Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Abstract

Chronic pain patients enter treatment with different problem profiles making careful assessment a necessity for more individualized treatment plans. In this cross-sectional study we assigned 320 patients entering tertiary multidisciplinary pain treatment into four categories based on whether they scored low or high on the activity and the affective pain interference dimensions of the Brief Pain Inventory (BPI). To determine whether this categorization system delineates issues that should be assessed further, the categories were compared with ANOVA and MANOVA analyses on three domains: variables affecting physical well-being (body mass index, exercise, substance use), psychological resources (mood), and pain-specific psychological factors (pain anxiety, pain acceptance). The results indicated that subjects who scored low on both interference dimensions compared similarly in weight: mean Body Mass Index (BMI) 27.0 (SD 6.0) kg/m 2 , and exercise: mean of 2.4 (SD 1.7) exercising sessions over 20 minutes per week, to the general population, had no depressive symptoms on average: mean Beck Depression Index II (BDI-II) score 11.7 (SD 7.5), and had the most favorable psychological reactions to pain relative to the other categories: mean total Pain Anxiety Symptoms Scale-20 (PASS-20) score 36.4 (SD 17.9). In contrast, when interference was high on activity, more physical well-being problems were evident e.g. weight: mean BMI 31.0 (SD 7.3) kg/m 2 , diminished exercise: mean of 1.5 (SD 1.6) exercising sessions per week, and avoidance behavior: mean PASS-20 Escape/Avoidance subscale 3.7 (95% CI: 1.7 to 5.8) scores higher in comparison to activity interference remaining low. With high affective interference, more depressive symptoms: mean BDI-II score 17.7 (SD 7.3), and more cognitive pain anxiety: mean PASS-20 Cognitive Anxiety subscale 2.8 (95% CI 0.7 to 4.8) scores higher in comparison to affective interference remaining low, emerged. Having high interference on both dimensions indicated accumulated risks for reduced physical well-being: mean BMI 29.9 (SD 6.1) kg/m 2 , mean of 1.2 (SD 1.7) exercising sessions per week, mood problems: mean BDI-II 20.3 (SD 10.6), and negative psychological reactions to pain: mean total PASS-20 score 53.2 (18.4). The results suggest that low interference on both dimensions may allow assessment with only physician consultations, while high interference on either dimension may call attention to distinct issues to be addressed with the help of a physiotherapist or a psychologist, whereas high interference on both dimensions highlights the need for a full multidisciplinary assessment.

Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study

“…The composite score “pain-severity” was constructed as a mean of the four pain intensity items of the BPI (baseline, worst, weakest, mean). The two dimensions of pain-interference were derived as a composite score (mean) of the “activity” (walking, work, general activity) and “affective” items (mood, relation with others, enjoyment of life, sleep) of the BPI, as described previously [ 22 ]. Pain-relief received by medications or treatments during the last week’s treatments was rated on a numerical scale 0 (no relief)–10 (complete relief) point scale [ 22 ].…”

“…The two dimensions of pain-interference were derived as a composite score (mean) of the “activity” (walking, work, general activity) and “affective” items (mood, relation with others, enjoyment of life, sleep) of the BPI, as described previously [ 22 ]. Pain-relief received by medications or treatments during the last week’s treatments was rated on a numerical scale 0 (no relief)–10 (complete relief) point scale [ 22 ]. Numerical rating (NRS) intensity scale for pain and pruritus—Pain and pruritus intensity were evaluated by the patient using a numerical rating scale (NRS), at baseline (at the time of consultation) and with a recall period of seven days for the worst, mean and weakest intensities [ 23 ].…”

A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

“…In accordance with previous literature, pain interference scores ≥7 were categorized as high [ 27 ].…”

The Effect of Pain Catastrophizing on Depression among Older Korean Adults with Chronic Pain: The Mediating Role of Chronic Pain Interference and Sleep Quality

“…Chronic pain interference leads to a loss of control over the elderly’s lives [ 9 ] and prevents older adults from procuring sufficient rest and sleep [ 47 ]. Chronic pain interferes with sleep, reduces activity levels, and lowers mood [ 52 ]. The last path that emerged suggests that chronic pain interference and sleep quality are vital factors in the management of depression among older adults.…”