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The findings highlight the important roles of trauma history and recent life events in adjustment to cancer and have implications for screening and treatment.

Through empirical methods we now characterize patients with chronic pain as either dysfunctional, interpersonally distressed, or adaptive copers. Studying factors that differentiate these groups may reveal the behavioral processes that determine adjustment to pain. Subjects for this study were 190 patients referred for treatment of chronic pain. They were classified as dysfunctional (n = 41), interpersonally distressed (n = 28) or adaptive copers (n = 59) based on the Multidimensional Pain Inventory (Kerns, R.D., Turk, D.C. and Rudy, T.E., The West Haven-Yale Multidimensional Pain Inventory (WHYMPI), Pain, 23 (1985) 345-356) and compared on measures of pain-related anxiety and pain acceptance. Our analyses showed that the dysfunctional group reported greater pain-related anxiety and less acceptance of pain than the other groups. Additional analyses, statistically controlling for pain severity and depression, showed that the patient subtypes continued to differ on pain-related anxiety and acceptance. Discriminant function analyses including pain-related anxiety and acceptance correctly classified 72.5% of dysfunctional and 90.9% of adaptive copers. Again, anxiety and acceptance contributed uniquely to classification independent of depression and pain intensity. Pain-related anxiety and acceptance of pain appear to be unique behavioral dimensions of adjustment to chronic pain. Decreasing anxiety and increasing acceptance may 'move' patients with chronic pain from the dysfunctional to the adaptive coper category.

This study examines the relationship between a trauma history and emotional functioning in response to a chronic pain condition. We broadened the traditional study of trauma in chronic pain from sexual and physical abuse to include a variety of traumatic events and experiences that occurred not only during childhood, but during adulthood as well. Seventy-three (51% female, 60% lower back) chronic pain patients were administered the Trauma History Questionnaire (Green, B.L., Trauma History Questionnaire. In B.H. Stamm (Eds.), Measurement of Stress, Trauma and Adaptation, Sidran, Lutherville, MD, 1996, pp. 366-369), the Multidimensional Pain Inventory (Kerns, R.D., Turk, D.C. and Rudy, T.E., The West Haven-Yale Multidimensional Pain Inventory (WHYMPI), Pain, 23 (1985) 345-356), The Beck Depression Inventory (Beck, A.T., Ward, C.H., Mendelson, M., Mock, J. and Erbaugh, J., An inventory for measuring depression, Arch. Gen Psychiatry, 4 (1961) 561-571), and the Pain Anxiety Symptoms Scale (McCracken, L.M., Zayfert, C., Gross, R.T. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain, Pain, 50 (1992) 67-73) prior to starting a multidisciplinary pain program. We hypothesized that high levels of emotional distress and anxiety would differentiate patients with a substantial history of trauma from those without, while levels of pain severity and disability would not. A MANOVA revealed a significant Trauma Group (low vs. high) by Gender interaction for the dependent variables, which included both measures of emotional distress and pain severity and disability. Univariate tests showed that the interaction was significant only for emotional distress variables and not for pain severity and disability. Further, the multivariate effect of Trauma Group and the univariate effects for emotional distress variables were significant only among men. Results indicate that a substantial history of trauma may detrimentally impact a chronic pain patient's ability to manage their pain effectively, particularly among men.