A Biopsychosocial Approach to Pretreatment Assessment of Patients With Persistent Pain: Identifying Factors Associated With Pain-related Disability

Abstract

Purpose of the study: Determining factors contributing to pain-related disability is a major challenge in persistent pain management. Individual biological, psychological, and social predictors of disability have been identified previously, yet few studies have examined the relative contribution of these factors using an integrated approach. This clinical evaluation sought to test a biopsychosocial model of pain-related disability by assessing patients attending a multidisciplinary Pain Medicine Centre (PMC). Methods: Seventy-nine of 141 patients (M age=55.19 yrs, 54.4% female, pain chronicity Mdn=5 yrs) attending the PMC for the first time over a 4-month period completed a structured pretreatment questionnaire comprised of standardised measures which assessed pain, psychological function, and social background. Results: High levels of pain intensity, distress, and disability were reported. Nearly a third of patients were uncertain of the cause of their pain (29.9%), over half (52.7%) reported pain across multiple sites, 42.4% believed that pain medication provided the most effective pain relief, 24% believed nothing relieved their pain, and 48% had taken medication for mood disturbances occurring subsequent to pain onset. Only 13% of patients were employed, 39% were receiving a disability support pension, 28.6% had a current pain-related compensation claim, and 40.9% indicated a desire to return to work in future. The relative contribution of pain (intensity, distress, duration), psychological (self-efficacy, anxiety, and coping), and social (social support, age, gender, employment and legal status) factors to variance in disability was examined using sequential linear regression analyses. Preliminary findings suggest that pain intensity, self-efficacy for coping with pain, and behavioural coping strategies were important predictors of disability. Conclusions: This evaluation highlights the heterogenous nature of patients with persistent pain presenting in a 'real world' clinical setting, and signals the importance of assessing psychosocial factors in order to better understand and manage pain-related disability.