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Relationships between Psychological Factors, Disability, Quality of Life and Health in Chronic Pain Disorders
Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-4385-428X
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic pain is a very common condition with a prevalence of 40-65% in the community. The high prevalence of chronic pain causes a lot of human suffering but also high societal costs. The development and maintenance of chronic pain constitutes a complex interplay between neurobiological, psychosocial and genetic factors. A biopsychosocial model of chronic pain has been suggested to make a comprehensive context of the understanding of this issue.

The main aims of this thesis were to analyze the relationships of the different components of the biopsychosocial model of pain and to study the relative importance of pain, stress and different psychological factors on disability and health related quality of life.

The thesis is based on two groups of patients. One group consists of 275 patients with chronic Whiplash Associated Disorder (WAD) and one group comprise 433 patients with WAD, fibromyalgia (FM) and patients with chronic pain related to Spinal Cord Injury (SCI). The patients were investigated by questionnaires assessing different aspects of pain, depression, anxiety, catastrophizing, self-efficacy, disability and Health Related Quality of Life (HRQL).

The main results were that psychological factors (especially depression) correlated relatively strongly with perceived HRQL and disability. The degree of depression appeared to have the most important relationship to perceived HRQL. Despite the fact that the patients rated depression just mild or moderate, depression had a great importance for the outcome of HQRL and disability. Pain intensity and duration played, in the cross-sectional perspective, a minor role for perceived HRQL, whereas pain intensity related more to the outcome of perceived disability.

From a clinical point of view it is important to assess the complex and unique situation of each individual with respect to depression, anxiety, self-efficacy and pain when planning treatment and rehabilitation in order to optimise the outcome of such programmes.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1079
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-15691ISBN: 978-91-7393-797-9 (print)OAI: oai:DiVA.org:liu-15691DiVA: diva2:126949
Public defence
2008-12-12, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, Sverige, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2013-09-03Bibliographically approved
List of papers
1. Generalized pain is associated with more negative consequences than local or regional pain: A study of chronic whiplash-associated disorders
Open this publication in new window or tab >>Generalized pain is associated with more negative consequences than local or regional pain: A study of chronic whiplash-associated disorders
2007 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 39, no 3, 260-269 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The main aims of this study were: (i) to determine, for chronic whiplash-associated disorders, whether widespread pain has more severe consequences for other symptoms and different aspects of perceived health than does local/regional pain; (ii) to investigate whether pain, depression, and symptoms not directly related to pain are intercorrelated and to what extent these symptoms correlate with catastrophizing according to the Coping Strategy Questionnaire.

Design: Descriptive cross-sectional study.

Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital.

Methods: Background history, Beck Depression Inventory, Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey and EuroQol were used to collect data.

Results: Spreading of pain was associated with negative consequences with respect to pain intensity and prevalence of other symptoms, life satisfaction/quality and general health. The subjects differ with respect to the presence of symptoms not directly related to pain. A minor part of the variation in Back Depression Inventory was explained by direct aspects of pain, indicating that, to some extent, generalization of pain is related to catastrophizing thoughts.

Conclusion: Widespread pain was associated with negative consequences with respect to pain intensity, prevalence of other symptoms including depressive symptoms, some aspects of coping, life satisfaction and general health.

Keyword
Neck, whiplash, generalized pain, neuroplasticity, depression, catastrophizing.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15687 (URN)10.2340/16501977-0052 (DOI)
Available from: 2008-12-04 Created: 2008-11-26 Last updated: 2013-09-03Bibliographically approved
2. Catastrophizing, depression, and pain: Correlation with and influence on quality of life and health: A study of chronic whiplash-associated disorders
Open this publication in new window or tab >>Catastrophizing, depression, and pain: Correlation with and influence on quality of life and health: A study of chronic whiplash-associated disorders
2008 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 40, no 7, 562-569 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aims of this study were: (i) to classify subgroups according to the degree of pain intensity, depression, and catastrophizing, and investigate distribution in a group of patients with chronic whiplash-associated disorders; and (ii) to investigate how these subgroups were distributed and inter-related multivariately with respect to consequences such as health and quality of life outcome measures.

Design: Descriptive cross-sectional study.

Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital.

Methods: The following data were obtained by means of self-report questionnaires: pain intensity in neck and shoulders, background history, Beck Depression Inventory, the catastrophizing scale of Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey, and the EuroQol.

Results: Principal component analysis was used to recognize subgroups according to the degree of pain intensity, depression, and catastrophizing. These subgroups have specific characteristics according to perceived health and quality of life, and the degree of depression appears to be the most important influencing factor.

Conclusion: From a clinical point of view, these findings indicate that it is important to assess patients for intensity of pain, depression, and catastrophizing when planning a rehabilitation programme. Such an evaluation will help individualize therapy and intervention techniques so as to optimize the efficiency of the programme.

Keyword
Neck, whiplash, pain, depression, catastrophizing, health, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15688 (URN)10.2340/16501977-0207 (DOI)
Available from: 2008-12-04 Created: 2008-11-26 Last updated: 2013-09-03Bibliographically approved
3. The complex interplay between pain intensity, depression, anxiety and catastrophizing with respect to quality of life and disability
Open this publication in new window or tab >>The complex interplay between pain intensity, depression, anxiety and catastrophizing with respect to quality of life and disability
2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 19, 1605-1613 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To identify subgroups of chronic pain patients based on the occurrence of depression, anxiety, and catastrophizing and the duration of pain and pain intensity. In addition to this, to investigate the relationship between the subgroups with respect to background variables, diagnosis, pain-related disability, and perceived quality of life.

Methods: This study used 433 chronic pain patients including 47 patients with spinal cord injury related pain, 150 with chronic whiplash associated disorders, and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological and health related items.

Results: Based on depression, anxiety, catastrophizing, pain intensity and duration, we identified subgroups of chronic pain patients that differed with respect to perceived quality of life, disability and diagnosis. The psychological factors, especially depression, significantly influenced perceived quality of life and disability. Pain intensity and duration play a minor role with respect to quality of life although pain intensity is associated contributes more to perceived disability.

Conclusions: The results of this study highlight the importance of not looking at chronic pain patients as a homogenous entity. A detailed assessment, including psychological factors with emphasis on depressive symptoms, might be essential for planning and carrying through treatment and rehabilitation.

Keyword
Chronic pain, catastrophizing, depression, anxiety, quality of life, disability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15689 (URN)10.1080/09638280903110079 (DOI)
Available from: 2008-12-04 Created: 2008-11-26 Last updated: 2013-09-03Bibliographically approved
4. Impact of the interaction between selfefficacy, symptoms and catastrophizing on disability, quality of life and health in chronic pain patients
Open this publication in new window or tab >>Impact of the interaction between selfefficacy, symptoms and catastrophizing on disability, quality of life and health in chronic pain patients
2010 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 17, 1387-1396 p.Article in journal (Refereed) Published
Abstract [en]

This study investigates the interactions between self-efficacy–including subcomponents–and symptoms (pain, depression, and anxiety), catastrophizing, disability, quality of life, and health in a population of chronic pain patients. The study used 433 chronic pain patients including 47 patients with spinal cord injuryrelated pain, 150 with chronic whiplash-associated disorders, and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration, and psychological- and health-related items. In the multivariate context, depression, anxiety, catastrophizing, and disability were intercorrelated. Self-efficacy correlated positively with variables of quality of life and general health. These two groups of variables were negatively correlated. The pain variables–duration of pain, pain intensity, and spreading of pain–formed a third group of variables. Self-efficacy function was negatively correlated to these three pain variables. When regressing disability, quality of life, and health, we found that self-efficacy had a positive impact whereas symptoms, catastrophizing, and pain had a negative influence on these aspects. Different patterns of influencing variables were discerned for the three different analyses, and specific patterns of the subscales of self-efficacy corresponded to specific patterns of negative factors for the outcome of disability, quality of life, and health.

Perspective: This article presents the complex interaction of psychological factors and symptoms and their positive and negative influence on disability, quality of life, and health. The results indicate that it might be important to assess and influence both enhancing and detoriating factors to ensure an effective pain management programme.

Place, publisher, year, edition, pages
Informa Healthcare, 2010
Keyword
Chronic pain, self-efficacy, disability, quality of life, health, depression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15690 (URN)10.3109/09638280903419269 (DOI)000280755100001 ()
Note
Original Publication: Björn Börsbo, Björn Gerdle and Michael Peolsson, Impact of the interaction between selfefficacy, symptoms and catastrophizing on disability, quality of life and health in chronic pain patients, 2010, Disability and rehabilitation, (32), 17, 1387-1396. http://dx.doi.org/10.3109/09638280903419269 Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2008-12-04 Created: 2008-11-26 Last updated: 2013-09-03Bibliographically approved

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