Medical help-seeking by different types of chronic pain patients

This paper reports on a study of the use of health services by different ty pes of patients with chronic benign pain. The purpose of the study was to i dentify differences in medical consumption between different types of pain patients. In the course of one year 586 patients were selected by 45 genera l practitioners: they included patients who had had almost daily chronic pa in symptoms for at least six months, without a medical diagnosis (such as c ancer or arthritis) to explain the pain. Patients were categorized accordin g to the Multidimensional Pain Inventory which distinguishes four categorie s: the dysfunctional, who perceive severe pain and gain social support; the interpersonally distressed, who combine pain with affective and relational distress; adaptive copers, who cope with their pain in a number of ways; t he average type, with characteristics of all three other types. It was hypo thesised that adaptive copers would make less use of health services and wo uld be more involved in self-help activities than dysfunctional or interper sonally distressed patients. Frequent use of psychological services by the interpersonally distressed group was expected. It was predicted that differ ence in health services use would continue during the subsequent year. No differences were found between the four groups in location, temporal cha racteristics, or possible medical causes of the pain symptoms. Dysfunctiona l patients used more services than the others. Adaptive copers used the lea st. The four groups did not differ in self-care activities. Group-membershi p as well as pain severity are related to the use of health services. None of the groups showed a significant decline in the use of health services du ring the year. It is concluded that chronic pain is invalidating, but that not all patients are equally excessive in their use of medical services.