The findings support a biopsychosocial model of long-term adjustment to amputation and PLP. In addition, results suggest that some psychosocial variables are more important than others for predicting adjustment, providing important implications for early interventions after amputation.

Abstract-This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper-and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full-or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered.

Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain-related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease-related factors. Participants were 125 community-dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease-related variables (p<.001). These variables explained an additional 22% of the variance in pain-related interference (p<.001) and 43% of the variance in psychological functioning (p<.001), after adjusting for demographic and MS-related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.

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The current study examined the utility of a biopsychosocial model of chronic pain, and the associations between specific pain-related beliefs, coping, and social support and both mental health and pain interference, in persons with Spinal Cord Injury (SCI) and pain. A total of 157 patients completed surveys assessing physical and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Greater catastrophizing and pain-related beliefs (e.g., the belief that pain signals damage) were related with increased pain interference and poorer mental health, while coping styles (e.g., resting, asking for assistance) were related only with pain interference. Alternatively, greater perceived social support was related with better mental health. The findings are consistent with a biopsychosocial model, implicating the need to consider the impact of process and clinical variables on adjustment to chronic pain in persons with SCI.Perspective: This article identifies several psychosocial variables, including coping, catastrophizing, pain-related beliefs, and social support, that are related to adjustment in persons with SCI and pain. These results have implications for interventions designed to treat pain interference in persons with SCI.Keywords mental health; coping; spinal cord injury; pain Pain following spinal cord injury (SCI) is well-documented, with prevalence rates from 11% to 94%, and reports of 'current' pain problems between 67% to 79% 14. Pain in persons with SCI has been found to interfere with daily activities beyond the functional limitations related to the injury 47,52,60,69,70. A recent survey found that participants with SCI-related pain rated only a few pharmacological pain treatments as more than "somewhat" helpful 76.These issues highlight the importance of identifying psychosocial variables related to adjustment and pain interference in persons with SCI-related pain. Biopsychosocial models of pain recognize the likely impact of both biological and psychosocial components. The most common psychosocial categories within the biopsychosocial model (i.e., cognitions and appraisals, coping responses, and social environmental variables 50) have evidenced Correspondence to: Katherine A. Raichle, Ph.D., Department of Psychology, Seattle University, 901 12 th Ave, Box 222000, Seattle, WA 98122-1090. Tel.: 206-296-2815. Fax: 206-296-2141. E-mail: raichlek@seattleu.edu + Now at Department of Psychology, Seattle University, Seattle, WA;°N ow at Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and al...