Mediators of Pain and Physical Function in Female and Male Patients with Chronic Pain
Received 5 October 2019
Accepted for publication 19 February 2020
Published 19 May 2020 Volume 2020:13 Pages 1059—1071
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Michael A Überall
Lena Danielsson,1,2 Gunnvald Kvarstein,1,2 Svein Bergvik3
1Pain Clinic, Division Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway; 2Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway; 3Department of Psychology, UiT the Arctic University of Norway, Tromsø, Norway
Correspondence: Lena Danielsson
Pain Clinic, Division Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø NO-9038, Norway
Purpose: Chronic pain is often multifactorial and accompanied by psychological distress, catastrophizing thoughts, reduced physical function, and socio-economic worries. In this explorative study, we investigated potential mediators in the relationships of psychological and demographic variables with chronic pain and physical function in women and men.
Patients and Methods: The study included 301 patients admitted to a multidisciplinary pain clinic. Prior to their first consultation, patients completed a questionnaire including items on demographics (age, education, occupational and financial situation), catastrophizing thoughts, psychological distress, pain intensity, and physical function. Hierarchical multiple regression analyses examined demographic and psychological factors associated with pain intensity and physical function. Mediation and reversed mediation models were tested and developed based on calculated relations in the regression analyses between demographic, psychological, pain intensity and physical function variables.
Results: Fifty-eight percent were females and mean age 43.8 and 46.0 years for women and men, respectively. In the regression analyses, psychological factors accounted better for pain intensity than demographic variables, while physical function was best accounted for by demographic variables. Among women, catastrophizing thoughts mediated significantly the relationships between education and pain intensity, and between education and physical function. Psychological distress mediated significantly the relationships between financial situation and pain intensity, and between financial situation and physical function in women. In men, the only significant mediation model was psychological distress mediating the relationship between financial situation and pain intensity. Some of the reversed models revealed indirect effects, indicating bidirectionality.
Conclusion: The results indicate that there might be gender-specific mediators in how demographic variables are associated with pain intensity and physical function. This suggests an awareness among clinicians of potential gender-specific factors mediating pain problems, and the need for a gender-specific, multidisciplinary approach in the treatment of chronic pain.
Keywords: depression, physical disability, comorbidity, catastrophizing, mediation, multidisciplinary treatment
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