Health-related Quality of Life and Pain Beliefs Among People Suffering From Chronic Pain yyy

hronic pain, when not effectively treated and relieved, may have a armful effect on all aspects of health-related quality of life (HRQL). urthermore, pain beliefs are considered an important mediating psyhological factor in chronic pain. The present study focused on HRQL s measured by the Medical Outcomes Survey-Short Form (SF-36) and ddressed possible relationships between pain beliefs as measured by he Pain Beliefs and Perceptions Inventory (PBAPI). The possible imact of background variables such as age, gender, social support, pain ntensity, pain duration, and analgesics on HRQL were controlled for n the analyses. The study sample consisted of 81 people who were ecruited from a multidisciplinary pain management program. Data ere collected as the first part of a routine pretreatment evaluation. he chronic-pain patients reported lower scores on all dimensions of RQL compared to normal controls and other patient groups. No sigificant association was found between pain beliefs and the physical ealth dimension of HRQL whereas gender, pain duration, and pain ntensity were significant predictors of that dimension. In addition, ne of the dimensions of pain beliefs (i.e., mystery) was found to be redictive of the mental health dimension of HRQL. Social support ade an additional contribution to the explained variance in mental ealth. The implications of these results for assessing HRQL and pain eliefs in chronic pain are discussed. 2004 by the American Society for Pain Management Nursing hronic pain, when not effectively treated and relieved, may have a harmful ffect on all aspects of health-related quality of life (HRQL). Chronic pain is efined as “pain that has lasted 6 months or longer, is ongoing, is due to non-lifehreatening causes, has not responded to currently available treatment methods, nd may continue for the remainder of the patient’s life” (Dunajcik, 1999, p. 71). It produces emotional stress; interferes with functional capacity; and Pain Management Nursing, Vol 5, No 2 (June), 2004: pp 66-74 h 1 n p H O M c p 1 b c i ( p b n i i h t t G n t p i p p c p a p h a e b B s i d t l & i H f ( p i t c c c t a w 1 v o s w l S s i S n a c n i n o a 1 p w o T g p m 2 s n t i D m f i r p e m m d a i ( T a 67 HRQL and Pain Beliefs Among Chronic-Pain Sufferers inders family, social, and vocational roles (Turk, 996). More effective treatments for chronic pain are eeded. Consequently, multidisciplinary treatment aproaches have gained more attention in improving RQL in chronic-pain patients (Becker, Sjøgren, Bech, lsen, & Eriksen, 2000; Flor, Fydrich, & Turk, 1992; orley, Eccleston, & Williams, 1999). A common coneptual framework within these approaches is a biosychosocial understanding of chronic pain (Gatchel, 999). This understanding views pain as influenced y biological, psychological, and social factors that ombine and interact in various ways. Furthermore, t often incorporates cognitive behavioral therapy CBT), which aims at improving the quality of life and ain beliefs of chronic-pain patients (Turk, Meichenaum, & Genest, 1983). HRQL is a multidimensional construct given a umber of more or less broad interpretations, dependng on which aspects concerning the patient’s life are ncluded. In this study, HRQL was defined as personal ealth status and refers to aspects of the patients’ lives hat are dominated or significantly influenced by menal and physical well-being (Ware, Snow, Kosinski, & andek, 2000). It is argued that the main goal of ursing care is to identify the professional activities hat may promote and safeguard the quality of life of atients (Draper, 1997). HRQL is also increasingly beng recognized as one of the most important outcome arameters in chronic conditions, including those for ain management. In practical situations, HRQL data an be used as guidelines to identify specific patient roblems as well as decisions about health programs nd resource allocations (Wiklund, 1990). Chronicain patients often experience a burden of disease that as a negative effect on HRQL (Schlenk et al., 1998), nd all dimensions of HRQL may be reduced (Becker t al., 1997; Katz, 2002). However, the relationship etween pain and HRQL is complex (Anderson & urckhardt, 1999) and may be mediated by biopsychoocial factors (Wilson & Cleary, 1995). Research findngs suggest that patients with various chronic disorers may have lower HRQL in most domains compared o a healthy population (Nortvedt, Riise, Myhr, & Nyand, 1999; Schlenk et al., 1998; Wahl, Loge, Wiklund, Hanestad, 2000). It must be added that these findngs are unclear regarding the specific dimensions of RQL that are influenced by chronic disorders, and ew comparisons across these patient groups exist Schlenk et al., 1998). Thus, when comparing chronicain patients to groups with various chronic disorders, t may help to build up a database of chronic condiions, which is a major aim in HRQL research. In a cognitive behavioral model, pain beliefs are onsidered to be an important factor in chronic pain p onditions and are defined as “the patients’ own coneptualizations of what pain is, and what pain means o them” (Williams & Thorn, 1989) or as “assumptions bout reality, which serve as a perceptual lens through hich events are interpreted” (Lazarus & Folkman, 984). Pain beliefs are often linked to culturally shared alues and powerful emotions (Morris, 1999). In varius reports, significant associations have been oberved between pain beliefs and functioning in people ith chronic pain. For example, pain duration (Wiliams & Thorn, 1989) and pain constancy (Herda, iegeris, & Basler, 1994; Williams, Robinson, & Geiser, 1994) have been associated with greater pain ntensity. Pain beliefs in constancy (Herda et al., 1994; troud, Thorn, Jensen, & Boothby, 2000) and permaence (Turner, Jensen, & Romano, 2000; Williams et l., 1994) have shown higher correlations with psyhological symptomatology. Furthermore, time permaence has been related to decreased physical functionng (Turner et al., 2000). Beliefs about the mysterious ature of pain have been related to poorer treatment utcomes and greater psychosocial distress (Herda et l., 1994; Williams & Thorn, 1989; Williams et al. 994). Lastly, self-blame has been associated with deression (Williams et al. 1994). Health professionals ho ignore the patients’ pain beliefs may complicate r entirely undermine effective treatment (Williams & horn, 1989). Several studies in pain indicate that sociodemoraphic differences exist. Gender differences are reorted in chronic pain, which indicate that women are ore sensitive to painful stimuli than men (Fillingim, 000; Miaskowski, 1999). Research has suggested that ocial factors also play a central role in the mainteance of chronic pain and disability (Turk, 1996). In he medical tradition, pain has been studied as a physcal symptom often related to duration and intensity. espite advances in medicine, there is a general agreeent that physical factors cannot completely account or reported physical symptoms (Turk, 1996). Exploring HRQL in chronic-pain patients seems mportant for several reasons. Research reveals that a eduction in HRQL is a common problem in chronic ain (Becker et al., 1997; Katz 2002) and that more ffective treatments are needed. In this respect, inforation about HRQL data is considered useful to estiate the burden of chronic pain and evaluate possible ifferences between patient groups. Research findings lso show that pain beliefs may have an impact on pain ntensity, functioning, and treatment compliance Herda et al., 1994; Turner et al., 2000; Williams & horn, 1989; Williams et al., 1994). Thus, information bout pain beliefs may provide insight into important sychological factors of the pain experience that may h f o s m m o l s e c t s d p i l r p g