Korean J Pain.  2011 Mar;24(1):13-21. 10.3344/kjp.2011.24.1.13.

Daily Functioning in Chronic Pain: Study of Structural Relations with Posttraumatic Stress Disorder Symptoms, Pain Intensity, and Pain Avoidance

• Cho SK
• Heiby EM
• McCracken
• Moon DE
• Lee JH

• KMID: 2278092
• DOI: http://doi.org/10.3344/kjp.2011.24.1.13

Abstract

BACKGROUND
This study aimed to evaluate processes from the mutual maintenance model in relation to daily functioning in patients with both chronic pain and a history of a traumatic experience. The mechanism illustrated the structural relations for daily functioning among pain intensity, hyperarousal, re-experiencing, trauma avoidance, and pain avoidance.
METHODS
Archival data (N = 214) was used for this study and data were analyzed for 142 chronic pain patients reporting a traumatic experience and seeking treatment at a tertiary pain clinic in Korea.
RESULTS
The results indicated that pain intensity, hyperarousal, and pain avoidance had significant direct effects on daily functioning. Also, pain intensity showed significant indirect effects on daily functioning through hyperarousal and pain avoidance; and hyperarousal through pain avoidance.
CONCLUSIONS
Results suggest a direct contribution of high levels of pain, hyperarousal symptoms of PTSD, and pain avoidance behaviors to reduced daily functioning. Also, elevated pain as reminders of the trauma may trigger high levels of hyperarousal symptoms of PTSD. Subsequently, avoidant coping strategies may be used to minimize pain so that the trauma would not be re-experienced, thus inhibiting the activation of hyperarousal symptoms of PTSD. However, prolonged use of such strategies may contribute to decline in daily functioning.

Keyword

chronic pain; daily functioning; Korean; mutual maintenance model; PTSD

MeSH Terms

Chronic Pain
Humans
Pain Clinics
Stress Disorders, Post-Traumatic

Figure

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  Fig. 1 Full theoretical model.

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  Fig. 2 Parsimonious model 1. All correlations are significant at P < 0.01.

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  Fig. 3 Final model (Parsimonious model 2). All correlations are significant at P < 0.01.

Reference

1. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002; 47:930–937. PMID: 12553128.

2. Tomarken AJ, Waller NG. Potential problems with "well fitting" models. J Abnorm Psychol. 2003; 112:578–598. PMID: 14674870.

3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington DC: American Psychiatric Association.

4. Laursen BS, Bajaj P, Olesen AS, Delmar C, Arendt-Nielsen L. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Eur J Pain. 2005; 9:267–275. PMID: 15862476.

5. McCracken LM, Gauntlett-Gilbert J, Vowles KE. The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain. 2007; 131:63–69. PMID: 17257755.

6. Schnurr PP, Hayes AF, Lunney CA, McFall M, Uddo M. Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. J Consult Clin Psychol. 2006; 74:707–713. PMID: 16881778.

7. Zayfert C, Dums AR, Ferguson RJ, Hegel MT. Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression. J Nerv Ment Dis. 2002; 190:233–240. PMID: 11960084.

8. Clapp JD, Beck JG, Palyo SA, Grant DM. An examination of the synergy of pain and PTSD on quality of life: additive or multiplicative effects? Pain. 2008; 138:301–309. PMID: 18280044.

9. Katz J, Asmundson GJ, McRae K, Halket E. Emotional numbing and pain intensity predict the development of pain disability up to one year after lateral thoracotomy. Eur J Pain. 2009; 13:870–878. PMID: 19027333.

10. Tsui P, Stein T, Sonty N. The relationship among PTSD symptoms, chronic pain acceptance, and disability. J Pain. 2010; 11:S58.

11. Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev. 2001; 21:857–877. PMID: 11497210.

12. Beck JG, Freeman JB, Shipherd JC, Hamblen JL, Lackner JM. Specificity of Stroop interference in patients with pain and PTSD. J Abnorm Psychol. 2001; 110:536–543. PMID: 11727943.

13. MacLeod CM. Half a century of research on the Stroop effect: an integrative review. Psychol Bull. 1991; 109:163–203. PMID: 2034749.

14. Geisser ME, Roth RS, Bachman JE, Eckert TA. The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance, and disability among patients with accident and non-accident related pain. Pain. 1996; 66:207–214. PMID: 8880842.

15. Blanchard EB, Kolb LC, Geradi RJ, Ryan P, Pallmeyer TP. Cardiac response to relevant stimuli as an adjunctive tool for diagnosing post-traumatic stress disorder in Vietnam veterans. Behav Ther. 1986; 17:592–606.

16. Jensen MP, Karoly P. Turk DC, Melzack R, editors. Self-report scales and procedures for assessing pain in adults. Handbook of pain assessment. 2001. 2nd ed. New York: Guilford Press;p. 15–34.

17. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol Assess. 1997; 9:445–451.

18. Nam B, Kwon HI, Kwon JH. Psychometric qualities of the Korean version of the Post-traumatic Diagnosis Scale (PDS-K). Korean J Clin Psychol. 2010; 29:147–167.

19. McCracken LM, Dhingra L. A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002; 7:45–50. PMID: 16231066.

20. Coons MJ, Hadjistavropoulos HD, Asmundson GJ. Factor structure and psychometric properties of the Pain Anxiety Symptoms Scale-20 in a community physiotherapy clinic sample. Eur J Pain. 2004; 8:511–516. PMID: 15531218.

21. Cho S, Lee SM, McCracken LM, Moon DE, Heiby EM. Psychometric properties of a Korean version of the Pain Anxiety Symptoms Scale-20 in chronic pain patients. Int J Behav Med. 2010; 17:108–117. PMID: 20186509.

22. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med care. 1992; 30:473–483. PMID: 1593914.

23. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Econ. 1993; 2:217–227. PMID: 8275167.

24. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992; 305:160–164. PMID: 1285753.

25. Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ. 1993; 306:1440–1444. PMID: 8518640.

26. Han CW, Lee EJ, Iwaya T, Kataoka H, Kohzuki M. Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med. 2004; 203:189–194. PMID: 15240928.

27. Koh SB, Chang SJ, Kang MG, Cha BS, Park JK. Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean J Prev Med. 1997; 30:251–266.

28. Steiger JH. Structural model evaluation and modification: An interval estimation approach. Multivariate Behav Res. 1990; 25:173–180.

29. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990; 107:238–246. PMID: 2320703.

30. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999; 6:1–55.

31. Loehlin JC. Latent variable models: an introduction to factor, path, and structural analysis. 1992. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum.

32. Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002; 7:422–445. PMID: 12530702.

33. Leveille SG, Guralnik JM, Ferrucci L, Hirsch R, Simonsick E, Hochberg MC. Foot pain and disability in older women. Am J Epidemiol. 1998; 148:657–665. PMID: 9778172.

34. Unruh AM, Henriksson C. Strong J, Unruh AM, Wright A, Baxter GD, editors. Psychological, environmental and behavioural dimensions ofthe pain experience. Pain: A textbook for therapists. 2002. London: Churchill Livingstone;p. 65–79.

35. Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999; 19:97–119. PMID: 9987586.

36. McCracken LM, Gross RT, Aikens J, Carnrike CL Jr. The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments. Behav Res Ther. 1996; 34:927–933. PMID: 8990544.

37. McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992; 50:67–73. PMID: 1513605.

38. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. Trauma and the Vietnam War generation: report of findings from the National Vietnam Veterans Readjustment Study. 1990. New York: Brunner/Mazel.

39. Resick PA, Calhoun KS. Barlow DH, editor. Posttraumatic stress disorder. Clinical handbook of psychological disorders. 2001. 3rd ed. New York: Guilford Press;p. 60–113.

40. Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008; 59:961–967. PMID: 18576297.

41. American Psychiatric Association. Insomnia: Both Symptom and Syndrome. Psychiatr News. 2005; 40:30.

42. Sharp TJ. The prevalence of post-traumatic stress disorder in chronic pain patients. Curr Pain Headache Rep. 2004; 8:111–115. PMID: 14980145.

43. Breckler SJ. Applications of covariance structure modeling in psychology: cause for concern. Psychol Bull. 1990; 107:260–273. PMID: 2320704.