Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance

Abstract

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.

Acceptance: What's in a Name? A Content Analysis of Acceptance Instruments in Individuals With Chronic Pain

“…One instrument Items that belonged to a factor labeled "believing that controlling thoughts controls pain", were found not to fit within the found structure, and were eliminated from subscale calculation 30 . Later research favored two instead of three factors, i.e.…”

“…The scoring procedure described by Geiser (1992) did not include these five items either. The item selection and scoring procedure proposed by McCracken and colleagues 30 nearly resembled the original one proposed by Geiser (1992). While the original scoring included 24 of the 34 items, the one proposed by McCracken and colleagues included 21 of the 24 selected by Geiser and one item (item 15) that was not originally selected.…”

“…One approach stems from behaviorism, and defines acceptance as "… a willingness to remain in contact with and to actively experience particular private experiences" 18 . Within this tradition, McCracken and colleagues 30 started research in chronic pain. Research has identified two core constituents of acceptance: a willingness to experience pain, and the engagement into valued-based life activity despite pain 32, 51,53 .…”

“…30 subsequently examined the factor structure of the original 34 -item pool. They found evidence for a three-factor structure constituting of the subscales (1) Engaging in normal life activities (10 items); (2) Recognizing that pain may not change (4 items); and (3) Needing to avoid or control pain (8 items).…”

Evolução psicossomática e clínica de pacientes com estenose do canal lombar operados com sistema interespinhoso

“…65,66 As is known, this aspect has an especially important role in situations of chronic pain. 67,68 We also evaluated pain at the time it was felt, and over the two years post-surgery as some authors have recommended. 69 The VAS value obtained preoperatively averaged higher than six in all of the areas studied, regressing 5.6 points (p < 0.001) in the lower limbs and 4.9 points (p < 0.001) in the lumbar region.…”