Self-perceived burden in chronic pain: Relevance, prevalence, and predictors

Abstract

Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual's chronic pain, none have examined patients' perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.

Self-perceived burden, perceived burdensomeness, and suicidal ideation in patients with chronic pain

“…This measure of functional limitation has been found to show good internal consistency and sensitivity to change. 9,38 The internal consistency in this sample was excellent (α = 0.91).…”

“…1 The prevalence of a problematic sense of self-perceived burden is quite high in some medical populations, ranging from 26% to 65% among patients receiving palliative care for cancer, [2][3][4][5][6] 65% to 70% among stroke survivors, 7,8 and over 70% among patients entering treatment for chronic nonmalignant pain. 9 Self-perceived burden has been correlated with measures of pain, disability, and depression in different patient groups. In the palliative care setting, it has been associated with expressions of a desire for death and an interest in receiving physician-assisted suicide.…”

“…2,10,11 In chronic pain, it has been associated specifically with selfreports of SI. 9,12,13 The second body of research is grounded in the interpersonal theory of suicide, 14,15 which proposes that serious SI depends on the emergence of two psychological precursor conditions, namely, thwarted belongingness and perceived burdensomeness. Thwarted belongingness refers to an unmet need for a sense of social connection and is reflected in issues such as isolation, loneliness, and impoverished social networks.…”

Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience

“…This SPB may have a negative impact upon psychological wellbeing and is predictive of suicidal ideation [56]. Feelings of SPB are important to target in pain management, particularly due to its positive correlation with pain intensity, depression and anxiety [57,58], and its impact on the well-being of patient friends and families, who are at increased risk of suffering depression and anxiety [59]. Outpatient social support through the use of peer and family mentoring discussions may therefore be informed by staff knowledge of ongoing pain, in order to improve such social support.…”

The Conundrum of Treating Chronic Pain in Older Adults

“…Patients with persistent severe pain are significantly more likely to attempt suicide than those without pain. In particular, pain intensity, mental defeat, functional limitations, and being perceived as a burden to others is strongly associated with suicidal ideation and attempts [12][13][14]. Even after controlling for life-limiting diseases, those with severe chronic pain die at a 50% higher rate (especially from cardiovascular events) over 10 years than those without pain [15].…”