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Pain Intensity And Attribution Mediate The Impact Of Patient Weight And Gender On Activity Recommendations For Chronic Pain

Authors Mehok LE, Miller MM, Trost Z, Goubert L, De Ruddere L, Hirsh AT

Received 8 June 2019

Accepted for publication 30 August 2019

Published 19 September 2019 Volume 2019:12 Pages 2743—2753

DOI https://doi.org/10.2147/JPR.S218761

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon


Lauren E Mehok,1 Megan M Miller,1 Zina Trost,2 Liesbet Goubert,3 Lies De Ruddere,3 Adam T Hirsh1

1Department of Psychology, Indiana University – Purdue University Indianapolis, Indianapolis, IN, USA; 2Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; 3Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium

Correspondence: Adam T Hirsh
Department of Psychology, Indiana University – Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202, USA
Tel +1 317 2746942
Fax +1 317 2746756
Email athirsh@iupui.edu

Background and purpose: Despite the notable benefits of physical activity for chronic pain, a large proportion of patients with chronic pain report that they do not receive activity-related recommendations from their providers. Research suggests that patient factors such as weight and gender influence activity-related recommendations for chronic pain. Research also suggests that appraisals of the intensity and cause of pain may explain these weight and gender effects. We investigated the influence of patient weight and gender on observers’ likelihood of recommending activity-related treatments for pain. We also explored the mediating effects of observers’ ratings of pain severity and the extent to which pain was due to medical and lifestyle factors (pain attribution).
Patients and methods: Healthy young adults (N=616; 76% female) viewed videos (Ghent Pain Videos of Daily Activities) and vignettes of 4 patients with chronic back pain performing a standardized functional task. Patients varied by gender (female, male) and weight (normal, obese), but were otherwise equivalent on demographic characteristics and pain behaviors. Participants rated how much pain they perceived the patients to be experiencing, the extent to which they attributed the pain to medical and lifestyle factors, and their likelihood of recommending exercise, physical therapy (PT), and rest.
Results: Patient weight and gender significantly interacted to influence exercise, PT, and rest recommendations. Both pain intensity and pain attribution mediated the relationships between patient weight and activity recommendations; however, these mediation effects differed across gender and recommendation type.
Conclusion: Patient weight and gender influenced laypeople’s activity recommendations for chronic pain. Moreover, the results suggest that observers’ perceptions of pain intensity and pain attributions are mechanisms underlying these effects. If these findings are replicated in providers, interventions may need to be developed to reduce provider biases and increase their recognition of the benefits of physical activity for chronic pain.

Keywords: pain, weight, gender, physical activity, recommendations

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