The role of psychological factors on prediction of disturbance in daily activities among patients with chronic pain

Document Type : Research Paper

Authors

1 Ph.D. student in health psychology, Karaj Islamic Azad University, Karaj, Iran

2 Associate professor of Iran University of Medical Sciences, Tehran, Iran

3 Assistant professor of Karaj Islamic Azad University, Karaj, Iran

4 Associate professor of anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction:  It’s important to study chronic pain as a comprehensive physical problem. Studies demonstrated emotions and regulation of them, cognitive components, self-efficacy and inflexible pattern of behavior can affect the pain severity and disturbance in daily activities. The aim of this research is to determine predictive variables on disturbance in daily activities in patients with chronic pain.
Materials and Methods: In this descriptive-correlational study, a sample of 345 patients with chronic pain who referred to pain, rheumatoid and acupuncture clinics (Mashhad-Iran) was selected through convenient method. The patients completed these questionnaires: Pain Inflexibility (PIPS), Emotion Regulation (ER), Attachment Styles (RQ), Pain Self-efficacy (PSEQ) and multi facet pain questionnaire. Data analyzed by descriptive statistics, Pearson coefficient, step by step regression and SPSS software version 24.
Results:The relation of predictive variables- attachment styles, emotion regulation (reappraisal and suppression) self-efficacy and inflexibility-with disturbance in daily function was significant (P=0.01). Regression analysis showed that inflexibility, reappraisal, secure attachment and self-efficacy are the best predictors of disturbance daily activities in patients with chronic pain.
Conclusion: Based on the results, the predictors explain 34% of variance of disturbance daily activities. So, it’s essential to consider psychological variables in planning of therapeutic intervention in patients with chronic pain.

Keywords

Main Subjects


  1. Thron BE. Cognitive therapy for chronic pain: Step by step guide. New York: Guilford; 2004.
  2. Mohammadzadeh F, Mahdavi MV, Asadi ML, Baghestani A, Faghihzade S, Arab KJ, et al. [Epidemiology of chronic pain in Tehran small area estimation of it prevalence in Tehran neighborhoods by Bayesian approach (Urban Heart-2 study)]. Iranian journal of epidemiology 2013; 9(1): 19-31. (Persian)
  3. Asghari M A, Karami B, Rezaie S. [Prevalence of chronic pain and pain in the city of Ilam Ghorveh]. Journal of psychology 2002; 6: 30-50. (Persian)
  1. Asghari MA. [Investigating the prevalence of recurrent chronic pain and its effect on social performance in industrial unit in Tehran]. Daneshvar Raftar 2004; 11(4): 1-14. (Persian)
  2. Asghari A, Ghaderi N, Ashory A. The prevalence of pain among residents of nursing homes and the impact of pain on their mood and quality of life. Arch Iran Med 2006; 9(4): 368-73.
  1. Sjogren P, Ekholm O, Peuckmann V. Epidemiology of chronic pain in Denmark: An update. Eur J Pain 2009; 13: 287-92.
  2. Bala M, Bekkering T, Riemsma R, Harker J, Huygen F, Kleijnen J. Epidemiology of chronic pain in [cited September 14, 2012]. Available from: https://secure.grunenthal.com/cms/cda/_common/inc/displa y_file.jsp?fileID=189100037
  3. Scott W, McCracken LM. Psychological flexibility, acceptance an commitment therapy, and chronic pain. Curr Opin Psychol 2015; 2: 91-6.
  4. Vowles K E, Thompson M. Acceptance and commitment therapy for chronic pain. In: McCracken LM. (editor). Mindfulness and acceptance in behavioral medicine: Current theory and practice. Oakland, CA: New Harbinger; 2011: 31-60.
  5. Godfery E, Holmes MG, Wileman V, McCracken LM, Norton S, Moss-Morris R, et al. Physiotherapy informed by acceptance and Commitment Therapy (PACT): Protocol for a randomized controlled trial if PACT versus usual physiotherapy care for adult with chronic low back pain. BMJ open 2016; 6(6).
  6. John OP, Gross JJ, Healthy and unhealthy emotion regulation: personality process, individual differences and life span development. J Pers 2004; 72: 1301-33.
  7. Keefe FJ, Porter LS, Labban J. Emotion regulation prices in disease-related pain: A couples based perspectives. In: Synder DK, Sympson J, Hughes JN. (editors). Emotion regulation in couples and families. Pathways to dysfunction and health. Washington. DC: APA; 2006.
  8. Koole SL. The psychology of emotion regulation: an integrative review. Cognit Emot 2009; 23: 4-41.
  9. Kokonyei G, Urban R, Reinhardt M, Jozan A, Demetrovics Z. The difficulties in emotion regulation scales: Factor structure in chronic pain patients. J Clin Psychol 2013; 70(6): 589-600.
  10. Kano M, Hamaguchi T, Hoh M. Correlation between alexithymia and hypersensitivity to visceral stimulation in human. Pain 2007; 132: 252-63.
  11. Mehling WE, Krause N. Are difficulties perceiving and expressing emotions associated with low back pain? The relationship between lack of emotional awareness (alexithymia) and 12-month prevalence of low- back pain in 1180 public transit operators. J Psychosom Res 2005; 58: 73-81.
  12. Jackson T, Nagasaka T, Fritch A. Alexithymia is not related to tolerance for cold pressure pain. Percept Motor Skill 2002; 94: 487-8.
  13. Lumley MA, Radcliffe AM, Macklem DJ. Alexithymia and pain in three chronic pain samples: Comparing Caucasians and African Americans. Pain Med 2005; 6: 251-
  14. Turk DC, Monarch ES. Chronic pain. In: Kennedy P, Llewelyn S. (editors). The essentials of clinical health psychology; 2006: 111-34.
  15. Bowlby J. Attachment and loss. New York: Basic Books; 1982.
  16. Hurter S, Paloyelis Y, Amanda C, Williams de C, Fotopoulou A. Partners’ empathy increases pain ratings: Effects of perceived empathy and attachment style on pain report and display. J Pain 2014; 9(15): 934-44.
  17. Meredith P, Ownsworth T, Strong J. A review of the evidence linking adult attachment theory and chronic pain: presenting a conceptual model. Clin Psychol Rev 2008; 28: 407-29.
  18. Bandura A. Self –efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; B4: 191-215.
  19. Turk DC, Okifuji A. Psychological factors in chronic pain: Evolution and revolution. J Consult Clin Psychol 2002; 79: 678-90.
  20. Besharat MA, Kochi S, Dehghani M, Farahani H, Momenzadeh S. [The moderating role of self-efficacy on the relation of alexithymia with severity and disability of pain in chronic pain patients]. Modern psychological researches 2011; 6: 43-60. (Persian)
  1. Kline P. An easy guide to factor analysis. New York, NY: Routledge.
  2. Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991; 61: 226-44.
  3. Dibajiforoshani FS, Emamipoor S, Mahmoodi GR. [The relation between attachment styles and strategies of conflict solving among females]. Andisheh va Raftar 2009; 3(11): 87-101. (Persian)
  1. Bigdeli I, Najafy M, Rostami M. [The relation of attachment styles, emotion regulation, and resilience to well-being among students of medical sciences]. Iranian journal of medical education 2013; 13(9): 721-9. (Persian)
  2. Wicksell RK, Renofalt J, Olsson GL, Bond FW, Melin L. Avoidance and cognitive fusion-central components in pain related disability? Development and preliminary validation of the psychological inflexibility in pain scale (PIPS). Eur J Pain 2008; 12(4): 491-500.
  3. Aghayousefi AR, Tarkhan M, Mohammadi N, Afshar H. [The role of psychological inflexibility and pain acceptance in predicting of resiliency in chronic pain patients]. Health psychology 2016; 5: 15-27. (Persian)
  4. Asghari MA. [Pain and its assessment]. Tehran: Roshd; 2011. (Persian)
  5. Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J Pers Soc Psychol 2003; 85(2): 348-62.
  6. Sadat Hosini F, Khayyr M. [Survey the role teacher in mathematic academic emotions and emotional regulation of students]. Quarterly journal of psychology of Tabriz University 2010; 5(20): 41-63. (Persian)
  7. McBetha J, Nicholla BI, Lis Cordingley B, Daviesa KA, Gary J, Macfarlane C. Chronic widespread pain predicts physical inactivity: Results from the prospective EPIFUND study. Eur J Pain 2010; 14: 972-9.
  8. Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. The association between the physical activity of patients with idiopathic chronic neck pain and their psychological state. Arch Hel Med 2017; 34(1): 100-3.
  9. McCracken L. Committed action: An application of psychological flexibility model to activity patterns in chronic pain. J Pain 2013; 14(8): 828-35.
  10. Morleyy S. The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. J Pain 2014; 15(3): 221-34.
  11. Middendrop HV, Lumley MA, Jacobs WG, Doornen LV, Bijlsma WJ, Geenen R. Emotions and emotional approach and avoidance strategies in fibromyalgia. J Psychoso Res 2008; 64: 159-67.
  12. Wong WS, Fielding RW. Suppression of emotion expression mediates the effects of negative affect on pain catastrophizing a cross-sectional analysis. Clin J Pain 2013; 29(10): 865-72.
  13. Agar-Wilson ml, Jackson T. Are emotion regulation skills related to adjustment among people with chronic pain, independent of pain coping? Eur J Pain 2012; 16: 105-14.
  14. Davies KA, Macfarlane GJ, McBetha J, Morriss R, Dickens C. Insecure attachment style is associated with chronic widespread pain. Pain 2009; 143: 200-5.
  15. Ciechanowski Sullivan M, Jensen M, Romano MJ, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain 2003; 104: 627-37.
  16. Meredith P, Strong J, Feeney JA. Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain 2006; 123: 146-54.