Highlights
- •Multiple pain conditions and sites are very common among people with chronic pain.
- •Some demographic factors are related to the number of pain conditions and sites.
- •The number of pain conditions and sites are associated with pain adjustment profiles.
- •Greater number of pain conditions predicted a higher level of emotional distress.
Abstract
The present study examined how multiple chronic pain conditions and pain sites are
associated with sociodemographics, chronic pain adjustment profiles, and emotional
distress. A total of 2,407 individuals who reported at least 6 months of having consistent
pain severity, pain interference, and/or emotional burden due to pain were recruited
through random digit dialing across the United States. Participants’ chronic pain
adjustment profiles (ie, pain intensity, pain interference, emotional burden, pain
catastrophizing, pain coping, pain attitudes, and social resources) were assessed.
Anxiety and depressive symptoms were also measured using a subsample of 181 participants
who provided 3-month follow-up data. More than 60% of individuals with chronic pain
reported having multiple pain conditions. Middle-aged single women with fibromyalgia,
disability and of low socioeconomic status reported a greater number of pain conditions
and pain sites. Structural equation modeling revealed that a higher number of pain
conditions and sites were associated with more dysfunctional chronic pain adjustment
profiles. The subsample analyses showed that reporting a greater number of pain conditions
predicted a higher level of depression and anxiety 3 months later, controlling for
pain-related anxiety and depressive symptoms, pain severity and interference at baseline.
Having multiple pain conditions and sites may represent a psychosocial barrier to
successful adjustment to chronic pain.
Perspective
This article argues for the importance of assessing the number of co-occurring chronic
pain conditions and bodily areas that are affected by pain in both pain research and
clinical settings. Measuring and incorporating such information could potentially
enhance our nascent understanding of the adjustment processes of chronic pain.
Key Words
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References
- Comparative fit indexes in structural models.Psychol Bull. 1990; 107: 238-246
- Chronic pain in Australia: A prevalence study.Pain. 2001; 89: 127-134
- Prevalence of chronic pain with neuropathic characteristics in the general population.Pain. 2008; 136: 380-387
- Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.Eur J Pain. 2006; 10: 287-333
Centers for Disease Control and Prevention: Preliminary data from the 2005 national health interview survey. Available at: https://www.cdc.gov/nchs/data/hestat/wireless2005/wireless2005.htm. Accessed April 16, 2019.
- Fibromyalgia: A clinical review.JAMA. 2014; 311: 1547-1555
- Pain assessment: Global use of the Brief Pain Inventory.Ann Acad Med Singapore. 1994; 23: 129-138
- A power primer.Psychol Bull. 1992; 112: 155-159
- Prevalence of chronic pain and high-impact chronic pain among adults–United States, 2016.Morb Mortal Wkly Rep Centers Dis Control Prev. 2018; 67: 1001
- Pain as a risk factor for common mental disorders. Results from the Netherlands Mental Health Survey and Incidence Study-2: A longitudinal, population-based study.Pain. 2018; 159: 712-718
- Chronic pain and psychopathology: Research findings and theoretical considerations.Psychosom Med. 2002; 64: 773-786
- Multidimensional diagnostic criteria for chronic pain: Introduction to the ACTTION–American pain society pain taxonomy (AAPT).J Pain. 2016; 17: T1-T9
- Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.Pain. 2005; 113: 9-19
- Sex, gender, and pain: A review of recent clinical and experimental findings.J Pain. 2009; 10: 447-485
- Assessing depression among persons with chronic pain using the center for epidemiological studies-depression scale and the beck depression inventory: A comparative analysis.Clin J Pain. 1997; 13: 163-170
- Unravelling fibromyalgia—steps toward individualized management.J Pain. 2018; 19: 125-134
- Pain and depressive symptoms in primary care: Moderating role of positive and negative affect.Clin J Pain. 2016; 32: 562-567
- Chronic pain and mental health disorders: Shared neural mechanisms, epidemiology, and treatment.Mayo Clin Proc. 2016; 91: 955-970
- A blueprint for transforming prevention, care, education, and research.The National Academies Press, Washington, DC2011
- Racial and socioeconomic disparities in disabling chronic pain: Findings from the health and retirement study.J Pain. 2017; 18: 1459-1467
- Survey of Pain Attitudes (SOPA) professional manual.Psychol Assess. 2007;
- The prevalence of chronic pain in United States adults: Results of an internet-based Survey.J Pain. 2010; 11: 1230-1239
- Chronic pain and psychopathology: Exploring the motivational context and its clinical implications.in: Karoly P Crombez G Motivational Perspectives on Chronic Pain Theory. Oxford University, New York2018: 355-403
- The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).Pain. 1985; 23: 345-356
- Software review: Software programs for structural equation modeling: Amos, EQS, and LISREL.J Psychoeduc Assess. 1998; 16: 343-364
- Characterization of whole body pain in urological chronic pelvic pain syndrome at baseline: A MAPP Research Network Study.J Urol. 2017; 198: 622-631
- Pain and emotion: A biopsychosocial review of recent research.J Clin Psychol. 2011; 67: 942-968
- The Hamilton Anxiety Scale: Reliability, validity and sensitivity to change in anxiety and depressive disorders.J Affect Disord. 1988; 14: 61-68
- Overlapping chronic pain conditions: Implications for diagnosis and classification.J Pain. 2016; 9: 93-107
- Personality and affect when the central nervous system is sensitized: An analysis of central sensitization syndromes in a substance use disorder population.Psychodyn Psychiatry. 2017; 45: 385-409
- Sex differences in pain and pain inhibition: Multiple explanations of a controversial phenomenon.Nat Rev Neurosci. 2012; 13: 859-866
- Estimates of pain prevalence and severity in adults: United States, 2012.J Pain. 2015; 16: 769-780
- As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes.J Pain Res. 2018; 11: 237-254
- Preliminary validity study of the pain disability index.Percept Mot Skill. 1984; 59: 974
- A systematic literature review of 10 years of research on sex/gender and experimental pain perception - Part 1: Are there really differences between women and men?.Pain. 2012; 153: 602-618
- A systematic literature review of 10 years of research on sex/gender and pain perception - Part 2: Do biopsychosocial factors alter pain sensitivity differently in women and men?.Pain. 2012; 153: 619-635
- The CES-D scale: A self-report depression scale for research in the general population.Appl Psychol Meas. 1977; 1: 385-401
- Evidence for overlap between urological and nonurological unexplained clinical conditions.J Urol. 2013; 189: S66-S74
- Chronic pain and depression: Toward a cognitive-behavioral mediation model.Pain. 1988; 35: 129-140
- The development and preliminary validation of a brief measure of chronic pain impact for use in the general population.Pain. 2005; 113: 82-90
- The development and preliminary validation of the profile of chronic pain: Extended assessment battery.Pain. 2005; 118: 380-389
- Age and the experience of chronic pain.Clin J Pain. 2005; 21: 513-523
- Pain and health related functioning among employees.J Epidemiol Commun Health. 2006; 60: 793-798
- A note on multiple sample extensions of the RMSEA fit index.Struct Equ Model. 1998; 5: 411-419
- The prevalence of pain and pain interference in a general population of older adults: Cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP).Pain. 2004; 110: 361-368
- Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.Pain. 2003; 106: 337-345
- Impact of chronic overlapping pain conditions on public health and the urgent need for safe and effective treatment: 2015 analysis and policy recommendations.Chronic Pain Res Alliance. 2015; : 1-46
- Phenotypic features of central sensitization.J Appl Biobehav Res. 2018; 23: 1-15
- Central sensitization: Implications for the diagnosis and treatment of pain.Pain. 2011; 152: S2-S15
- A rating instrument for anxiety disorders.Psychosomatics. 1971; 12: 371-379
Article info
Publication history
Published online: June 12, 2019
Accepted:
June 10,
2019
Received in revised form:
May 24,
2019
Received:
January 13,
2019
Footnotes
Funding support: Funding for this research was supported by T32NS070201 (postdoctoral training for Chung Jung Mun) and R44NS38772-02 (Small Business Innovation Research Grant awarded to Linda Ruehlman) from the National Institute of Neurological Disorders and Stroke.
Conflicts of interest: The authors have no conflicts of interest in the conduct of this research.
Identification
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© 2019 by United States Association for the Study of Pain, Inc.
