KNOWLEDGE OF AND AGREEMENT WITH CHRONIC PAIN DIAGNOSIS - RELATION TO AFFECTIVE DISTRESS, PAIN BELIEFS AND COPING, PAIN INTENSITY, AND DISABILITY

Many authors report that a high percentage of patients with chronic pa in have no or insufficient underlying physical pathology to explain th eir pain. Even when patients do have an identified diagnosis, many pat ient profess to have little understanding of the source of their pain or fear that they may suffer from more severe pathology. This may be p articularly title for patients with chronic musculoskeletal pain given the lack of ''objective'' findings for soft tissue pain complaints. I n the present study, we examined whether chronic neck and back pain pa tients were able to identify the physiologic source of their pain, and based on their responses patients were placed ii? one of three groups : (1) patients who did not know the cause of their pain; (2) patients who did know the cause and agreed with their clinical diagnosis; and ( 3) patients who identified a cause for their pain that was different f rom their clinical diagnosis. The sample was comprised primarily of in dividuals with musculoskeletal pain problems (70%) referred to an outp atient chronic pain rehabilitation program. Each patient completed a p retreatment test battery and group differences were examined on respon ses to the McGill Pain questionnaire, Survey of Pain Attitudes, Brief Symptom Inventory, Coping Strategies questionnaire, and Pain Disabilit y Index. Upon initial evaluation, 47.2% (n = 85) of patients indicated that they did not know what was causing their pain. Of patients who a rticulated a cause for their pain, 20% (n = 36) attributed it to facto rs that did not agree with their diagnosis. Only 32.8% (n = 59) of per sons in the entire sample were able to accurately identify the cause o f their pain. Patients who disagreed with their clinical diagnosis wer e more likely to be diagnosed with musculoskeletal pain and reported t he highest levels of pain CF(2,169) = 3.41, p < .05) as well as the gr eatest levels of affective distress (F(2,169) = 3.54, p < .05). Patien ts who were unsure of or disagreed with their diagnosis tended to repo rt a gi eater belief in pain being a signal of harm (F(2,169) = 11.5, p < .001) and described themselves as more disabled (F(2,169) = 8.43, p < .001). In addition, both the ''unsure'' and ''disagree'' groups te nded to use maladaptive pain strategies more frequently, and persons u nsure of their diagnosis had the lowest levels of perceived control ov er pain. A hierarchical regression analysis examining a cognitive/beha vioral model of pain disability indicated that lack of knowledge of pa in etiology, a belief that pain is a signal of harm, catastrophizing a nd affective distress all significantly predicted increased disability , while pain intensity did not. The data suggests that lack of knowled ge about the origin of pain is associated with maladaptive cognitions in relation to pain (i.e., fear of harming oneself and catastrophizing ) and increased emotional distress which in turn are related to height ened disability due to pain. These data argue that educating patients regarding their diagnosis and the origin of their pain, thereby dispel ling dysfunctional pain beliefs, may be an important component of pain treatment, particularly among patients with chronic musculoskeletal p ain.