Psychosocial aspects of everyday life with chronic musculoskeletal pain: A systematic review
Authors: Andersen Lotte Nygaard , Kohberg Maria , Juul-Kristensen Birgit , Herborg Lene Gram , Søgaard Karen , Roessler Kirsten Kaya 
Published: February 2014

Abstract

Background and objective
Chronic pain is a growing phenomenon worldwide. It is considered a medical problem because, besides the socio-economic issues involved, pain is often accompanied by psychosocial problems. Apart from the physical pain, living with chronic pain has many additional consequences. People living with chronic pain generally suffer from other physical and psychological consequences. The impact of chronic pain varies enormously between individuals, but the suffering is frequently pervasive and detrimental. The objective of this study was to review the evidence concerning, ways in which people living with chronic pain are affected in their everyday lives.

Methods
Electronic databases Scopus, Cinahl and PsycINFO were searched from 2008 to September 2012 using a ‘building blocks’ approach and reference lists were scanned. PubMed was also searched and checked for duplicates compared to Scopus, Cinahl and PsycINFO. Data were extracted from included studies and methodological quality assessed with a view to exploring quality differences. To guide the review and interpretation, individual components of methodological quality were compared against a checklist. A narrative synthesis was formulated involving three categories: (1) clinical aspects, (2) everyday life aspects and (3) interpersonal aspects.

Results
The search strategy identified 1140 citations; one study was found during the preliminary searching through references, and a search of reference lists provided five publications. Of these, 24 publications, representing 23 populations, met the inclusion criteria. In total, there were 22 cross-sectional studies and 2 cohort studies. Study populations ranged from 74 to 3928 participants and were heterogeneous in nature across studies with respect to age, duration and localisations of pain and outcome measures. We found a general consensus that life with chronic pain was associated with higher prevalence and higher levels of depression and diagnoses of widespread pain and nonspecific pain are more clearly associated with depression than is specific pain. The results of link between chronic pain and anxiety and stress were not obvious. Overall, there is plausible evidence to suggest a positive relationship between chronic pain and disability and the evidence is stronger for a significant positive association between nonspecific pain and disability, compared to specific pain. It can be summarized that there is a lack of evidence for a relationship between intensity of pain and quality of life. However, there is evidence that nonspecific pain is more compellingly associated with low quality of life than is specific pain.
The evidence of a positive relation between pain and problems in close relations is not convincing but there is an indication to suggest that there is a pain-related issue regarding participation in many social aspects of everyday life.

Conclusion
Besides the pain itself, people living with chronic pain are affected in other aspects of life. In particular, it is evident that they experience challenges with respect to depressive thoughts, disability, lower quality of life and conflicts in close relationships.

Implications
When designing interventions for people with chronic pain, it is essential to take into consideration the fact that living with chronic pain has far-reaching consequences beyond the pain suffered.