Determining the biobehavioral pain patterns for chronic spine pain assessment
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Chronic Spine Pain (CSP) is the most common pain management problem. Treatment guidelines recommend a biopsychosocial approach targeting pain responses. Biobehavioral assessment is a strategy using a biopsychosocial approach that could streamline assessment. The purpose of this study was to describe biobehavioral pain patterns (BPP) of a CSP population, determine potential areas for biobehavioral interventions, and determine outcomes predicted by biobehavioral patterns. There were 4 aims: (1) To describe biobehavioral pain constructs for CSP. (2) To determine the relationship of demographic and clinical characteristics to the biobehavioral pain constructs. (3) To determine the extent to which chronic pain self-efficacy, coping self-efficacy, functional self-efficacy, and chronic pain coping strategies predicted biobehavioral pain constructs as potential areas for intervention. (4) To determine the extent to which biobehavioral pain constructs predicted chronic pain, pain right now, pain disability, physical and mental quality of life, and depressed mood. The Biopsychosocial Model for CSP, Social Learning and Stress and Coping Theories supported biobehavioral assessment for CSP. The design was a descriptive correlational survey. The setting was an urban outpatient clinic providing treatment for musculoskeletal pain. Patients were invited on one occasion. Recruitment continued until a sample size of 100 was reached based upon power analysis. Measurement included the Biobehavioral Pain Profile Instrument, Chronic Pain Coping Inventory, Chronic Pain Self-efficacy Scales, VAS for pain scales, Pain Disability Index, MOS Short Form-36, and the Centers for Epidemiologic Studies Depression Survey. Data analysis included descriptive statistics to summarize the biobehavioral constructs and scores on all study variables. Chi-Squared Analysis was used to examine relationships of gender, age, ethnicity, education levels, spine pain site, medications taken for pain, disability status, and pain with elevated BPP constructs in Aim #2. Multiple Regression was used to analyze relationships of elevated biobehavioral pain constructs with psychological and biopsychosocial pain factors in Aims #3 and #4. Results indicated that the BPP constructs physiologic responsivity, thoughts of disease progression, past and current experiences and loss of control are relevant clinical indicators for assessment. Pain responses that should be targeted for assessment and treatment include self efficacy to manage pain and coping strategies. Discouraging guarding behavior and excessive seeking of social support; and improving confidence to cope with pain and relaxation strategies are potential areas for clinical intervention. Assessing biobehavioral patterns are considerations for prescribing pain medications, as one dimensional pain scales do not adequately address the clinically relevant areas. Assessing depression, quality of life, and disability are important to improve outcomes. Improving education and ethnic sample representation are required in future studies of CSP. These results are preliminary, requiring replication in other CSP populations.