Chronic pain profile: An interaction between biological and psychosocial factors*
Author(s)
Marcus A. Alcântara,
Rosana F. Sampaio*,
Mariana A. P. Souza,
Fabiana C. M. Silva,
Renata N. Kirkwood
Affiliation(s)
Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil;Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil. Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil. Department of Occupational Therapy, Institute of Health Sciences, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, Brazil. Kinesiology Department, University of Waterloo, Waterloo, Canada.
Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil;Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil. Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil. Department of Occupational Therapy, Institute of Health Sciences, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, Brazil. Kinesiology Department, University of Waterloo, Waterloo, Canada.
ABSTRACT
OBJECTIVE: To Identify subgroups of workers with chronic pain based on the interaction of different pain dimensions (sensory, affective, evaluative and mixed), depression, beliefs regarding pain, physical incapacity and socio-demographic-clinical data. METHODS:An observational cross-sectional study was carried out with a convenience sample made up of 115 patients with work-related musculoskeletal disorders (WRMD). The participants answered the McGill Pain Questionnaire, Beck Depression Inventory, Survey of Pain Attitudes, Roland-Morris Disability Questionnaire and a form for socio-demographic and clinical data. RESULTS: Four distinct subgroups were identified, two of which reported pain of a sensory-affective nature and two reported predominantly sensory pain. The individuals in subgroups I and III reported higher levels for all variables analyzed, while the first cluster had the highest mean scores. The subgroup II exhibited moderate degrees of physical disability and a high sick leave index, although the members of this group were less depressed and less dependent upon analgesics. Lower levels of pain, physical disability and depression were associated to subgroup IV, which also had the greatest proportion of males. Beliefs were similar among the subgroups. CONCLUSIONS: Patients with moderate to strong chronic pain associated to sensory and affective components exhibited a higher degree of disability and depression. The results suggest that the chronification process of pain and its functional consequences vary between individuals and are influenced by emotional factors.
OBJECTIVE: To Identify subgroups of workers with chronic pain based on the interaction of different pain dimensions (sensory, affective, evaluative and mixed), depression, beliefs regarding pain, physical incapacity and socio-demographic-clinical data. METHODS:An observational cross-sectional study was carried out with a convenience sample made up of 115 patients with work-related musculoskeletal disorders (WRMD). The participants answered the McGill Pain Questionnaire, Beck Depression Inventory, Survey of Pain Attitudes, Roland-Morris Disability Questionnaire and a form for socio-demographic and clinical data. RESULTS: Four distinct subgroups were identified, two of which reported pain of a sensory-affective nature and two reported predominantly sensory pain. The individuals in subgroups I and III reported higher levels for all variables analyzed, while the first cluster had the highest mean scores. The subgroup II exhibited moderate degrees of physical disability and a high sick leave index, although the members of this group were less depressed and less dependent upon analgesics. Lower levels of pain, physical disability and depression were associated to subgroup IV, which also had the greatest proportion of males. Beliefs were similar among the subgroups. CONCLUSIONS: Patients with moderate to strong chronic pain associated to sensory and affective components exhibited a higher degree of disability and depression. The results suggest that the chronification process of pain and its functional consequences vary between individuals and are influenced by emotional factors.
Cite this paper
A. Alcântara, M. , F. Sampaio, R. , A. P. Souza, M. , C. M. Silva, F. and N. Kirkwood, R. (2013) Chronic pain profile: An interaction between biological and psychosocial factors*. Pain Studies and Treatment, 1, 9-16. doi: 10.4236/pst.2013.12003.
A. Alcântara, M. , F. Sampaio, R. , A. P. Souza, M. , C. M. Silva, F. and N. Kirkwood, R. (2013) Chronic pain profile: An interaction between biological and psychosocial factors*. Pain Studies and Treatment, 1, 9-16. doi: 10.4236/pst.2013.12003.
References
[1] World Health Organization (2008) WHO treatment guideline on non-malignant pain in adults. WHO, Geneva, 14. [2] Sá, K., Baptista, A.F., Matos, M.A. and Lessa, I. (2009) Prevalence of chronic pain and associated factors in the population of Salvador, Bahia. Revista de Saúde Pública, 43, 622-630. doi:10.1590/S0034-89102009005000032 [3] Kreling, M.C.G.D., Cruz, D.A.L.M. and Pimenta, C.A.M. (2006) Prevalence of chronic pain in adult workers. Re- vista Brasileira de Enfermagem, 59, 509-513. doi:10.1590/S0034-71672006000400007 [4] Gheldof, E.L., Vinck, J., Van den Bussche, E., et al. (2006) Pain and pain-related fear are associated with functional and social disability in an occupational setting: Evidence of mediation by pain-related fear. European Journal of Pain, 10, 513-525. doi:10.1016/j.ejpain.2005.07.005 [5] Turner, J.A., Franklin, G., Heagerty, P.J., et al. (2004) The association between pain and disability. Pain, 112, 307- 314. doi:10.1016/j.pain.2004.09.010 [6] Castro, M.M. and Daltro, C. (2009) Sleep patterns and symptoms of anxiety and depression in patients with chronic pain. Arquivos de Neuro-Psiquiatria, 67, 25-28. doi:10.1590/S0004-282X2009000100007 [7] McWilliams, L.A., Cox, B.J. and Enns, M.W. (2003) Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106, 127-133. doi:10.1016/S0304-3959(03)00301-4 [8] Ratzon, N.Z., Jarus, T. and Catz, A. (2007) The relationship between work function and low back pain history in occupationally active individuals. Disability and Rehabilitation, 29, 791-796. doi:10.1080/09638280600919681 [9] Mossey, J.M., Gallagher, R.M. and Tirumalasetti, F. (2000) The effects of pain and depression on physical functioning in elderly residents of a continuing care retirement community. Pain Medicine, 1, 340-350. doi:10.1046/j.1526-4637.2000.00040.x [10] Gatchel, R.J., Peng, Y.B., Peters, M.L., et al. (2007) The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581-624. doi:10.1037/0033-2909.133.4.581 [11] Geertzen, J.H., Van Wilgen, C.P., Schrier, E., et al. (2006) Chronic pain in rehabilitation medicine. Disability and Rehabilitation, 28, 363-367. doi:10.1080/09638280500287437 [12] Sampaio, R.F., Mancini, M.C., Gon?alves, G.G.P., et al. (2005) Application of the international classification of functioning, disability and health (ICF) in physiotherapists clinical practice. Brazilian Journal of Physical Therapy, 9, 1-7. [13] Linton, S.J., Buer, N., Vlaeyen, J., et al. (2000) Are fear avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psychology & Health, 14, 1051-1059. doi:10.1080/08870440008407366 [14] Burns, J.W., Kubilus, A., Bruehl, S., et al. (2001) A fourth empirically derived cluster of chronic pain patients based on the Multidimensional Pain Inventory: Evidence for repression within the dysfunctional group. Journal of Consulting and Clinical Psychology, 69, 663-673. doi:10.1037/0022-006X.69.4.663 [15] Turk, D.C. and Okifuji, A. (2002) Psychological factors in chronic pain: Evolution and revolution. Journal Consulting and Clinical Psychology, 70, 678-690. [16] Alcantara, M.A., Sampaio, R.F., Pereira, L.S.M., et al. (2010) Disability associated with pain—A clinical approximation of the mediating effect of belief and attitudes. Physiotherapy Theory and Practice, 26, 459-467. doi:10.3109/09593980903580233 [17] Turk, D.C. (2005) The potential of treatment matching for subgroups of patients with chronic pain: Lumping versus splitting. Clinical Journal of Pain, 21, 44-55. doi:10.1097/00002508-200501000-00006 [18] Corbière, M., Sullivan, M.J.L., Stanish, W.D., et al. (2007) Pain and depression in injured workers and their return to work: A longitudinal study. Canadian Journal of Behavioural Science, 39, 23-31. doi:10.1037/cjbs2007002 [19] Gironda, R.J. and Clark, M.E. (2008) Cluster analysis of the pain outcomes questionnaire. Pain Medicine, 9, 813- 823. doi:10.1111/j.1526-4637.2007.00397.x [20] Von Korff, M. and Miglioretti, D.L. (2005) A prognostic approach to defining chronic pain. Pain, 117, 304-313. doi:10.1016/j.pain.2005.06.017 [21] Brazil Ministry of Social Welfare (2003) Normative No. 98. http://www.prt21.mpt.gov.br/fepmat/inst_normativa.htm [22] Castro, C.E.S. (2001) Formulation linguistics pain: Linguistic value and clinical pain complaints. Revista Dor Pesquisa Clínica e Terapêutica, 3, 114-122. [23] Grafton, K., Foster, N. and Wright, C. (2002) Evaluation of the test-retest reliability of the short-form McGill pain questionnaire. Physiotherapy, 88, 108. doi:10.1016/S0031-9406(05)60934-0 [24] Jensen, M.P., Strom, S.E., Turner, J.A., et al. (1992) Validity of the sickness impact profile Roland scale as a measure of dysfunction in chronic pain patients. Pain, 50, 157-162. doi:10.1016/0304-3959(92)90156-6 [25] Nusbaum, L., Natour, J., Ferraz, M.B., et al. (2001) Translation, adaptation and validation of the Roland-Morris questionnaire—Brazil Roland-Morris. Brazilian Journal of Medical and Biological Research, 34, 203-210. doi:10.1590/S0100-879X2001000200007 [26] Gorestein, C. and Andrade, L. (1998) Beck depression inventory: Psychometric properties of the Portuguese version. Rev Psi Clin, 25, 245-250. [27] Pimenta, C.A. and Da Cruz Dde, A. (2006) Chronic pain beliefs: Validation of the survey of pain attitudes for the Portuguese language. Revista da Escola Enfermagem da USP, 40, 365-373. [28] Mingoti, S.A. (2005) Analyze data using multivariate statistical methods: An applied approach. Federal University of Minas Gerais (UFMG), Belo Horizonte. [29] Hair, J.F., Black, W.C., Babin, B.J., et al. (2009) Multi-variate data analysis. 6th Edition, Prentice Hall, Upper Saddle River. [30] Possoli, S. (1984) Multivariate analysis techniques for the assessment of the health status of the “counties” of State of Rio Grande do Sul, Brazil. Revista de Saúde Pública, 18, 288-300. doi:10.1590/S0034-89101984000400004 [31] Turk, D.C., Okifuji, A., Starz, T.W., et al. (1998) Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care & Research, 11, 397-404. doi:10.1002/art.1790110511 [32] Mongini, F., Rota, E., Evangelista, A., et al. (2009) Personality profiles and subjective perception of pain in head pain patients. Pain, 144, 125-129. doi:10.1016/j.pain.2009.03.026 [33] Brant, L.C. and Minayo-Gomes, C. (2004) The transformation process of suffering into illness: From the birth of the clinic to the psychodynamic work. Ciência & Saúde Coletiva, 9, 213-223. doi:10.1590/S1413-81232004000100021 [34] Silva, F.C.M., Sampaio, R.F., Mancini, M.C., et al. (2011) A qualitative study of workers with chronic pain in Brazil and its social consequences. Occupational Therapy International, 18, 85-95. doi:10.1002/oti.302 [35] Crook, J., Milner, R., Schultz, I.Z., et al. (2002) Determinants of occupational disability following a low back Injury: A critical review of the literature. Occupational Therapy International, 12, 277-295. doi:10.1023/A:1020278708861 [36] Rainville, P., Bao, Q.V.H. and Chrétien, P. (2005) Pain-related emotions modulate experimental pain perception and autonomic responses. Pain, 118, 306-318. doi:10.1016/j.pain.2005.08.022 [37] Denison, E., Asenlof, P., Sandborgh, M., et al. (2007) Musculoskeletal pain in primary health care: Subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables. The Journal of Pain, 8, 67-74. doi:10.1016/j.jpain.2006.06.007 [38] Paller, C.J., Campbell, C.M., Edwards, R.R., et al. (2009) Sex-based differences in pain perception and treatment. Pain Medicine, 10, 289-299. doi:10.1111/j.1526-4637.2008.00558.x [39] Smitherman, A.H. (2012) Psychological predictors of pain responsivity: Explaining race and sex differences. Ph.D. Thesis, University of Alabama, Tuscaloosa. [40] Rentsch, D., Piguet, V., Cedraschi, C., et al. (2009) Chronic pain and depression: A return trip? Revue Medicale Suisse, 5, 1364-1369. [41] Dersh, J., Polatin, P.B. and Gatchel, R.J. (2002) Chronic pain and psychopathology: Research findings and theoretical considerations. Psychosomatic Medicine, 64, 773- 786. doi:10.1097/01.PSY.0000024232.11538.54
[1] World Health Organization (2008) WHO treatment guideline on non-malignant pain in adults. WHO, Geneva, 14. [2] Sá, K., Baptista, A.F., Matos, M.A. and Lessa, I. (2009) Prevalence of chronic pain and associated factors in the population of Salvador, Bahia. Revista de Saúde Pública, 43, 622-630. doi:10.1590/S0034-89102009005000032 [3] Kreling, M.C.G.D., Cruz, D.A.L.M. and Pimenta, C.A.M. (2006) Prevalence of chronic pain in adult workers. Re- vista Brasileira de Enfermagem, 59, 509-513. doi:10.1590/S0034-71672006000400007 [4] Gheldof, E.L., Vinck, J., Van den Bussche, E., et al. (2006) Pain and pain-related fear are associated with functional and social disability in an occupational setting: Evidence of mediation by pain-related fear. European Journal of Pain, 10, 513-525. doi:10.1016/j.ejpain.2005.07.005 [5] Turner, J.A., Franklin, G., Heagerty, P.J., et al. (2004) The association between pain and disability. Pain, 112, 307- 314. doi:10.1016/j.pain.2004.09.010 [6] Castro, M.M. and Daltro, C. (2009) Sleep patterns and symptoms of anxiety and depression in patients with chronic pain. Arquivos de Neuro-Psiquiatria, 67, 25-28. doi:10.1590/S0004-282X2009000100007 [7] McWilliams, L.A., Cox, B.J. and Enns, M.W. (2003) Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106, 127-133. doi:10.1016/S0304-3959(03)00301-4 [8] Ratzon, N.Z., Jarus, T. and Catz, A. (2007) The relationship between work function and low back pain history in occupationally active individuals. Disability and Rehabilitation, 29, 791-796. doi:10.1080/09638280600919681 [9] Mossey, J.M., Gallagher, R.M. and Tirumalasetti, F. (2000) The effects of pain and depression on physical functioning in elderly residents of a continuing care retirement community. Pain Medicine, 1, 340-350. doi:10.1046/j.1526-4637.2000.00040.x [10] Gatchel, R.J., Peng, Y.B., Peters, M.L., et al. (2007) The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581-624. doi:10.1037/0033-2909.133.4.581 [11] Geertzen, J.H., Van Wilgen, C.P., Schrier, E., et al. (2006) Chronic pain in rehabilitation medicine. Disability and Rehabilitation, 28, 363-367. doi:10.1080/09638280500287437 [12] Sampaio, R.F., Mancini, M.C., Gon?alves, G.G.P., et al. (2005) Application of the international classification of functioning, disability and health (ICF) in physiotherapists clinical practice. Brazilian Journal of Physical Therapy, 9, 1-7. [13] Linton, S.J., Buer, N., Vlaeyen, J., et al. (2000) Are fear avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psychology & Health, 14, 1051-1059. doi:10.1080/08870440008407366 [14] Burns, J.W., Kubilus, A., Bruehl, S., et al. (2001) A fourth empirically derived cluster of chronic pain patients based on the Multidimensional Pain Inventory: Evidence for repression within the dysfunctional group. Journal of Consulting and Clinical Psychology, 69, 663-673. doi:10.1037/0022-006X.69.4.663 [15] Turk, D.C. and Okifuji, A. (2002) Psychological factors in chronic pain: Evolution and revolution. Journal Consulting and Clinical Psychology, 70, 678-690. [16] Alcantara, M.A., Sampaio, R.F., Pereira, L.S.M., et al. (2010) Disability associated with pain—A clinical approximation of the mediating effect of belief and attitudes. Physiotherapy Theory and Practice, 26, 459-467. doi:10.3109/09593980903580233 [17] Turk, D.C. (2005) The potential of treatment matching for subgroups of patients with chronic pain: Lumping versus splitting. Clinical Journal of Pain, 21, 44-55. doi:10.1097/00002508-200501000-00006 [18] Corbière, M., Sullivan, M.J.L., Stanish, W.D., et al. (2007) Pain and depression in injured workers and their return to work: A longitudinal study. Canadian Journal of Behavioural Science, 39, 23-31. doi:10.1037/cjbs2007002 [19] Gironda, R.J. and Clark, M.E. (2008) Cluster analysis of the pain outcomes questionnaire. Pain Medicine, 9, 813- 823. doi:10.1111/j.1526-4637.2007.00397.x [20] Von Korff, M. and Miglioretti, D.L. (2005) A prognostic approach to defining chronic pain. Pain, 117, 304-313. doi:10.1016/j.pain.2005.06.017 [21] Brazil Ministry of Social Welfare (2003) Normative No. 98. http://www.prt21.mpt.gov.br/fepmat/inst_normativa.htm [22] Castro, C.E.S. (2001) Formulation linguistics pain: Linguistic value and clinical pain complaints. Revista Dor Pesquisa Clínica e Terapêutica, 3, 114-122. [23] Grafton, K., Foster, N. and Wright, C. (2002) Evaluation of the test-retest reliability of the short-form McGill pain questionnaire. Physiotherapy, 88, 108. doi:10.1016/S0031-9406(05)60934-0 [24] Jensen, M.P., Strom, S.E., Turner, J.A., et al. (1992) Validity of the sickness impact profile Roland scale as a measure of dysfunction in chronic pain patients. Pain, 50, 157-162. doi:10.1016/0304-3959(92)90156-6 [25] Nusbaum, L., Natour, J., Ferraz, M.B., et al. (2001) Translation, adaptation and validation of the Roland-Morris questionnaire—Brazil Roland-Morris. Brazilian Journal of Medical and Biological Research, 34, 203-210. doi:10.1590/S0100-879X2001000200007 [26] Gorestein, C. and Andrade, L. (1998) Beck depression inventory: Psychometric properties of the Portuguese version. Rev Psi Clin, 25, 245-250. [27] Pimenta, C.A. and Da Cruz Dde, A. (2006) Chronic pain beliefs: Validation of the survey of pain attitudes for the Portuguese language. Revista da Escola Enfermagem da USP, 40, 365-373. [28] Mingoti, S.A. (2005) Analyze data using multivariate statistical methods: An applied approach. Federal University of Minas Gerais (UFMG), Belo Horizonte. [29] Hair, J.F., Black, W.C., Babin, B.J., et al. (2009) Multi-variate data analysis. 6th Edition, Prentice Hall, Upper Saddle River. [30] Possoli, S. (1984) Multivariate analysis techniques for the assessment of the health status of the “counties” of State of Rio Grande do Sul, Brazil. Revista de Saúde Pública, 18, 288-300. doi:10.1590/S0034-89101984000400004 [31] Turk, D.C., Okifuji, A., Starz, T.W., et al. (1998) Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care & Research, 11, 397-404. doi:10.1002/art.1790110511 [32] Mongini, F., Rota, E., Evangelista, A., et al. (2009) Personality profiles and subjective perception of pain in head pain patients. Pain, 144, 125-129. doi:10.1016/j.pain.2009.03.026 [33] Brant, L.C. and Minayo-Gomes, C. (2004) The transformation process of suffering into illness: From the birth of the clinic to the psychodynamic work. Ciência & Saúde Coletiva, 9, 213-223. doi:10.1590/S1413-81232004000100021 [34] Silva, F.C.M., Sampaio, R.F., Mancini, M.C., et al. (2011) A qualitative study of workers with chronic pain in Brazil and its social consequences. Occupational Therapy International, 18, 85-95. doi:10.1002/oti.302 [35] Crook, J., Milner, R., Schultz, I.Z., et al. (2002) Determinants of occupational disability following a low back Injury: A critical review of the literature. Occupational Therapy International, 12, 277-295. doi:10.1023/A:1020278708861 [36] Rainville, P., Bao, Q.V.H. and Chrétien, P. (2005) Pain-related emotions modulate experimental pain perception and autonomic responses. Pain, 118, 306-318. doi:10.1016/j.pain.2005.08.022 [37] Denison, E., Asenlof, P., Sandborgh, M., et al. (2007) Musculoskeletal pain in primary health care: Subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables. The Journal of Pain, 8, 67-74. doi:10.1016/j.jpain.2006.06.007 [38] Paller, C.J., Campbell, C.M., Edwards, R.R., et al. (2009) Sex-based differences in pain perception and treatment. Pain Medicine, 10, 289-299. doi:10.1111/j.1526-4637.2008.00558.x [39] Smitherman, A.H. (2012) Psychological predictors of pain responsivity: Explaining race and sex differences. Ph.D. Thesis, University of Alabama, Tuscaloosa. [40] Rentsch, D., Piguet, V., Cedraschi, C., et al. (2009) Chronic pain and depression: A return trip? Revue Medicale Suisse, 5, 1364-1369. [41] Dersh, J., Polatin, P.B. and Gatchel, R.J. (2002) Chronic pain and psychopathology: Research findings and theoretical considerations. Psychosomatic Medicine, 64, 773- 786. doi:10.1097/01.PSY.0000024232.11538.54