Psychologic and Psychosocial Factors Contributing to Chronic Pain

The Impact of Disease Activity on the Quality of Life, Mental Health Status, and Family Dysfunction in Colombian Patients With Rheumatoid Arthritis

This study investigated the relationship between activity of disease, mental health status, quality of life, and family dysfunction in northwestern Colombian patients with rheumatoid arthritis (RA). Seventy-nine patients completed a 2-phase study that included physical examination (objective measurement of disease activity according to adapted American College of Rheumatology criteria) and a pretested questionnaire that sought information on helplessness, disability, depression, anxiety, quality of life, arthritis self-efficacy for pain, and other symptoms, as well as family dysfunction and socioeconomic status. Nineteen patients (24%) had active RA, 48 (61%) had moderately active RA, and 12 (15%) were in remission. Symptoms of depression, helplessness, disability, pain, anxiety, lower quality of life, and self-efficacy were associated with RA activity regardless of age, sex, and duration of the disease. Symptoms of depression were directly correlated with anxiety, helplessness, pain, and disability and inversely correlated with quality of life and self-efficacy. Although family dysfunction was present in 39% of patients, no associations between family dysfunction, activity of RA, mental health variables, socioeconomical status or quality of life were observed. These results indicate that RA activity significantly influences mental health status and quality of life in this population. Accordingly, a holistic conception of therapy should guide the treatment of patients with RA.

Pain: psychiatric aspects of impairment and disability

Patients with chronic pain frequently experience a complex and convoluted journey through the health care system that often is unrewarding for all involved. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound. There often is no direct correlation between objective impairment and a patient's request for disability status. Injured workers maintained on workers' compensation may have an increased risk for developing chronic pain syndromes unresponsive to conventional treatments. These patients may have significant financial, psychosocial, and environmental reinforcement for maintenance of their disability and little incentive to return to work. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. Patients with chronic pain syndrome who have not had psychosocial treatment may not be at maximum medical improvement. The purpose of this paper is to help the readership identify types of psychiatric, psychologic, and psychosocial issues that can coexist in patients with chronic pain who are applying for disability, and to help treating physicians avoid contributing to iatrogenic pain and disability by performing needless and potentially harmful procedures on patients who may be better served with an emphasis on psychiatric or psychologic care.