EMOTIONAL DISTRESS AND CONTROL COGNITIONS AS MEDIATORS OF THE IMPACT OF CHRONIC PAIN ON DISABILITY

Objectives. To explore the hypothesized mediating effects of cognition s and emotional distress on che pain-disability relationship. Design. Pain (McGill Pain Questionnaire), disability (Oswestry Low Back Pain D isability Questionnaire), emotional distress (General Health Questionn aire 28) and Locus of Control (Multidimensional Health Locus of Contro l) were examined by MANOVA for differences between admission to a pain rehabilitation programme and follow-up and by correlation to examine inter-relationships. Stepwise multiple regressions rested for the sign ificant predictors of disability on admission and follow-up and propor tional change. Methods. Seventy-three patients met the criteria for in clusion (age between 16 and 65 years, low back pain for six months, En glish speaker). Fifty-four patients were available for follow-up. Pati ents attended a three-week programme based on cognitive behavioural pr inciples. Data were collected by self-report on admission to the progr amme and at three-month follow-up. Results. At follow-up, disability, pain and emotional distress were all found to have improved. Admission , follow-up and proportional change scores showed no correlation betwe en pain and disability at any stage. However, distress and internal Lo cus of Control (IHLC) were related to disability and distress was also related to pain. Multiple regressions showed chat IHLC and distress p redicted disability on admission and follow-up. Distress predicted the proportional change in disability Conclusions. No direct relationship was found between pain and disability. It appeared that IHLC modified , and emotional distress mediated, the pain-disability relationship.