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Knowledge of and Agreement with Chronic Pain Diagnosis: Relation to Affective Distress, Pain Beliefs and Coping, Pain Intensity, and Disability

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Abstract

Many authors report that a high percentage of patients with chronic pain have no or insufficient underlying physical pathology to explain their pain. Even when patients do have an identified diagnosis, many patients profess to have little understanding of the source of their pain or fear that they may suffer from more severe pathology. This may be particularly true for patients with chronic musculoskeletal pain given the lack of “objective” findings for soft tissue pain complaints. In the present study, we examined whether chronic neck and back pain patients were able to identify the physiologic source of their pain, and based on their responses patients were placed in one of three groups: (1) patients who did not know the cause of their pain; (2) patients who did know the cause and agreed with their clinical diagnosis; and (3) patients who identified a cause for their pain that was different from their clinical diagnosis. The sample was comprised primarily of individuals with musculoskeletal pain problems (70%) referred to an outpatient chronic pain rehabilitation program. Each patient completed a pretreatment test battery, and group differences were examined on responses to the McGill Pain Questionnaire, Survey of Pain Attitudes, Brief Symptom Inventory, Coping Strategies Questionnaire, and Pain Disability Index. Upon initial evaluation, 47.2%(n = 85) of patients indicated that they did not know what was causing their pain. Of patients who articulated a cause for their pain, 20%(n = 36) attributed it to factors that did not agree with their diagnosis. Only 32.8%(n = 59) of persons in the entire sample were able to accurately identify the cause of their pain. Patients who disagreed with their clinical diagnosis were more likely to be diagnosed with musculoskeletal pain and reported the highest levels of pain(F(2,169) = 3.41, p > .05) as well as the greatest levels of affective distress(F(2,169) = 3.54, p > .05). Patients who were unsure of or disagreed with their diagnosis tended to report a greater belief in pain being a signal of harm(F(2,169) = 11.5, p > .001) and described themselves as more disabled(F(2,169) = 8.43, p > .001). In addition, both the “unsure” and “disagree” groups tended to use maladaptive pain strategies more frequently, and persons unsure of their diagnosis had the lowest levels of perceived control over pain. A hierarchical regression analysis examining a cognitive/behavioral model of pain disability indicated that lack of knowledge of pain etiology, a belief that pain is a signal of harm, catastrophizing and affective distress all significantly predicted increased disability, while pain intensity did not. The data suggests that lack of knowledge about the origin of pain is associated with maladaptive cognitions in relation to pain (i.e., fear of harming oneself and catastrophizing) and increased emotional distress which in turn are related to heightened disability due to pain. These data argue that educating patients regarding their diagnosis and the origin of their pain, thereby dispelling dysfunctional pain beliefs, may be an important component of pain treatment, particularly among patients with chronic musculoskeletal pain.

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REFERENCES

  1. Glanz K, Lewis FM, Rimer BK, eds. Health behavior and health education. San Francisco: Jossey-Bass, 1990.

    Google Scholar 

  2. Gochman D, ed. Health behavior. New York: Plenum Press, 1988.

  3. Rosenstock IM. Why people use health services. Milbank Mem Fund Q Bull 1966; 44: 94.

    Google Scholar 

  4. Rosenstock IM. The Health Belief Model and preventive health behavior. Health Educ Monogr 1974; 2: 354.

    Google Scholar 

  5. Turk DC, Rudy TE. Assessment of cognitive factors in chronic pain: A worthwhile enterprise? J Consult Clin Psychol 1986; 54: 760–768.

    PubMed  Google Scholar 

  6. DeGood DE. Reducing medical patients' reluctance to participate in psychological therapies: The initial session. Prof Psychol 1983; 14: 570–579.

    Google Scholar 

  7. Lackner JM, Carosella AM, Feuerstein M. Pain expectancies, pain and functional self-efficacy as determinants of disability in patients with chronic low back disorders. J Consult Clin Psychol 1996; 64: 212–220.

    PubMed  Google Scholar 

  8. Rainville J, Ahern DK, Phalen L. Altering beliefs about pain and impairment in a functionally oriented treatment program for chronic low back pain. Clin J Pain 1993; 9: 196–201.

    PubMed  Google Scholar 

  9. Riley JF, Ahern DK, Follick MJ. Chronic pain and functional impairment: Assessing beliefs about their relationship. Arch Phys Med Rehab 1988; 69: 579–582.

    Google Scholar 

  10. Shutty MS Jr, DeGood DE, Tuttle DH. Chronic pain patients' beliefs about their pain and treatment outcomes. Arch Phys Med Rehab 1990; 71: 128–132.

    Google Scholar 

  11. Roberts N, Smith R, Bennett JC, Norton R, Kilburn P. Health beliefs and rehabilitation after lumbar disc surgery. J Psychosomat Res 1984; 28: 139–144.

    Google Scholar 

  12. Deyo RA, Diehl AK. Psychosocial predictors of distress in patients with low back pain. J Rheumatol 1988; 15: 1557–1564.

    PubMed  Google Scholar 

  13. Gallagher RM, Rauh V, Haugh L, Milhous R, Callas PW, Langelier R, McCallen JM, Frymoyer J. Determinants of return to work among low-back pain patients. Pain 1989; 39: 55–67.

    PubMed  Google Scholar 

  14. Leavitt F. The role of psychological disturbance in extending disability time among compensable back injured industrial workers. J Psychosomat Res 1990; 34: 447–453.

    Google Scholar 

  15. Turk DC, Meichenbaum D, Genest M, eds. Pain and behavioral medicine: A cognitive-behavioral perspective. New York: Guilford, 1983.

    Google Scholar 

  16. Turner JA, Clancy S. Strategies for coping with chronic low back pain: Relationship to pain and disability. Pain 1986; 24: 355–364.

    PubMed  Google Scholar 

  17. Leventhal H, Nerenz DR. A model for stress research with some implications for the control of stress disorders. In: Meichenbaum D, Jarenko M, eds. Stress reduction and prevention. New York: Plenum Press, 1983, pp. 5–38.

    Google Scholar 

  18. Rimer BK. Perspectives on interpersonal theories in health education and health behavior. In: Glanz K, Lewis FM, Rimer BK, eds. Health behavior and health education. San Francisco: Jossey-Bass, 1990, pp. 140–157.

    Google Scholar 

  19. Weiner B. An attributional theory of achievement motivation and emotion. Psychol Rev 1985; 93: 548–575.

    Google Scholar 

  20. Follick MJ, Zitter RE, Ahern DK. Failures in the operant treatment of chronic pain. In Foa EB, Emmelkamp PMG, eds. Failures in behavior therapy. New York: Wiley and Sons, 1983.

    Google Scholar 

  21. Reading AE. Attribution and the management of the pain patient. In: Antaki C, Brewin C, eds. Attributions and psychological change. New York: Academic Press, 1982, pp. 157–174.

    Google Scholar 

  22. Skevington SM. Social cognitions, personality and chronic pain. J Psychosomat Res 1983; 27: 421–428.

    Google Scholar 

  23. Deyo RA, Diehl AK. Patient satisfaction with medical care for low-back pain. Spine 1986; 11: 28–30.

    PubMed  Google Scholar 

  24. Cherkin DC, MacCornack FA. Patient evaluations of low back pain care from family physicians and chiropractors. West J Med 1989; 150: 351–355.

    PubMed  Google Scholar 

  25. Lacroix JM, Powell J, Lloyd GJ, Doxey NCS, Mitson GL, Aldam CF. Low-back pain: Factors of value in predicting outcome. Spine 1990; 15: 495–499.

    PubMed  Google Scholar 

  26. Bigos S, et al. Acute Low Back Problems in Adults, Clinical Practice Guideline. AHCPR Publication no. 95–0642, U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville, MD, 1994.

    Google Scholar 

  27. Fordyce WE, ed. Back pain in the workplace: Management of disability in nonspecific conditions. Seattle WA: IASP Press, WA, 1995.

  28. Nachemson AL. Advances in low back pain. Clin Orthop 1985; 200: 266–278.

    PubMed  Google Scholar 

  29. White AA, Gordon SC. Synopsis: Workshop on idiopathic low back pain. Spine 1982; 7: 141–149.

    PubMed  Google Scholar 

  30. Fordyce WE. Environmental factors in the genesis of low back pain. In: Bonica JJ, et al., eds. Advances in pain research and therapy, Vol. 3, Proc. IInd World Congress on Pain. New York: Raven Press, 1979, pp. 659–666.

    Google Scholar 

  31. Cherkin DC, MacCornack FA, Berg AO. Managing low back pain: A comparison of the beliefs and behaviors of family physicians and chiropractors. West J Med 1988; 149: 475–480.

    PubMed  Google Scholar 

  32. Owen-Salters E, Gatchel RJ, Polatin PB, Mayer TG. Changes in psychopathology following functional restoration of chronic low back pain patients: A prospective study. J Occup Rehab 1996; 6: 215–223.

    Google Scholar 

  33. Sanders SH. Cross-validation of the back pain classification scale with chronic, intractable pain patients. Pain 1985; 22: 271–277.

    PubMed  Google Scholar 

  34. Weintraub MI. Regional pain is usually hysterical. Arch Neurol 1988; 45: 914–915.

    PubMed  Google Scholar 

  35. Crue BL. Multi-disciplinary pain treatment programs: Current status. Clin J Pain 1985; 1: 31–38.

    Google Scholar 

  36. Coste J, Paolaggi JB, Spira A. Classification of nonspecific low back pain. I. Psychological involvement in low back pain. Spine 1992; 17: 1028–1037.

    PubMed  Google Scholar 

  37. Bonica JJ, Sola AE. Other painful disorders of the low back. In: Bonica JJ, ed. The Management of Pain (Vol. 2, 2nd Ed.). Philadelphia: Lea and Febiger, 1990, pp. 1484–1514.

    Google Scholar 

  38. Rachlin ES. Myofascial pain and fibromyalgia: Trigger point management. St. Louis: Mosby, 1994.

    Google Scholar 

  39. Travell JG, Simons DG. Myofascial pain and dysfunction: The trigger point manual (Vol. 1). Baltimore: Williams and Wilkins, 1983.

    Google Scholar 

  40. Travell JG, Simons DG. Myofascial pain and dysfunction: The trigger point manual (Vol. 2). Baltimore: Williams and Wilkins, 1992.

    Google Scholar 

  41. Bourdillon F, Day EA, Bookhout MR. Spinal manipulation (5th Ed.). Oxford: Butterworth Heineman, 1992.

    Google Scholar 

  42. Greenman PE. Principles of manual medicine (2nd Ed.). Baltimore: Williams and Wilkins, 1996.

    Google Scholar 

  43. Janda V. Muscle function testing. London: Butterworths, 1983.

    Google Scholar 

  44. Lewit K. Manipulative therapy in rehabilitation of the locomotor system (2nd Ed.). Oxford: Butterworth Heineman, 1996.

    Google Scholar 

  45. Caillet R. Forward. In: Travell JG, Simons DG, eds. Myofascial pain and dysfunction: The trigger point manual (Vol. 1). Baltimore: Williams and Wilkins, 1983, pp. vii-viii.

    Google Scholar 

  46. Merskey H. Psychosocial factors and muscular pain. In: Fricton JR, Awad E, eds. Advances in pain research and therapy, Vol. 17, Myofascial pain and fibromyalgia. New York: Raven Press, 1990, pp. 213–225.

    Google Scholar 

  47. Thompson E. Myofascial pain: Asthma of the back and back pain in the workplace. Pain 1996; 65: 111.

    Google Scholar 

  48. Lewit K. Management of muscular pain associated with articular dysfunction. In: Fricton R, Awad E, eds. Advances in pain research and therapy, Vol. 17, Myofascial pain and fibromyalgia. New York: Raven Press, 1990, pp. 315–317.

    Google Scholar 

  49. Rosomoff HL, Fishbain DA, Goldberg M, Santana R, Rosomoff RS. Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain 1989; 37: 279–287.

    PubMed  Google Scholar 

  50. Roth RS, Horowitz K, Bachman JE. Knowledge of diagnosis and satisfaction with medical care in chronic myofascial pain. Arch Phys Med Rehab. In press.

  51. Gilmore MR, Hill CT. Reactions to patients who complain of pain: Effects of ambiguous diagnosis. J Appl Social Psychol 1981; 11: 14–22.

    Google Scholar 

  52. Turk DC. Psychological assessment of patients with persistent pain. Part II: Alternative views. Pain Management 1990; 3: 227–237.

    Google Scholar 

  53. Jensen MP, Turner JA, Romano JM, Lawler BK. Relationship of pain specific beliefs to chronic pain adjustment. Pain 1994; 57: 301–309.

    PubMed  Google Scholar 

  54. Fordyce WE, Shelton JL, Dundore DE. The modification of avoidance learning in pain behaviors. J Behav Med 1982; 5: 405–414.

    PubMed  Google Scholar 

  55. Lethem J, Slade PD, Troup JDG, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception. Behav Res Ther 1983; 21: 401–408.

    PubMed  Google Scholar 

  56. Main CJ, Watson PJ. Screening for patients at risk of developing chronic incapacity. J Occup Rehab 1995; 5: 207–217.

    Google Scholar 

  57. Philips HC. Avoidance behavior and its role in sustaining chronic pain. Behav Res Ther 1987; 25: 273–279.

    PubMed  Google Scholar 

  58. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52: 157–168.

    PubMed  Google Scholar 

  59. Rose MJ, Klenerman L, Atchison L, Slade PD. An application of the fear avoidance model to three chronic pain problems. Behav Res Ther 1992; 30: 359–365.

    PubMed  Google Scholar 

  60. Vlaeyen JWS, Kole-Snidjers AMJ, Rotteveel AM, Rvesink R, Heuts PHTG. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 1995; 5: 235–252.

    Google Scholar 

  61. Flor H, Turk DC. Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables. J Behav Med 1988; 11: 251–265.

    PubMed  Google Scholar 

  62. Bonica JJ. Definitions and taxonomy of pain. In: Bonica JJ, ed. The management of pain (Vol. 1, 2nd Ed). Philadelphia: Lea and Febiger, 1990, pp. 18–27.

    Google Scholar 

  63. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975; 1: 277–299.

    PubMed  Google Scholar 

  64. Derogatis LR, Spencer PM. Administration and procedures: BSI Manual I. Baltimore: Clinical Psychometric Research, 1982.

    Google Scholar 

  65. Beck AT. Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press, 1967.

    Google Scholar 

  66. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev 1988; 8: 77–100.

    Google Scholar 

  67. Tait RC, Chibnall JT, Krause S. The Pain Disability Index: Psychometric properties. Pain 1990; 40: 171–182.

    PubMed  Google Scholar 

  68. Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause S. The Pain Disability Index: Psychometric and validity data. Arch Phys Med Rehab 1987; 68: 438–441.

    Google Scholar 

  69. Gronblad M, Hupli M, Wennerstrand P, Jarvinen E, Lukinmaa A, Kouri J, Karaharju EO. Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin J Pain 1993; 9: 189–195.

    PubMed  Google Scholar 

  70. Jensen MP, Karoly P, Huger R. The development and preliminary validation of an instrument to assess patients' attitudes towards pain. J Psychosomat Res 1987; 31: 393–400.

    Google Scholar 

  71. Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain 1983; 17: 33–44.

    PubMed  Google Scholar 

  72. Millard RW, Wells N, Thebarge RW. A comparison of models describing reports of disability associated with chronic pain. Clin J Pain 1991; 7: 283–291.

    PubMed  Google Scholar 

  73. Bookhout MR. Exercise and somatic dysfunction. Phys Med Rehab Clin North Am 1996; 7: 845–862.

    Google Scholar 

  74. Twomey LT, Taylor JR. Physical therapy of low back pain (2nd Ed.). New York: Churchill Livingstone, 1994.

    Google Scholar 

  75. Symonds TL, Burton AK, Tillotson KM, Main CJ. Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place. Spine 1995; 20: 2738–2745.

    PubMed  Google Scholar 

  76. Hazard RG. Spine update: Functional restoration. Spine 1995; 21: 2345–2348.

    Google Scholar 

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  1. Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, 1500 E. Medical Center Drive, Box 0050, Ann Arbor, Michigan, 48109

    Michael E. Geisser & Randy S. Roth

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  1. Michael E. Geisser
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Geisser, M.E., Roth, R.S. Knowledge of and Agreement with Chronic Pain Diagnosis: Relation to Affective Distress, Pain Beliefs and Coping, Pain Intensity, and Disability. J Occup Rehabil 8, 73–88 (1998). https://doi.org/10.1023/A:1023060616201

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