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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3093 — Negative Emotions and Pain: Where Should the Focus be for Pain Management?

Tan G (MED VAMC and Baylor College of Medicine) , Jensen MP (University of Washington), Thornby J (Baylor College of Medicine), Sloan P (MEDVAMC)

To further examine the relationships between negative emotions (depression, anxiety, and anger) and pain-related variables (pain severity, pain interference, and disability) in order to determine whether the focus of pain management should be on changing pain-related variables or emotional variables

554 patients referred to a tertiary care hospital chronic pain program were asked to complete a packet of standardized questionnaires on pain and negative emotions. The Linear Structural Relations (LISREL) program was used to examine the relationships between measures of negative emotions on the one hand and measures of pain and functioning on the other. No prior expectation was accorded and all six variables were given equal opportunity by the estimation procedure to be either a predictor or criterion.

Results indicated that Pain Interference and Depression both have significant paths leading away from them but none leading towards them except from each other. Thus, pain interference affects depression and depression leads to increased pain interference. Pain interference also leads to increased disability, which in turn, leads to increased pain severity but the reverse is not supported by the finding. Depression contributes to increased anxiety and anger, and anxiety leads to decreased functioning and increased disability. Unexpectedly, Pain Severity has paths leading towards it from Pain Interference and Disability, but none coming from itself to other variables. The findings would indicate that pain severity is a weak predictor of negative emotions such as depression and does not directly affect pain interference and disability. While pain severity does not directly affect depression, depression does affect pain severity via its effect on interference and disability.

These findings suggest the possibility, consistent with contemporary applications of psychosocial pain treatments (but not, perhaps, with more traditional biomedical models) that better outcomes in pain treatment will occur when the focus of pain management is on decreasing pain interference and depression rather than on pain reduction.

The findings from this study suggest that veterans would benefit more if the focus of pain treatment in the Veterans Health Care system shifted from pain-focused (traditional biomedical) approaches to biopsychosocial approaches.

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