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Psychological Factors

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Most studies of chronic SCI pain have focused on the medical causes and clinical manifestations of pain while much less is understood about how psychosocial factors impact SCI pain (Summers et al. 1991). Pain itself was found to be associated with greater emotional distress than the SCI itself. A negative psychosocial environment along with increased age, depression, anxiety and intellect were found to be associated with reports of greater post-SCI pain severity interfering with activities of daily living (Richards et al. 1980). Greater pain severity was not associated with physiological factors such as injury level, completeness of injury, surgical fusion and/or instrumentation or veteran status. The authors were unable to distinguish whether the psychological factors were a consequence of, or contributors to, greater pain severity. Summers et al. (1991) studied 54 SCI patients (19 with quadriplegia and 35 with paraplegia) and of these, 42 patients assessed with the Pain questionnaire found that anger and negative cognitions were associated with greater pain severity. Severity of pain was higher in patients who reported pain in response to a question on general well-being, those that were less accepting of their disability and those that perceived that a significant other would express punishing responses to their pain behaviours. The authors concluded that the experience of pain was associated with psychosocial factors. Hence treatment of post-SCI pain should involve these multidimensional aspects.

Cohen et al. (1988) found that patients with complete SCIs reported significantly less severe pain than did pain clinic patients. However, they did not differ from patients with incomplete lesions. Patients with complete SCIs and pain clinic patients showed a significantly more disturbed Minnesota Multiphasic Personality Inventory (MMPI) profile than did patients with incomplete SCIs. It was hypothesized that those patients with complete lesions view themselves as more functionally limited than patients with incomplete lesions, and the completeness of the SCI may be more important in determining psychosocial adjustment than pain per se. Rintala et al. (1998) in community-based men with SCI found that chronic pain was associated with more depressive symptoms, more perceived stress and poorer self-assessed health.

Wollaars et al. (2007) administered questionnaires to persons with a SCI. Of the potential 575 subjects, 49% provided responses. SCI pain prevalence was 77%. Factors associated with less pain intensity included more internal pain control and coping, less catastrophizing, a higher level of lesion and a non-traumatic SCI cause. More pain was associated with greater pain-related disability. Lower catastrophizing was related to better health. Factors related to greater well-being included less helplessness and catastrophizing, greater SCI acceptance and lower anger levels. Greater levels of depression were associated with higher levels of SCI helplessness, catastrophizing and anger. The authors noted that chronic SCI pain and quality of life were both largely associated with several psychological factors of which pain catastrophizing and SCI helplessness were more important. Surprisingly, pain intensity showed no independent relationships with health, well-being and depression (Wollaars et al. 2007).

Widerström-Noga et al. (2007) studied 190 patients with SCI and chronic pain and were able to identify three subgroups. The first group was described as ‘dysfunctional’, characterized by higher pain severity, life interference, affective distress scores, and lower levels of life control and activities scores. The second group was described as ‘interpersonally supported’, characterized by moderately high pain severity, and higher life control, support from significant other, distracting responses, solicitous response, and activities scores. The final group was described as ‘adaptive copers’, characterized by lower pain severity, life interference, affective distress, support from significant others, distracting responses, solicitous responses, activities and higher life control scores. Compared with dysfunctional subgroup, the interpersonally supported group reported significantly greater social support (Widerström-Noga et al. 2007).