- Email: [email protected]
The role of neuroticism and social support in older adults with chronic pain behavior
Person. indkid. D# Vol. 23, No. I, pp. 165-167. 1997 mc1997 Elsevier Science Ltd. All rights reserved
Pergamon
PII: !30191-8869(97)00001-9
Printed in Great Britain 0191-8869/97 $17.00+-0.00
The role of neuroticism and social support in older adults with chronic pain behavior Sherri C. Lauver’*
and Judith L. Johnson*?
‘Department of Psychology, Villanova University, Villanova, PA 19454. U.S.A. and 2Department of Behavioral Sciences, LA Tech University, Ruston, LA 71272. U.S.A. (Received 6 February 1996)
Summary-The current investigation ascertains the role of Neuroticism and satisfaction with social support on pain behavior in the older patient with chronic pain. Forty-seven patients with chronic pain (mean age of 65.3 years) participated in the study. Measures included a Neuroticism score, a satisfaction with social support score, and a quantifiable score of pain behaviors. A multiple regression analysis was performed with Neuroticism and social support satisfaction as predictors and pain behaviors as the criterion. The analysis indicated that the personality facet of Neuroticism was a significant predictor of observable pain behavior in the older adult. There was no significant relationship between satisfaction with social support and pain behavior. Further, there was no interaction between Neuroticism and social support on pain behaviors. The current investigation supports the contention that Neuroticism is related to behavioral manifestations of pain in the older patient with chronic pain. c 1997 Elsevier Science Ltd
INTRODUCIION Pain that persists beyond a normal course of healing continues to pose a treatment challenge to the medical community. However, pain experts theorize that as pain becomes a chronic condition, it is less purely a physiological process than a complex constellation of physical, emotional, prsonologic, and environmental factors. The present study addressed the relative contribution of two such factors, Neuroticism (Eysenck, 1990) and social support satisfaction (Sarason et al., 1983) to manifestation of pain behaviors. At its outset, pain often results from injury, disease, or abnormal functioning ofmuscle or viscera (Bonica, 1990). However. for varied and complex reasons, some patients do not heal in a typical course of time, and develop the perpetuating condition of chronic pain. In these cases, chronic pain no longer serves as a warning signal of physical dysfunction and its pathophysiology is not readily understood by physicians or psychologists. Frequently, patients with chronic pain hve in constant pain that cannot be explained, nor effectively treated with traditional treatment modalities (Bonica, 1992). Treatment such as prescription drugs and physical therapy are surprisingly ineffective for patients with chronic pain. In clinical assessment of pain intensity, the physician must rely heavily upon patient subjective self-report and non-verbal cues. Although verbal self-reports of pain are important, observation of non-verbal behaviors may be even more critical in evaluating pain. A patient’s activity levels, motor behaviors, and medication-use can serve as objective indicators of pain experience. These observable behaviors were deemed ‘pain behaviors’ by Fordyce (1976) and conceptualized as “the interaction between the individual and the surrounding world” (Fordyce, 1976). Most researchers and clinicians agree that the most accurate assessment of pain involves not only verbal self-reports, but also the observation of non-verbal painrelated behaviors (Fordyce, 1976). Observation of pain is enhanced by quantifying pain behaviors. Pain behaviors suggest that one is experiencing pain, and include verbal complaints, taking medications, avoiding physical activity, taking leave from work and home responsibilities, and exhibiting certain motor behaviors. In patients with chronic pain, odd body posturing, facial grimacing, rubbing, or guarding the painful area are examples of common motor behaviors (Feuerstein, 1989; Keefe, Crisson & Trainor. 1987). Several studies implicate personality factors in the possible etiology and maintenance of chronic pain and pain behavior. For example, Neuroticism, or level of emotional stability (Eysenck, 1990) may influence pain behaviors. Neuroticism (N) includes anxiety and degree of emotional responsiveness. Neuroticism may also indicate one’s degree of negative reactivity to stress. Therefore, individuals high in Neuroticism may be more physiologically reactive to noxious stimuli such as physical pain (Eysenck, 1990). Furthermore, they may direct much more of their attention and anxiety towards physical functioning and complaints. Neuroticism is believed to be a stable factor of personality throughout development and even during changes in health status (Costa SCMcCrae, 1988; McCrae & Costa, 1984). Neuroticism has a demonstrated role in an individual’s pain tolerance and behavior (Sternbach, 1975). Individuals with high Neuroticism scores express greater autonomic reaction to stimuli and have a lower pain tolerance (Lynn & Eysenck, 1961). Furthermore, Neuroticism is predictive of complaint behavior in chronic pain patients (Philips & Jahanshahi, 1985; Stembach, 1975). Similarly, Wade et al. (1992) demonstrated that while Neuroticism is unrelated to an individual’s pain intensity, it does in fact significantly predict one’s rating of pain unpleasantness and pain behavior. Harkins, Price and Braith (1989) showed that Neuroticism seemed to have little or no effect on pain sensation, but was significant in predicting extent of reports of pain unpleasantness. Therefore, Neuroticism influences self-report more than actual threshold of pain.
*To whom all correspondence should be addressed: 148 Sumac St, Philadelphia, PA 19128, U.S.A. tWho may be contacted at: Louisiana Tech University, Department of Behavioral Sciences, P.O. Box 10048. Ruston, LA 71272. U.S.A. 165
166
Notes and Shorter
Communications
Taken as a whole, these studies indicate that it is quite likely that the personality factor of Neuroticism is positively related to pain behaviors and reporting of perceived pain in certain individuals. In addition to examining the role of Neuroticism in adult patients with chronic pain, the present study addressed the role of social support in the expression of pain behavior. While a social support network is typicahy advantageous to persons with medical illnesses, it may adversely affect treatment outcome of individuals experiencing chronic pain. Utilizing the operant model of learned pain behavior, pain behaviors displayed by the patient can be reinforced by the social environment. A patient’s pain behavior may afford him or her extra attention and support from family and friends, while allowing a reduction of home responsibilities. The pain-behavior display subsequently increases through these reinforcements from the environment (Fordyce, 1976; Sternbach, 1974). Other researchers have determined that a person’s satisfaction with social support may have more of an influence on his or her expression of pain behavior than social support itself. Gil et al. (1987) showed that patients who were highly satisfied with their social support displayed a greater number of pain behaviors (M= 16.79) during a IO-min obviation session than patients minimally satisfied with their support (M=9.37). Therefore, one’s perceived satisfaction with the social network appears more important than the size and availability of it. Thus, in patients with chronic pain, satisfaction with social support is positively related to maladaptive pain behaviors. Significant others, in their attempt to provide a chronic pain patient with relief, support, and attention, may inadvertently contribute to ongoing maladaptive pain-behavior patterns. Little attention is given to personologic or environmental mediators of pain expression. Accordingly, this investigation examined the role of Neuroticism (a personologic variable) and satisfaction with social support (an environmental variable) on pain behaviors, within a sample of older, adult chronic pain patients. It was predicted that both Neuroticism and social support would be sig~~~ntly related to pain behaviors. Further, the relative role of Neuroticism was expected to be stronger than social support. Finally, a theoretical question concerned whether Neuroticism and social support would demonstrate an interactive effect on pain behaviors.
METHOD Participants
Forty female and seven male, older patients who suffered from chronic pain (mean age = 65.3 years) volunteered to be in the present study. The sample was composed of 36 Caucasian and 11African-American participants who were recruited from a rehabilitation hospital and two senior citizens’ centers. All participants indicated that they had experienced pain on a daily basis for at least 3 months consecutively. An older adult was defined as age 50 and above. Consistent with Bonica (1990), chronic pain was defined atexperience of pain for I month or more. Although these chronic pain patients represented a heterogeneous sample of pain syndromes, headache patients, cancer patients, and patients diagnosed with a dementing disorder were excluded from the analyses as they may be qualitatively different from other chronic pain patients. Additionally, patients using prescription drugs for pain were asked to participate early during the day before any medication was taken, in order to maximize the probability of pain-behavior display. Design and procedure
Participants were contacted during an introductory meeting at each center where potential volunteers were asked to sign their name and phone number if interested in participation. Appointments were then scheduled at the center at the volunteer’s convenience. Each participant signed a consent form and was then interviewed in~viduatty for approximately I hr in a quiet, private room. During the first half hour, the Psychosocial Pain Inventory (Getto & Heaton, 1985) was administered. The Psychosocial Pain Inventory (PSPI) is a structured interview schedule with operationalized pain behaviors that yields a rating of these behaviors. This inventory was chosen for two reasons. One section of the PSPI catalogues pain behavior observed during the interview. Various common pain behaviors are listed in order to assist the assessment. The entire interview was completed in order to allow the interviewer 30min to assess both verbal and non-verbal pain behaviors. Each pain behavior observed was given one point, and a sum of these pain behaviors served as the score of pain behavior. During the second half hour, 6’s were given the Social Support Questionnaire (Samson ef al., 1983) and the Eysenck Personality Questionnaire-Revised (Eysenck, Eysenck L Barrett, 1985) in a pre-established random order. Only questions assessing Neuroticism and the Lie Scale (EPQ-R) were scored. The paper and pencil tests were administered in large print, and read aloud by the experimenter for participants with vision or concentration difficulties. When questions arose regarding items on the questionnaires, the experimenter followed standardized instructions of response. All S remained anonymous as test forms were numerically coded and separate from the consent forms. After the completion of the paper and pencil tests, each S was given a debriefing form.
RESULTS During scoring, five participants were removed due to EPQ-R Lie scale scores above one standard deviation from the norm. Forty-seven Ss data was available for analysis. Multiple regression analysis was utilized to assess the relative contributions of Neuroticism and satisfaction with social support to pain behavior. A significant relationship was found between pain behavior and the composite of Neuroticism and satisfaction with social support, R* = 0.207, 1;y2,44)= 5.74, Pt0.01. Next, standardized partiai correlation coefftcients for the two ind~ndent variables were compared. As expected, the standardized partial regression coeflicient for Neuroticism was considerably larger than that for satisfaction with social support, 0.425 and 0,138, respectively. It was of theoretical interest to establish whether there was an interaction between Neuroticism and social support, Accordingly, the sample was divided into those high and low in Neuroticism and social support, which resulted in a two (Neuroticism) by two (social support) design with 10 Ss per cell. Analysis of Variance on the pain behavior data revealed a significant main effect for Neuroticism, F(I,36)=4.45, P~0.05. The effect of satisfaction with social support was not statistically significant, F( 1,36)= I .99, P = 0.17. There was no significant interaction between Neuroticism and social support, F(1,39)=1.12, P
Notes
and
Shorter
Communications
167
DISCUSSION
The present study supports the hypothesis that high Neuroticism is significantly related to enhanced expression of maladaptive pain behavior in older patients with chronic pain. High N scores have also been associated to elevated painbehavior levels in previous samples of middle-aged patients with chronic pain (Harkins et al., 1989; Wade et al.. 1992). The present finding is particularly relevant because there have been no previous studies regarding the role of Neuroticism within the older patient with chronic pain. The relationship between Neuroticism and pain behaviors found in the present study has two major implications. First, clinical assessment of pain severity and intensity would be enhanced if the clinician were aware of levels of Neuroticism and potential impact of this variable on pain behavior expression. Second, pain management programs and clinical treatment of chronic pain would benefit from personality assessment to ascertain an individual’s level of emotional reactivity to pain. This information could then be used in providing education and interventions for the patient. For example, patients with chronic pain could be educated regarding their levels of emotional responsivity to physical pain, and be provided with behavioral and cognitive-behavioral interventions for self-management. No significant relationship between satisfaction with social support and pain behavior was found in the present study. These findings are not consistent with results that indicate a significant relationship between satisfaction with social support and maladaptive pain behavior in adults with chronic pain (Gil et al., 1987). Since the SSQ was developed on college students. it is possible it is not an effective measure of satisfaction with social support for the older adult. The mean satisfaction score among college students is a 5.21 in a scale that ranges from zero to six. The mean satisfaction score in the current study was 3.96. Participants highly satisfied with social support showed a mean of 5.46. and those low in satisfaction with social support demonstrated a mean of 2.47. Judging from young adult norms, these means are lower than usual, and indicate that many older adults are not as satisfied with their social support. This may occur as the older adult deals with the loss of close friends. spouses, and others in their age group to death. Hence. it is possible the SSQ is not a valid assessment tool fat the older adult. Unfortunately, no established norms are published for satisfaction with social support in the older adult. and this would be a fruitful area for future research. In summary, the personality trait of Neuroticism relates to pain behaviors and ultimately impacts the outcome of chronic pain. It is possible that evidence from this and similar studies may be utilized for preventive treatment of chronic pain. For example, if an individual visits his physician due to acute pain lasting approximately 1 month. psychological testing may be warranted to ascertain potential treatment areas. A chronic pain patient high in Neuroticism may benefit from psychological interventions such as relaxation training and cognitive-behavioral psychotherapy. Similarly. if social support does in some cases relate to pain behavior, then family members of chronic pain patients should be educated to reinforce positive ‘wellbehaviors’ rather than their maladaptive counterparts. Such focused psychological treatment, if needed. may prevent an acute pain from becoming a chronic one, saving the person from a lifelong struggle with pain and the accompanying financial burdens.
REFERENCES
Bonica. J. J. (1992). Importance of the problem. In G. M. Aronoff (Ed.), Ecaluarion and freatment qfchronic pain (pp. xxx xxviii). Baltimore: Williams & Wilkins, Bonica, J. J. (1990). The managemenf ofpain. Malvern, PA: Lea & Febiger. Costa. P. T. & McCrae, R. R. (1988). Personality in adulthood: A six year longitudinal study of self-reports and spouse ratings on the NE0 Personality Inventory. Journal of Personality and Social Psychology, 5.48534863. Eysenck. H. J. (1990). Biological dimensions of personality. In L. A. Pervin (Ed.). Handbook qfpersonality: Theor), and research (pp. 244276). New York: Guilford Press. Eysenck. S. B. C.. Eysenck. H. J. & Barrett, P. (1985). A revised version of the Psychoticism scale. Persona/it!, and Individual Differences,
6, 21-29.
Feuerstein. M. (1989). Definitions of pain. In C. D. Tollison (Ed.), Handbook of chronic pain management (pp. 2-5). Baltimore: Williams & Wilkins. Fordyce, W. E. (1976). Behaoioral methods for chronic pain and illness. St Louis, IL: C V. Mosby. Getto. C. J. & Heaton, R. K. (1985). Psychosocial Pain Inventory. Odessa, FL: Psychological Assessment Resources. Gil, K. M., Keefe. F. J., Crisson. J. E. & Van Dalfsen. P. J. (1987). Social sunnort and oain behavior. Pain. ZY. 209-217 Harkins, S. W., Price, D. D. & Braith, J. (1989). Effects of extraversion and neuroticism on experimental pain, clinical pain. and illness behavior. Pain, 36, 209-218. Keefe. F. J., Crisson, J. E. & Trainor, M. (1987). Observational methods for assessing pain: A practical guide. In .I. A. Blumenthal & D. C. McKee (Eds), Aoulications in behavioral medicine and health .osvcholoa\? . _. A clinician’s source hook (pp. 67-94). Sarasota, FL: Professional Resource Exchange. Lynn. R. & Eysenck. H. J. (1961). Tolerance for pain, extraverslon. and neuroticism. Perceptual and Motor Skills. 12, 161162. McCrae, R. R. & Costa, P. T. (1984). Personality is transcontextual: A replv to Veroff. Personality and Social Psl~choloa,~ Bulletin,
IO, 175-179.
Philips, H. C. & Jahanshahi, M. (1985). The effects of persistent pain: The chronic headache sufferer. Pain, 21, 163-176. Sarason, 1. G.. Levine, H. M.. Basham. R. B. & Sarason. B. R. (1983). Assessine social sunnort: The social sunnort a. c1 questionnaire. Journal of Personality and Social Psychology, 44, li7-13$. Sternbach, R. A. (1974). Pain patients: Traits and treatment. Academic Press: New York. Sternbach, R. A. (1975). Psychophysiology of pain. International Journal qf Psychiatry in Medicine, 6, 63-73. Wade, J. B., Dougherty, L. M., Hart, R. P., Rafii, A. & Price, D. D. (1992). A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering, and pain behavior. fain, 51, 67.-73.
Pergamon
PII: !30191-8869(97)00001-9
Printed in Great Britain 0191-8869/97 $17.00+-0.00
The role of neuroticism and social support in older adults with chronic pain behavior Sherri C. Lauver’*
and Judith L. Johnson*?
‘Department of Psychology, Villanova University, Villanova, PA 19454. U.S.A. and 2Department of Behavioral Sciences, LA Tech University, Ruston, LA 71272. U.S.A. (Received 6 February 1996)
Summary-The current investigation ascertains the role of Neuroticism and satisfaction with social support on pain behavior in the older patient with chronic pain. Forty-seven patients with chronic pain (mean age of 65.3 years) participated in the study. Measures included a Neuroticism score, a satisfaction with social support score, and a quantifiable score of pain behaviors. A multiple regression analysis was performed with Neuroticism and social support satisfaction as predictors and pain behaviors as the criterion. The analysis indicated that the personality facet of Neuroticism was a significant predictor of observable pain behavior in the older adult. There was no significant relationship between satisfaction with social support and pain behavior. Further, there was no interaction between Neuroticism and social support on pain behaviors. The current investigation supports the contention that Neuroticism is related to behavioral manifestations of pain in the older patient with chronic pain. c 1997 Elsevier Science Ltd
INTRODUCIION Pain that persists beyond a normal course of healing continues to pose a treatment challenge to the medical community. However, pain experts theorize that as pain becomes a chronic condition, it is less purely a physiological process than a complex constellation of physical, emotional, prsonologic, and environmental factors. The present study addressed the relative contribution of two such factors, Neuroticism (Eysenck, 1990) and social support satisfaction (Sarason et al., 1983) to manifestation of pain behaviors. At its outset, pain often results from injury, disease, or abnormal functioning ofmuscle or viscera (Bonica, 1990). However. for varied and complex reasons, some patients do not heal in a typical course of time, and develop the perpetuating condition of chronic pain. In these cases, chronic pain no longer serves as a warning signal of physical dysfunction and its pathophysiology is not readily understood by physicians or psychologists. Frequently, patients with chronic pain hve in constant pain that cannot be explained, nor effectively treated with traditional treatment modalities (Bonica, 1992). Treatment such as prescription drugs and physical therapy are surprisingly ineffective for patients with chronic pain. In clinical assessment of pain intensity, the physician must rely heavily upon patient subjective self-report and non-verbal cues. Although verbal self-reports of pain are important, observation of non-verbal behaviors may be even more critical in evaluating pain. A patient’s activity levels, motor behaviors, and medication-use can serve as objective indicators of pain experience. These observable behaviors were deemed ‘pain behaviors’ by Fordyce (1976) and conceptualized as “the interaction between the individual and the surrounding world” (Fordyce, 1976). Most researchers and clinicians agree that the most accurate assessment of pain involves not only verbal self-reports, but also the observation of non-verbal painrelated behaviors (Fordyce, 1976). Observation of pain is enhanced by quantifying pain behaviors. Pain behaviors suggest that one is experiencing pain, and include verbal complaints, taking medications, avoiding physical activity, taking leave from work and home responsibilities, and exhibiting certain motor behaviors. In patients with chronic pain, odd body posturing, facial grimacing, rubbing, or guarding the painful area are examples of common motor behaviors (Feuerstein, 1989; Keefe, Crisson & Trainor. 1987). Several studies implicate personality factors in the possible etiology and maintenance of chronic pain and pain behavior. For example, Neuroticism, or level of emotional stability (Eysenck, 1990) may influence pain behaviors. Neuroticism (N) includes anxiety and degree of emotional responsiveness. Neuroticism may also indicate one’s degree of negative reactivity to stress. Therefore, individuals high in Neuroticism may be more physiologically reactive to noxious stimuli such as physical pain (Eysenck, 1990). Furthermore, they may direct much more of their attention and anxiety towards physical functioning and complaints. Neuroticism is believed to be a stable factor of personality throughout development and even during changes in health status (Costa SCMcCrae, 1988; McCrae & Costa, 1984). Neuroticism has a demonstrated role in an individual’s pain tolerance and behavior (Sternbach, 1975). Individuals with high Neuroticism scores express greater autonomic reaction to stimuli and have a lower pain tolerance (Lynn & Eysenck, 1961). Furthermore, Neuroticism is predictive of complaint behavior in chronic pain patients (Philips & Jahanshahi, 1985; Stembach, 1975). Similarly, Wade et al. (1992) demonstrated that while Neuroticism is unrelated to an individual’s pain intensity, it does in fact significantly predict one’s rating of pain unpleasantness and pain behavior. Harkins, Price and Braith (1989) showed that Neuroticism seemed to have little or no effect on pain sensation, but was significant in predicting extent of reports of pain unpleasantness. Therefore, Neuroticism influences self-report more than actual threshold of pain.
*To whom all correspondence should be addressed: 148 Sumac St, Philadelphia, PA 19128, U.S.A. tWho may be contacted at: Louisiana Tech University, Department of Behavioral Sciences, P.O. Box 10048. Ruston, LA 71272. U.S.A. 165
166
Notes and Shorter
Communications
Taken as a whole, these studies indicate that it is quite likely that the personality factor of Neuroticism is positively related to pain behaviors and reporting of perceived pain in certain individuals. In addition to examining the role of Neuroticism in adult patients with chronic pain, the present study addressed the role of social support in the expression of pain behavior. While a social support network is typicahy advantageous to persons with medical illnesses, it may adversely affect treatment outcome of individuals experiencing chronic pain. Utilizing the operant model of learned pain behavior, pain behaviors displayed by the patient can be reinforced by the social environment. A patient’s pain behavior may afford him or her extra attention and support from family and friends, while allowing a reduction of home responsibilities. The pain-behavior display subsequently increases through these reinforcements from the environment (Fordyce, 1976; Sternbach, 1974). Other researchers have determined that a person’s satisfaction with social support may have more of an influence on his or her expression of pain behavior than social support itself. Gil et al. (1987) showed that patients who were highly satisfied with their social support displayed a greater number of pain behaviors (M= 16.79) during a IO-min obviation session than patients minimally satisfied with their support (M=9.37). Therefore, one’s perceived satisfaction with the social network appears more important than the size and availability of it. Thus, in patients with chronic pain, satisfaction with social support is positively related to maladaptive pain behaviors. Significant others, in their attempt to provide a chronic pain patient with relief, support, and attention, may inadvertently contribute to ongoing maladaptive pain-behavior patterns. Little attention is given to personologic or environmental mediators of pain expression. Accordingly, this investigation examined the role of Neuroticism (a personologic variable) and satisfaction with social support (an environmental variable) on pain behaviors, within a sample of older, adult chronic pain patients. It was predicted that both Neuroticism and social support would be sig~~~ntly related to pain behaviors. Further, the relative role of Neuroticism was expected to be stronger than social support. Finally, a theoretical question concerned whether Neuroticism and social support would demonstrate an interactive effect on pain behaviors.
METHOD Participants
Forty female and seven male, older patients who suffered from chronic pain (mean age = 65.3 years) volunteered to be in the present study. The sample was composed of 36 Caucasian and 11African-American participants who were recruited from a rehabilitation hospital and two senior citizens’ centers. All participants indicated that they had experienced pain on a daily basis for at least 3 months consecutively. An older adult was defined as age 50 and above. Consistent with Bonica (1990), chronic pain was defined atexperience of pain for I month or more. Although these chronic pain patients represented a heterogeneous sample of pain syndromes, headache patients, cancer patients, and patients diagnosed with a dementing disorder were excluded from the analyses as they may be qualitatively different from other chronic pain patients. Additionally, patients using prescription drugs for pain were asked to participate early during the day before any medication was taken, in order to maximize the probability of pain-behavior display. Design and procedure
Participants were contacted during an introductory meeting at each center where potential volunteers were asked to sign their name and phone number if interested in participation. Appointments were then scheduled at the center at the volunteer’s convenience. Each participant signed a consent form and was then interviewed in~viduatty for approximately I hr in a quiet, private room. During the first half hour, the Psychosocial Pain Inventory (Getto & Heaton, 1985) was administered. The Psychosocial Pain Inventory (PSPI) is a structured interview schedule with operationalized pain behaviors that yields a rating of these behaviors. This inventory was chosen for two reasons. One section of the PSPI catalogues pain behavior observed during the interview. Various common pain behaviors are listed in order to assist the assessment. The entire interview was completed in order to allow the interviewer 30min to assess both verbal and non-verbal pain behaviors. Each pain behavior observed was given one point, and a sum of these pain behaviors served as the score of pain behavior. During the second half hour, 6’s were given the Social Support Questionnaire (Samson ef al., 1983) and the Eysenck Personality Questionnaire-Revised (Eysenck, Eysenck L Barrett, 1985) in a pre-established random order. Only questions assessing Neuroticism and the Lie Scale (EPQ-R) were scored. The paper and pencil tests were administered in large print, and read aloud by the experimenter for participants with vision or concentration difficulties. When questions arose regarding items on the questionnaires, the experimenter followed standardized instructions of response. All S remained anonymous as test forms were numerically coded and separate from the consent forms. After the completion of the paper and pencil tests, each S was given a debriefing form.
RESULTS During scoring, five participants were removed due to EPQ-R Lie scale scores above one standard deviation from the norm. Forty-seven Ss data was available for analysis. Multiple regression analysis was utilized to assess the relative contributions of Neuroticism and satisfaction with social support to pain behavior. A significant relationship was found between pain behavior and the composite of Neuroticism and satisfaction with social support, R* = 0.207, 1;y2,44)= 5.74, Pt0.01. Next, standardized partiai correlation coefftcients for the two ind~ndent variables were compared. As expected, the standardized partial regression coeflicient for Neuroticism was considerably larger than that for satisfaction with social support, 0.425 and 0,138, respectively. It was of theoretical interest to establish whether there was an interaction between Neuroticism and social support, Accordingly, the sample was divided into those high and low in Neuroticism and social support, which resulted in a two (Neuroticism) by two (social support) design with 10 Ss per cell. Analysis of Variance on the pain behavior data revealed a significant main effect for Neuroticism, F(I,36)=4.45, P~0.05. The effect of satisfaction with social support was not statistically significant, F( 1,36)= I .99, P = 0.17. There was no significant interaction between Neuroticism and social support, F(1,39)=1.12, P
Notes
and
Shorter
Communications
167
DISCUSSION
The present study supports the hypothesis that high Neuroticism is significantly related to enhanced expression of maladaptive pain behavior in older patients with chronic pain. High N scores have also been associated to elevated painbehavior levels in previous samples of middle-aged patients with chronic pain (Harkins et al., 1989; Wade et al.. 1992). The present finding is particularly relevant because there have been no previous studies regarding the role of Neuroticism within the older patient with chronic pain. The relationship between Neuroticism and pain behaviors found in the present study has two major implications. First, clinical assessment of pain severity and intensity would be enhanced if the clinician were aware of levels of Neuroticism and potential impact of this variable on pain behavior expression. Second, pain management programs and clinical treatment of chronic pain would benefit from personality assessment to ascertain an individual’s level of emotional reactivity to pain. This information could then be used in providing education and interventions for the patient. For example, patients with chronic pain could be educated regarding their levels of emotional responsivity to physical pain, and be provided with behavioral and cognitive-behavioral interventions for self-management. No significant relationship between satisfaction with social support and pain behavior was found in the present study. These findings are not consistent with results that indicate a significant relationship between satisfaction with social support and maladaptive pain behavior in adults with chronic pain (Gil et al., 1987). Since the SSQ was developed on college students. it is possible it is not an effective measure of satisfaction with social support for the older adult. The mean satisfaction score among college students is a 5.21 in a scale that ranges from zero to six. The mean satisfaction score in the current study was 3.96. Participants highly satisfied with social support showed a mean of 5.46. and those low in satisfaction with social support demonstrated a mean of 2.47. Judging from young adult norms, these means are lower than usual, and indicate that many older adults are not as satisfied with their social support. This may occur as the older adult deals with the loss of close friends. spouses, and others in their age group to death. Hence. it is possible the SSQ is not a valid assessment tool fat the older adult. Unfortunately, no established norms are published for satisfaction with social support in the older adult. and this would be a fruitful area for future research. In summary, the personality trait of Neuroticism relates to pain behaviors and ultimately impacts the outcome of chronic pain. It is possible that evidence from this and similar studies may be utilized for preventive treatment of chronic pain. For example, if an individual visits his physician due to acute pain lasting approximately 1 month. psychological testing may be warranted to ascertain potential treatment areas. A chronic pain patient high in Neuroticism may benefit from psychological interventions such as relaxation training and cognitive-behavioral psychotherapy. Similarly. if social support does in some cases relate to pain behavior, then family members of chronic pain patients should be educated to reinforce positive ‘wellbehaviors’ rather than their maladaptive counterparts. Such focused psychological treatment, if needed. may prevent an acute pain from becoming a chronic one, saving the person from a lifelong struggle with pain and the accompanying financial burdens.
REFERENCES
Bonica. J. J. (1992). Importance of the problem. In G. M. Aronoff (Ed.), Ecaluarion and freatment qfchronic pain (pp. xxx xxviii). Baltimore: Williams & Wilkins, Bonica, J. J. (1990). The managemenf ofpain. Malvern, PA: Lea & Febiger. Costa. P. T. & McCrae, R. R. (1988). Personality in adulthood: A six year longitudinal study of self-reports and spouse ratings on the NE0 Personality Inventory. Journal of Personality and Social Psychology, 5.48534863. Eysenck. H. J. (1990). Biological dimensions of personality. In L. A. Pervin (Ed.). Handbook qfpersonality: Theor), and research (pp. 244276). New York: Guilford Press. Eysenck. S. B. C.. Eysenck. H. J. & Barrett, P. (1985). A revised version of the Psychoticism scale. Persona/it!, and Individual Differences,
6, 21-29.
Feuerstein. M. (1989). Definitions of pain. In C. D. Tollison (Ed.), Handbook of chronic pain management (pp. 2-5). Baltimore: Williams & Wilkins. Fordyce, W. E. (1976). Behaoioral methods for chronic pain and illness. St Louis, IL: C V. Mosby. Getto. C. J. & Heaton, R. K. (1985). Psychosocial Pain Inventory. Odessa, FL: Psychological Assessment Resources. Gil, K. M., Keefe. F. J., Crisson. J. E. & Van Dalfsen. P. J. (1987). Social sunnort and oain behavior. Pain. ZY. 209-217 Harkins, S. W., Price, D. D. & Braith, J. (1989). Effects of extraversion and neuroticism on experimental pain, clinical pain. and illness behavior. Pain, 36, 209-218. Keefe. F. J., Crisson, J. E. & Trainor, M. (1987). Observational methods for assessing pain: A practical guide. In .I. A. Blumenthal & D. C. McKee (Eds), Aoulications in behavioral medicine and health .osvcholoa\? . _. A clinician’s source hook (pp. 67-94). Sarasota, FL: Professional Resource Exchange. Lynn. R. & Eysenck. H. J. (1961). Tolerance for pain, extraverslon. and neuroticism. Perceptual and Motor Skills. 12, 161162. McCrae, R. R. & Costa, P. T. (1984). Personality is transcontextual: A replv to Veroff. Personality and Social Psl~choloa,~ Bulletin,
IO, 175-179.
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