The Clinical journal of pain
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This study examined the extent to which being involved in civil and industrial litigation predicted outcome in an population of chronic pain patients. Data were collected in a structured telephone interview for a litigant group of 80 patients and a nonlitigant group of 47 patients. There were no significant differences in the amount of medication used, the number of hours spent resting per day, or the number of individuals who were able to return to work. ⋯ Litigation was found to be the primary predictor of Zung depression scores. Discriminant function analyses indicated that litigation was not the most important variable in distinguishing between those working and not working. Results lend support to previous studies that suggest that the suspicion and disbelief with which litigating patients are often treated is unfounded.
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Previous findings in patients with nonmalignant pain indicate a relationship between pain coping strategies and psychological factors. Although coping strategies have been explored in patients with cancer pain, relationships with such factors have not been reported. We wished to examine relationships between selected pain and psychological variables and the use of pain coping strategies. ⋯ Pain intensity and state anxiety demonstrated similar relationships. Pain quality as measured with the MPQ demonstrated moderately strong correlation with diverting attention, praying and hoping, catastrophizing, and increased activity. Interventions aimed at reinforcing or expanding a patient's pain coping repertoire should be developed with consideration given to the patient's anxiety level, pain intensity, pain quality, and pain expression preference.
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Relationships between locus of control beliefs (HLC), psychological distress (GHQ-12), and coping strategies were studied in 415 subjects with low back pain (LBP) (2 of 3 were men, with a mean age of 45 years). Those with more external beliefs and symptoms of psychological distress reported more severe LBP. ⋯ Irrespective of the degree of LBP, use of more active behavioral coping strategies were more frequent in subjects who had strong beliefs in internal control over back pain. In addition, catastrophizing thoughts were more frequent in subjects who had symptoms of psychological distress.
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The treatment of chronic pain is costly and frustrating for the patient, health care provider, and health care system. This is due, in part, to the complexity of pain symptoms which are influenced by behavior patterns, socioeconomic factors, belief systems, and family dynamics as well as by physiological and mechanical components. Assessment of treatment outcomes is often limited to the patient's subjective, multidimensional, self-reports. ⋯ In this study, a 36% reduction in clinic visits in the first year postintervention was found among the 109 patients who participated in an outpatient behavioral medicine program. Decreased clinic use continued in the first 50 patients followed 2 years postintervention. Decreased use projected to an estimated net savings of $12,000 for the first year of the study posttreatment and $23,000 for the second year.
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Comparative Study
A comparison of models describing reports of disability associated with chronic pain.
We examined pain-related disability from two perspectives. A disability model, suggesting that disability is a direct consequence of pain, is compared with a symptom perception model emphasizing individual differences in perception and report of physical symptoms. Disability estimates (reported activity interference and employment status) were obtained from a sample of 179 patients with chronic pain. ⋯ When we controlled for distress, the frequency of reporting physical symptoms made the largest contribution to prediction of this kind of disability (14%). Neither symptom report or pain intensity was useful in predicting the more objective disability criterion of employment status. Results were interpreted as probable evidence against a disability model of pain-related disability and suggest the relative importance of individual cognitive differences in symptom responsivity.