A biopsychosocial investigation into the experience of chronic pain: the mediating role of dispositional cognitive factors

A biopsychosocial investigation into the experience of chronic pain: the mediating role of dispositional cognitive factors

Survey data from an Australian chronic pain sample was used to investigate physical, cognitive and affective factors associated with pain experience. Research instruments included paper and web-based versions of Profile of Chronic Pain: Screen (Ruehlman, Karoly, Newton, & Aiken, 2005), Negative Problem Orientation Questionnaire (Robichaud & Dugas, 2005a), Pain Catastrophizing Scale (Sullivan, Bishop, & Pivik, 1995), Five-Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006), and Depression, Anxiety and Positive Outlook Scale (Pincus, Williams, Vogel, & Field, 2004). Exploratory principal component analyses conducted on all scales, using parallel analysis for determining number of components for extraction, revealed differences in PCS dimensions (N=347), with rumination, magnification and helplessness not emerging as discrete components. DAPOS dimensions of depression and anxiety emerged as a single component called negative affect (N=345). PCP:S dimensions of severity and interference emerged as a single component called physical burden (N=337). NPOQ (N=326) and FFMQ (N=333) facets emerged as expected. All measures were internally reliable. Hierarchical regression analyses (N=269) revealed that, after accounting for previous emotional disorder diagnoses, pain-related distress could be appreciably understood and predicted in terms of physical burden of pain, negative problem orientation, catastrophizing, and non-judgement. Total variance accounted for in negative affect scores was 52%. Positive outlook scores were predicted by negative problem orientation, catastrophizing, observe, and non-reactivity. Total variance accounted for in positive outlook was 36%. Path analyses revealed that catastrophizing mediated the effect of emotional burden of pain on both negative affect and positive outlook. Negative problem orientation, catastrophizing, and mindful awareness, each also explained the influence of physical burden of pain on positive outlook. A subset of participants (N=140) took part in a follow-up study using identical measures. Test-retest coefficients (4 weeks) suggested temporal stability of constructs. Path analyses (n=100) revealed that negative problem orientation mediated the influence of negative affect (Time 1) on emotional burden of pain (Time 2). Negative problem orientation also mediated the effect of positive outlook (Time 1) on emotional burden of pain (Time 2). Hierarchical regression analyses revealed that, after controlling for affect (negative and positive, from Time 1), predictors of negative affect in the follow-up study were previous negative affect scores and negative problem orientation. Total variance accounted for in negative affect was 72%. Significant predictors of positive outlook across time were previous positive outlook scores and the mindfulness facet: non-reactivity. Total variance accounted for in positive outlook was 62%. The most salient predictors of pain-related affect were previous affect scores. Replicating path analyses conducted at Time 1, the effect of physical burden of pain on positive outlook was mediated by three cognitive variables: negative problem orientation, catastrophizing, and describe (N=140). Findings for NPO and catastrophizing are consistent with results from Time 1. Results from all studies highlighted variously significant contributions, dysfunctional and adaptive, of cognitions to overall pain experience. An important mediating role of a range of dispositional cognitions was demonstrated in the relationship between pain and affect. Implications were addressed and suggestions made for future research.