Patient Beliefs Predict Patient Functioning

What a person believes about chronic pain, obviously, can influence that person's physical and emotional functioning when faced with chronic pain. Yet, previous research on this important subject of patient beliefs has relied primarily on the patient's self report. The authors of this current study wanted to use three sources—patient self-report, spouse report, and objective observations—to examine the influence of beliefs on disposition and functioning. In addition, the authors were interested in the transformation of beliefs about pain. They hypothesized that over the course of a multidisciplinary treatment program, detrimental beliefs would decrease and physical and psychological dysfunction would improve.

The authors used various tools to gain both subjective and objective information on the 121 chronic pain patients involved in the study. The Survey of Pain Attitudes (SOPA) assesses if the patient believes the following:

  • that one should receive solicitous responses from family members if in pain,
  • that one is disabled if in pain, and
  • that pain indicates damage and subsequent activity should be restricted.

The Physical Disability Self-Report determines the impact of illness on body movement and mobility. Depression, pain duration and intensity were also quantified.

Both patients and spouses completed the Pain Behavior checklist. In addition, patients and spouses were videotaped performing household duties as observational research. The tapes were analyzed by the authors in terms of facial expressions, complaints of pain, and abnormal body positioning while performing seven tasks. All assessments were performed prior to the treatment program and then repeated six months later.

At the baseline, all participants agreed that they were disabled by pain and all disagreed with the idea that family members should show excessive concern about their pain. The patients were neutral on the issue of pain indicating damage. They had a moderate level of pain, and average scores for depression and physical disability.

The authors found that a decrease in a patients' belief of disability, damage, and restricted activity correlated with a real decrease in pain behavior, disability, and depression. The authors specify that the belief that "pain indicates damage" was, "closely linked to the measures of functioning and pain behavior in this study. In the change score analyses, for exampled, pretreatment to 6 month follow-up change, scores in harm beliefs were moderately to strongly related to all measures of patient function and behavior, regardless of the source of measurement."
The authors conclude:

"Although the findings of the current study cannot establish causal relationships, they suggest the possibility that interventions specifically designed to modify certain maladaptive patient beliefs, including the belief that on is disabled and that pain signals damage, may result in decreased patient pain behavior, physical disability and depression."
Thus, targeting these thought processes is important when treating patients with chronic pain.

Jensen MP, Romano JM, Turner JA, et al. Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain. Pain 1999;81: 95-104.