreted with some caution. For instance, though it may be that pessimism leads to greater disability among patients with mild to moderate pain, it is also possible that patients become more pessimistic when experiencing greater disability. Perhaps the most noteworthy finding is the absence of effect for the other four pain belief constructs. For instance it is commonly found that fear of movement can contribute towards a poor outcome [6], yet this appears not to be the case in this study [1].

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.07.003.

Norwegian Institute of Public Health, Department of Ageing and Health, Post box 4404, Nydalen,0403 Oslo, Norway.

  1. Conflict of interest: None declared.

References

[1] Whibley D, MacDonald R, Macfarlane GJ, Jones GT. Constructs of health belief and disabling distal upper limb pain. Scand J Pain 2016;13:91–7.Suche in Google Scholar

[2] Landmark T, Romundstad P, Dale O, Borchgrevink PC, Vatten L, Kaasa S. Chronic pain: one year prevalence and associated characteristics (the HUNT pain study). Scand J Pain 2013;4:182–7.Suche in Google Scholar

[3] Nielsen CS. Chronic pain is strongly associated with work disability. Scand J Pain 2013;4:180–1.Suche in Google Scholar

[4] Nielsen CS, Staud R, Price DD. Individual differences in pain sensitivity: measurement, causation, and consequences. J Pain 2009;10:231–7.Suche in Google Scholar

[5] Fitzcharles MA, Rampakakis E, Ste-Marie PA, Sampalis JS, Shir Y. The association of socioeconomic status and symptom severity in persons with fibromyalgia. J Rheumatol 2014;41:1398–404.Suche in Google Scholar

[6] Helminen EE, Sinikallio SH, Valjakka AL, Vaisanen-Rouvali RH, Arokoski JP. Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study. Clin Rehab 2016;30:890–900.Suche in Google Scholar

[7] Lee H, Hubscher M, Moseley GL, Kamper SJ, Traeger AC, Mansell G, McAuley JH. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain 2015; 156:988–97.Suche in Google Scholar
Published Online: 2016-10-01
Published in Print: 2016-10-01

© 2016 Scandinavian Association for the Study of Pain

Artikel in diesem Heft

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
https://doi.org/10.1016/j.sjpain.2016.09.009

Artikel in diesem Heft

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
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