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Attitudes toward pain and quality of life among chronic pain patients with high versus low perceived disability
Abstracts (811) Sex differences in the responses of healthy adults to the Multidimensional Affect and Pain Survey (MAPS) and to questionnaires on mood, depression, anger and anxiety W. Clark, B. Cesario, M. Hobara, J. Kuhl; Columbia University, New York, NY The healthy, pain-free, paid volunteers were 37 women, aged (mean, SD) 31.5 years (7.9) and 25 men, 30.l3 (8.8). Following the presentation of 16 noxious and non-noxious cold and heat stimuli, subjects rated on each occasion the intensity of the descriptive items on the 189 item MAPS. Women gave significantly higher intensity ratings to items in 3 clusters within the Sensory Pain and Emotional Pain Superclusters but not the Well-being Supercluster; this suggests that the women are slightly more apt to respond to some descriptors in a more emotional manner than men. On the Profile of Mood States, within the Clearheaded - Confused subscale women scored higher on Mixed-up and Shaky, and within the Confident - Unsure subscale, women scored higher on Weary, t ⫽ 1.98 to 2.51, df ⫽ 47, p ⫽ .015 to .050. On the Beck Depression Inventory-II, women were significantly higher on four items, Sadness, Indecisiveness, Concentration Difficulty, and Loss of Interest in Sex, t ⫽ 1.97 to 2.65, df ⫽ 60, p ⫽ .013 to .05. On the Spielberger Physical and Verbal Anger Questionnaires no sex differences were found. On the Expression of Anger Questionnaire, although there were no sex differences on the inwardly directed anger scale, women were higher than men on 7 of the 8 items on the expression of outwardly directed anger scale. On the Spielberger State Anxiety questionnaire the sexes did not differ on any of the items in the State Anxiety scale, but men were significantly less anxious than women on 5 items in the State NonAnxiety scale, e.g., I Feel Secure, I Feel Comfortable, and I Am Relaxed. Similar results were found for the Spielberger Trait Anxiety questionnaire. Although the number of differences is small, women appear more likely to feel slightly depressed, anxious, angry, and less confident than men.
F07 - Pain and Illness: Behavior (812) Exploratory principle components analysis of the Pain Medication Attitudes Questionnaire J. Hoskins, L. McCracken, C. Eccleston; Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK The Pain Medication Attitudes Questionnaire (PMAQ) is composed of seven scales assessing attitudes and beliefs of chronic non-malignant pain patients towards their use of pain medications. Scale development integrated items derived from the literature, pain clinicians, and patient focus groups. Item and scale analyses resulted in a 47-item measure assessing 7 pain medication attitudes: addiction, unfavourable scrutiny, side effects, tolerance, withdrawal, perceived need, and mistrust of doctors. These seven scales had good internal consistency showing Cronbach’s alpha coefficients of between 0.77 and 0.90. The scales have face validity for clinicians and patients alike, measuring meaningful aspects of concern about chronic use of analgesic medications. The aim of this study was to explore the structure of these attitudes towards pain medications using a principle components analysis of the 47 PMAQ items. The number of components to be extracted was determined following examination of eigenvalues, a scree plot, and component markers. The initial components obtained were rotated both orthogonally and obliquely. The analysis revealed that a six-component solution best described the data. Of the original 47 items, 35 were retained and 12 discarded. Three components (side effects, scrutiny, and doctor/patient relationships) replicated the scales of the PMAQ. However, the other three components revealed an alternative component structure for PMAQ items. Both addiction and withdrawal items combined to form a component concerned not only with addiction but also vigilance for withdrawal symptoms and interpretation of these symptoms as an indication of addiction. Perceived need items formed a component reflecting a perception of pain medications as a core component of treatment and combined with tolerance items forming a component concerning the maintenance of analgesic effects from medication. This analysis provides an informative interpretation of concerns about chronic analgesic use reflecting patients’ perceptions of the consequences of consuming analgesic medication over a prolonged period.
S61 (813) Cigarette smoking and chronic pain: Relationship to pain severity and affective distress M. Davidson, P. Davidson, D. Tripp, Y. Borshch; Queen’s University, Kingston, ON Little research exists regarding the relationship between cigarette smoking and chronic pain. Jamison et al. (Addict Behav, 1991) reported that 54% of their sample of chronic low-back pain patients smoked, and suggested that these patients have an increased need to smoke during periods of greater pain. Further, smokers reported significantly higher levels of affective distress than nonsmokers. The present study was designed to replicate and extend these findings in a general chronic pain population. Forty-one chronic pain patients referred to a chronic pain service completed the McGill Pain Questionnaire-SF (MPQ-SF; pain severity) and the Beck Depression Inventory (BDI; affective distress). Smoking status was indicated through a demographic questionnaire. 39% of chronic pain patients indicated they smoked. Logistic regression analyses were used to predict smoking status from pain severity and affective distress. The overall regression equation was significant (p ⬍ .05). The Sensory scale of the MPQ-SF emerged as a significant predictor of smoking status, such that higher scores were associated with higher rates of smoking (p ⬍ .02). The MPQ-SF Affective scale did not significantly predict smoking, although inspection of the means indicated a trend for smokers to score higher than nonsmokers. Affective distress did not predict smoking status. Possible explanations for this relationship are discussed, including the use of smoking as a coping strategy, and the physiological and psychological “benefits” of smoking during severe pain.
(814) Attitudes toward pain and quality of life among chronic pain patients with high versus low perceived disability N. Sonty, S. Park; Columbia University, New York, NY Attempts to conceptualize chronic pain have moved from a unidimensional model to a multidimensional one by incorporating into the paradigm physiological, psychological, and social factors. Extant research suggests that there is a high comorbidity between a number of medical illnesses and psychological distress and a strong correlation between perceptions of increased disability with poorer treatment outcome. The current study examined psychological distress, perception of pain-related disability, and quality of life in a sample of 57 chronic pain patients. It was predicted that individuals perceiving greater disability would report poorer quality of life and greater psychological distress. Data was based on clinical interviews and two self-report measures – the Survey of Pain Attitudes (SOPA) and a quality of life measure. Based on the score on the SOPA Disability subscale, the sample was divided into the high perceived disability group (n⫽27) and the low perceived disability group (n⫽30). Results indicated that patients in the high perceived disability group reported significantly greater pain-related interference on measures of quality of life such as general activity level (t⫽ ⫺2.685, p⫽ .01), normal work routine (t⫽ ⫺3.182, p⫽ .002), enjoyment of life (t⫽ ⫺2.478, p⫽ .016), and ability to concentrate (t⫽ ⫺3.729, p⫽.00) compared to patients in the low perceived disability group. Furthermore, patients reporting high perceived disability were more likely to endorse current suicidal ideation (t⫽3.133, p⫽ .003), hopelessness (t⫽2.138, p⫽ .037), and decreased energy levels (t⫽⫺2.120, p⫽.038) than those reporting low perceived disability. The results of this preliminary study highlight the role of perceived pain-related disability in contributing to psychological distress and poorer quality of life.
F07 - Pain and Illness: Behavior (812) Exploratory principle components analysis of the Pain Medication Attitudes Questionnaire J. Hoskins, L. McCracken, C. Eccleston; Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK The Pain Medication Attitudes Questionnaire (PMAQ) is composed of seven scales assessing attitudes and beliefs of chronic non-malignant pain patients towards their use of pain medications. Scale development integrated items derived from the literature, pain clinicians, and patient focus groups. Item and scale analyses resulted in a 47-item measure assessing 7 pain medication attitudes: addiction, unfavourable scrutiny, side effects, tolerance, withdrawal, perceived need, and mistrust of doctors. These seven scales had good internal consistency showing Cronbach’s alpha coefficients of between 0.77 and 0.90. The scales have face validity for clinicians and patients alike, measuring meaningful aspects of concern about chronic use of analgesic medications. The aim of this study was to explore the structure of these attitudes towards pain medications using a principle components analysis of the 47 PMAQ items. The number of components to be extracted was determined following examination of eigenvalues, a scree plot, and component markers. The initial components obtained were rotated both orthogonally and obliquely. The analysis revealed that a six-component solution best described the data. Of the original 47 items, 35 were retained and 12 discarded. Three components (side effects, scrutiny, and doctor/patient relationships) replicated the scales of the PMAQ. However, the other three components revealed an alternative component structure for PMAQ items. Both addiction and withdrawal items combined to form a component concerned not only with addiction but also vigilance for withdrawal symptoms and interpretation of these symptoms as an indication of addiction. Perceived need items formed a component reflecting a perception of pain medications as a core component of treatment and combined with tolerance items forming a component concerning the maintenance of analgesic effects from medication. This analysis provides an informative interpretation of concerns about chronic analgesic use reflecting patients’ perceptions of the consequences of consuming analgesic medication over a prolonged period.
S61 (813) Cigarette smoking and chronic pain: Relationship to pain severity and affective distress M. Davidson, P. Davidson, D. Tripp, Y. Borshch; Queen’s University, Kingston, ON Little research exists regarding the relationship between cigarette smoking and chronic pain. Jamison et al. (Addict Behav, 1991) reported that 54% of their sample of chronic low-back pain patients smoked, and suggested that these patients have an increased need to smoke during periods of greater pain. Further, smokers reported significantly higher levels of affective distress than nonsmokers. The present study was designed to replicate and extend these findings in a general chronic pain population. Forty-one chronic pain patients referred to a chronic pain service completed the McGill Pain Questionnaire-SF (MPQ-SF; pain severity) and the Beck Depression Inventory (BDI; affective distress). Smoking status was indicated through a demographic questionnaire. 39% of chronic pain patients indicated they smoked. Logistic regression analyses were used to predict smoking status from pain severity and affective distress. The overall regression equation was significant (p ⬍ .05). The Sensory scale of the MPQ-SF emerged as a significant predictor of smoking status, such that higher scores were associated with higher rates of smoking (p ⬍ .02). The MPQ-SF Affective scale did not significantly predict smoking, although inspection of the means indicated a trend for smokers to score higher than nonsmokers. Affective distress did not predict smoking status. Possible explanations for this relationship are discussed, including the use of smoking as a coping strategy, and the physiological and psychological “benefits” of smoking during severe pain.
(814) Attitudes toward pain and quality of life among chronic pain patients with high versus low perceived disability N. Sonty, S. Park; Columbia University, New York, NY Attempts to conceptualize chronic pain have moved from a unidimensional model to a multidimensional one by incorporating into the paradigm physiological, psychological, and social factors. Extant research suggests that there is a high comorbidity between a number of medical illnesses and psychological distress and a strong correlation between perceptions of increased disability with poorer treatment outcome. The current study examined psychological distress, perception of pain-related disability, and quality of life in a sample of 57 chronic pain patients. It was predicted that individuals perceiving greater disability would report poorer quality of life and greater psychological distress. Data was based on clinical interviews and two self-report measures – the Survey of Pain Attitudes (SOPA) and a quality of life measure. Based on the score on the SOPA Disability subscale, the sample was divided into the high perceived disability group (n⫽27) and the low perceived disability group (n⫽30). Results indicated that patients in the high perceived disability group reported significantly greater pain-related interference on measures of quality of life such as general activity level (t⫽ ⫺2.685, p⫽ .01), normal work routine (t⫽ ⫺3.182, p⫽ .002), enjoyment of life (t⫽ ⫺2.478, p⫽ .016), and ability to concentrate (t⫽ ⫺3.729, p⫽.00) compared to patients in the low perceived disability group. Furthermore, patients reporting high perceived disability were more likely to endorse current suicidal ideation (t⫽3.133, p⫽ .003), hopelessness (t⫽2.138, p⫽ .037), and decreased energy levels (t⫽⫺2.120, p⫽.038) than those reporting low perceived disability. The results of this preliminary study highlight the role of perceived pain-related disability in contributing to psychological distress and poorer quality of life.