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Developing a Model of Associations Between Chronic Pain, Depressive Mood, Chronic Fatigue, and Self-Efficacy in People With Spinal Cord Injury

  • Ashley Craig
    Correspondence
    Address reprint requests to Ashley Craig, PhD, Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, PO Box 6, Ryde, New South Wales, Australia.
    Affiliations
    Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia
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  • Yvonne Tran
    Affiliations
    Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia

    Key University Centre for Health Technologies, University of Technology, Sydney, Broadway, New South Wales, Australia.
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  • Philip Siddall
    Affiliations
    Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia.

    Department of Pain Management, Greenwich Hospital, HammondCare, Greenwich, New South Wales, Australia.
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  • Nirupama Wijesuriya
    Affiliations
    Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia
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  • Judy Lovas
    Affiliations
    Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia
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  • Roger Bartrop
    Affiliations
    Discipline of Psychiatry, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia
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  • James Middleton
    Affiliations
    Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney, New South Wales, Australia
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      Abstract

      Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed.

      Perspective

      The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI.

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      References

        • Arnstein P.
        • Caudill M.
        • Mandle C.L.
        • Norris A.
        • Beasley R.
        Self-efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.
        Pain. 1999; 80: 483-491
        • Baliki M.N.
        • Geha P.Y.
        • Apkarian A.V.
        • Chialvo D.R.
        Beyond feeling: Chronic pain hurts the brain, disrupting the default-mode network dynamics.
        J Neurosci. 2008; 28: 1398-1403
        • Bandura A.
        Self-efficacy: Toward a unifying theory of behaviour.
        Psychol Rev. 1977; 84: 191-215
        • Barat M.
        • Dehail P.
        • de Seze M.
        Fatigue after spinal cord injury.
        Ann Readapt Med Phys. 2006; 49: 365-369
        • Baron R.M.
        • Kenny D.A.
        The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.
        J Person Soc Psychol. 1986; 51: 1173-1182
        • Bombardier C.H.
        • Richards J.S.
        • Krause J.S.
        • Tulsky D.
        Symptoms of major depression in people with spinal cord injury: Implications for screening.
        Arch Phys Med Rehabil. 2004; 85: 1749-1756
        • Cella M.
        • Chalder T.
        Measuring fatigue in clinical and community settings.
        J Psychosom Res. 2010; 69: 17-22
        • Chalder T.
        • Berelowitz G.
        • Pawlikowska T.
        • Watts L.
        • Wessely S.
        • Wright D.
        • Wallace E.P.
        Development of a fatigue scale.
        J Psychosom Res. 1993; 37: 147-153
        • Cohen J.
        Statistical power analysis for the behavioral Sciences.
        Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Craig A.
        • Tran Y.
        • Middleton J.
        Psychological morbidity and spinal cord injury: a systematic review.
        Spinal Cord. 2009; 47: 108-114
        • Craig A.
        • Tran Y.
        • Wijesuriya N.
        • Boord P.
        A controlled investigation into the psychological determinants of fatigue.
        Bio Psychol. 2006; 72: 78-87
        • Craig A.
        • Tran Y.
        • Wijesuriya N.
        • Middleton J.
        Fatigue and tiredness in people with spinal cord injury.
        J Psychosom Res. 2012; 73: 205-210
        • Dittner A.J.
        • Wessely S.C.
        • Brown R.G.
        The assessment of fatigue. A practical guide for clinicians and researchers.
        J Psychosom Res. 2004; 157: 157-170
        • Gaskin D.J.
        • Richard P.
        The economic costs of pain in the United States.
        J Pain. 2012; 13: 715-724
        • Gerrits M.M.J.G.
        • Vogelzangs N.
        • van Oppen P.
        • van Marwijk H.W.J.
        • van der Horst H.
        • Penninx B.W.J.H.
        Impact of pain on the course of depressive and anxiety disorders.
        Pain. 2012; 153: 429-436
        • Hall A.M.
        • Kamper S.J.
        • Maher C.G.
        • Latimer J.
        • Ferreira M.L.
        • Nicholas M.K.
        Symptoms of depression and stress mediate the effect of pain on disability.
        Pain. 2011; 152: 1044-1051
        • Hammell K.W.
        • Miller W.C.
        • Forwell S.J.
        • Forman B.E.
        • Jacobsen B.A.
        Fatigue and spinal cord injury: A qualitative analysis.
        Spinal Cord. 2009; 47: 44-49
        • Hendriksson P.K.
        • Gundmark I.
        • Bengtsson A.
        • Ek A.
        Living with fibromyalgia, consequences for everyday life.
        Clin J Pain. 1992; 8: 138-144
        • Hoyt W.T.
        • Imel Z.E.
        • Chan F.
        Multiple regression and correlation techniques: recent controversies and best practices.
        Rehab Psychol. 2008; 53: 321-339
      1. International standards for neurological classification of spinal cord injury, revised 2000. American Spinal Injury Association, Chicago2002
        • Irwin M.R.
        • Olmstead R.
        • Carrillo C.
        • Sadeghi N.
        • FitzGerald J.D.
        • Ranganath V.K.
        • Nicassio P.M.
        Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis.
        Sleep. 2012; 35: 537-543
        • Jaccard J.
        • Guilamo-Ramos V.
        • Johansson M.
        • Bouris A.
        Multiple regression analyses in clinical child and adolescent psychology.
        J Clin Child Adolesc Psychol. 2006; 35: 456-479
        • Jensen M.
        Psychosocial approaches to pain management: An organizational framework.
        Pain. 2011; 152: 717-725
        • Jensen M.P.
        • Chodroff M.J.
        • Dworkin R.H.
        The impact of neuropathic pain on health-related quality of life. Review and implications.
        Neurology. 2007; 68: 1178-1182
        • Kowal J.
        • Wilson K.G.
        • McWilliams L.A.
        • Péloquin K.
        • Duong D.
        Self-perceived burden in chronic pain: Relevance, prevalence, and predictors.
        Pain. 2012; 153: 1735-1741
        • Kroenke K.
        • Wu J.
        • Bair M.J.
        • Krebs E.E.
        • Damush T.M.
        • Tu W.
        Reciprocal relationship between pain and depression: A 12-month longitudinal analysis in primary care.
        J Pain. 2011; 12: 964-973
        • Laird B.J.A.
        • Scott A.C.
        • Colvin L.A.
        • McKeon A.-L.
        • Murray G.D.
        • Fearon K.C.H.
        • Fallon M.T.
        Pain, depression, and fatigue as a symptom cluster in advanced cancer.
        J Pain Sympt Manage. 2011; 42: 1-11
        • Lovejoy T.I.
        • Turk D.C.
        • Morasco B.J.
        Evaluation of the psychometric properties of the revised Short-Form McGill Pain Questionnaire.
        The J Pain. 2012; 13: 1250-1257
        • Maciejewski P.K.
        • Prigerson H.G.
        • Mazure C.M.
        Self-efficacy as a mediator between stressful life events and depressive symptoms.
        Br J Psychiatry. 2000; 174: 373-378
        • Melzack R.
        The short-form McGill Pain Questionnaire.
        Pain. 1987; 30: 191-197
        • McNair D.M.
        • Lorr M.
        • Droppleman L.F.
        POMS. Profile of mood states manual.
        MHS, New York2005
        • Middleton J.
        • Craig A.
        Psychological challenges in treating persons with spinal cord injury.
        in: Craig A. Tran Y. Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. Nova Science Publishers, New York2008: 3-53
        • Middleton J.W.
        • Tate R.L.
        • Geraghty T.J.
        Self-efficacy and spinal cord injury: Psychometric properties of a new scale.
        Rehabil Psychol. 2003; 48: 281-288
        • Middleton J.
        • Tran Y.
        • Craig A.
        Relationship between quality of life and self-efficacy in persons with spinal cord injuries.
        Arch Phys Med Rehabil. 2007; 88: 1643-1648
        • Nicassio P.M.
        • Moxham E.G.
        • Schuman C.E.
        • Gevirtz R.N.
        The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia.
        Pain. 2002; 100: 271-279
        • Rosenzweig S.
        • Greeson J.M.
        • Reibel D.K.
        • Green J.S.
        • Jasser S.A.
        • Beasley D.
        Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice.
        J Psychosom Res. 2010; 68: 29-36
        • Shahid A.
        • Shen J.
        • Shapiro C.M.
        Measurements of sleepiness and fatigue.
        J Psychosom Res. 2010; 69: 81-89
        • Siddall P.J.
        • McClelland J.M.
        • Rutkowski S.B.
        • Cousins M.J.
        A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury.
        Pain. 2003; 103: 249-257
        • Strand L.I.
        • Ljunggren A.E.
        • Bogen B.
        • Ask T.
        • Johnsen T.B.
        The Short-Form McGill Pain Questionnaire as an outcome measure: Test–retest reliability and responsiveness to change.
        Eur J Pain. 2008; 12: 917-925
        • Tran Y.
        • Wijesuriya N.
        • Tarvainen M.
        • Karjalainen P.
        • Craig A.
        The relationship between spectral changes in HRV and fatigue.
        J Psychophys. 2009; 23: 143-151
        • Turner J.A.
        • Mancl L.
        • Aaron L.A.
        Pain-related catastrophizing: A daily process study.
        Pain. 2004; 110: 103-111
        • Velly A.M.
        • Look J.O.
        • Carlson C.
        • Lenton P.A.
        • Kang W.
        • Holcroft C.A.
        • Fricton J.R.
        The effect of catastrophizing and depression on chronic pain—A prospective cohort study of temporomandibular muscle and joint pain disorders.
        Pain. 2011; 152: 2377-2383
        • Wegener S.T.
        • Castillo R.C.
        • Haythornthwaite J.
        • MacKenzie E.J.
        • Bosse M.J.
        Psychological distress mediates the effect of pain on function.
        Pain. 2011; 152: 1349-1357
        • Westgren N.
        • Levi R.
        Quality of life and traumatic spinal injury.
        Arch Phys Med Rehabil. 1998; 79: 1433-1439
        • Widerström-Noga E.G.
        • Turk D.C.
        Exacerbation of chronic pain following spinal cord injury.
        J Neurotrauma. 2004; 21: 1384-1395
        • Wittig R.M.
        • Frank J.
        • Zorick F.J.
        • Blumer D.
        • Heilbronn M.
        • Roth T.
        Disturbed sleep in patients complaining of chronic pain.
        J Nerv Ment Dis. 1982; 170: 429-431
        • Tabachnick B.G.
        • Fidell L.S.
        Using multivariate statistics.
        Harper & Row, Publishers, Inc., New York1989
        • Wijesuriya N.
        • Tran Y.
        • Middleton J.
        • Craig A.
        The impact of fatigue on the health related quality of life in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 319-324