How does reduction in pain lead to reduction in disability in patients with musculoskeletal pain?

Abstract

Maryam Shaygan,1 Andreas Böger,2 Birgit Kröner-Herwig31Community Based Psychiatric Care Research Centre, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran; 2Pain Management Clinic at the Red Cross Hospital, Kassel, Germany; 3Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, Georg-August-University, Göttingen, GermanyPurpose: Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history.Patients and methods: Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up.Results: Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance.Conclusion: Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation.Perspective: The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time.Keywords: musculoskeletal pain, disability, psychological variables

Keywords

• musculoskeletal pain
• disability
• psychological variables