Pain Catastrophizing and Beliefs Predict Changes in Pain Interference and Psychological Functioning in Persons With Spinal Cord Injury

Abstract

The current study sought to examine how changes in pain-related beliefs and coping responses are related to changes in pain interference and psychological functioning in individuals with spinal cord injuries (SCI) and pain. To measure longitudinal changes in these variables, respondents completed a survey which included measures of pain intensity, pain interference, and psychological functioning, as well as specific psychosocial variables (pain-related beliefs, coping, and social support), and then completed the same survey 6 months later; analyses included only the individuals who reported pain at both times (N = 40). Demographic and injury-related variables were also assessed, but none were found to be significantly associated with changes in functioning. Changes in catastrophizing and belief in one's ability to control pain were each significantly associated with changes in the outcome variables: greater pain interference and poorer psychological functioning. Changes in specific coping strategies and social support were not predictors of changes in pain, interference, or psychological functioning . These findings support a biopsychosocial model of pain in persons with SCI. Intervention studies targeting maladaptive pain-related beliefs and catastrophizing may help to identify the causal nature of these relationships and may improve multidisciplinary treatment of pain in SCI.Perspective-Intervention studies targeting catastrophizing and maladaptive pain-related beliefs may be the next step in determining which variables play a causal role in the pain interference and psychological functioning of individuals with pain and SCI. Keywords coping; cognitions; spinal cord injury; pain; mental health; catastrophizing Pain is a common 8,16 and often difficult to treat 4,50,51 problem in persons with spinal cord injuries (SCI) which can be associated with increased physical and psychological dysfunction, independent of the effects of the injury. 16,27,32,41,43 Given the refractory nature of pain in

Psychological resources in spinal cord injury: a systematic literature review

“…32 Persons with SCI and pain experienced lower HSE and exercise SE than persons without pain. 33,38 High pain control was associated with less pain interference 39,40 and lower pain intensity, 40 while inconsistent relationships of SE with these variables were found. 32,33,38,41 Mental health.…”

“…Persons with high GSE, HSE or pain control were consistently less anxious or depressed, [32][33][34]38,41,42 and reported better mental health. 39,40 However, these studies were cross-sectional and statements about the direction of relationships or causality cannot be made.…”

Chronic Pain in People with Physically Disabling Conditions: A Review of the Application of Biopsychosocial Models

“…Among the many studies of individuals with spinal cord injury pain, veterans with the condition appear to have higher levels of pain catastrophizing than non-veterans (Ullrich, Jensen, Loeser, Cardenas, & Weaver, 2008). While most of these studies are cross-sectional in nature, a prospective study of people with spinal cord injury with chronic pain found that over a six month period decreases in pain catastrophizing were associated with decreased pain interference and improved psychological functioning (Hanley, Raichle, Jensen, & Cardenas, 2008). Conversely, a similar study in phantom limb pain found that pain catastrophizing at one month following amputation (that is, before chronic pain had developed) was predictive of decreased depressive symptoms and pain-related interference at both 12 and 24 months (Hanley, et al, 2004).…”

“…Perceived control over pain has also been investigated, and there is less extensive evidence to support its role in relation to psychological functioning and disability in those with chronic pain secondary to physically disabling conditions. A study of people with spinal cord injury related chronic pain found that increases in perceived control over pain in a six month period was related to decreased pain intensity and pain interference, as well as increased psychological functioning, although the former was a non-significant finding (Hanley, et al, 2008). External locus of control in relation to pain as also been positively associated with depression among people with spinal cord injury related pain (Wollaars, et al, 2007).…”

“…The authors suggest that some of these differences may be attributable to different background levels of the use of behavioural strategies such as resting and guarding, which may already be employed for non-pain related reasons among those with physically disabling conditions, and increased reliance on cognitive strategies over which they may be hypothesized to have more control. The association of particular coping strategies with pain intensity or associated psychological distress or disability has been explored in a number of physically disabling conditions, including spinal cord injury, but with few significant relationships detected (Hanley, et al, 2008;Turner, et al, 2002). In some other studies, however, significant relationships have been found.…”