Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain

Abstract

Individuals with chronic pain show a greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The current study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of PROMIS Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress appears to be disruption of social relationships, rather than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification

“…Computer adaptive testing approaches also can be implemented, which greatly reduce respondent burden. 103, 104 In addition, more comprehensive approaches can be useful in phenotyping and mechanistic-based research. Work from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has helped to identify the primary domains that should be used as outcome measures (eg, end points) in the context of clinical trials of pain treatments, which include: 1) pain intensity, 2) physical functioning, 3) emotional functioning, 4) overall improvement/well-being, and (5) side effects.…”

Assessment of Chronic Pain: Domains, Methods, and Mechanisms

“…For example, the Patient Reported Outcomes Measurement Information Systems (PROMIS) has implemented computer adaptive testing to optimize the efficiency of reliable and valid assessment of patient reported outcomes, including pain. PROMIS measures have recently been implemented in a chronic pain registry in order to collect research quality data in the context of clinical care 82, 83 . Also, numerous pain assessment apps are available for mobile devices; however, most of the scientifically validated apps are not available in app stores 16 .…”

Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit

“…Pain is a global health problem with broad negative impacts on physical (Sturgeon, Darnall, Kao, & Mackey, 2015; Sturgeon, Dixon, Darnall, & Mackey, 2015), mental (Bair, Robinson, Katon, & Kroenke, 2003; Feinstein et al, 2017; Ziadni, Sturgeon, & Darnall, 2018), spiritual (Halawa, Al-Diri, McLean, & Darnall, 2015), psychosocial (Karos, Meulders, Goubert, & Vlaeyen, 2018; Karos, Williams, Meulders, & Vlaeyen, 2018; Sturgeon et al, 2016; Ziadni, You, Wilson, & Darnall, 2018), and economic domains (Groenewald, Essner, Wright, Fesinmeyer, & Palermo, 2014; Gustavsson et al, 2012). The 2016 Institute of Medicine report on Relieving Pain in America estimated that roughly one-third of the world population is living with ongoing pain of some type (IOM Committee on Advancing Pain Research, 2011).…”