Sad, Distressed Patients’ Misperceptions Can Affect Their Relationship with Pain

Elizabeth Hofheinz, M.P.H., M.Ed.

While pain is most likely not “all in your head,” how you perceive that pain in your head definitely matters. A new study on this topic, “Moderators and Mediators of Activity Intolerance Related to Pain,” was published in the February 3, 2021 edition of The Journal of Bone and Joint Surgery.

Noting that some patients’ illness exceeds what would be expected given their physical issues, researchers from the Musculoskeletal Institute at the Dell Medical School—The University of Texas at Austin undertook a study of 125 musculoskeletal patients. They examined cognitive bias regarding pain (worst case thinking) and psychological distress in related to pain intensity and activity intolerance.

The patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Computer Adaptive Test and the PROMIS Physical Function CAT, as well as the PROMIS Depression CAT and the PROMIS Anxiety CAT, a pain intensity scale, an abbreviated version of the Negative Pain Thoughts Questionnaire, Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia.

The authors wrote, “Mediation analysis confirmed the large indirect relationship between pain intensity and activity intolerance through cognitive bias. Symptoms of depression and anxiety had an unconditional (consistent) relationship with cognitive bias, but there was no significant conditional effect/moderation (i.e., no increase in the magnitude of the relationship with increasing symptoms of depression and anxiety).”

David Ring, M.D., Ph.D. is Associate Dean for Comprehensive Care, Professor of Surgery and PsychiatryMedical Director of Worklife, and Upper Extremity Clinical Director, Musculoskeletal Institute at the Dell Medical School—The University of Texas at Austin. Dr. Ring told OSN, “This is part of the mounting evidence of the superiority of the biopsychosocial paradigm of human illness (health is physical, mental, and social) over the biomedical paradigm (all symptoms are accounted for pathology).”

“Misconceptions about symptoms make the symptoms more intense and they make us less capable. Misconceptions affect comfort and capability more when we are feeling worry or despair.”

“The next steps,” says Dr. Ring, “are to build strategies for prompt diagnosis and care of mental and social health opportunities in people that present for care of musculoskeletal symptoms. People that are hopeless and worried may sometimes feel more comfortable talking about physical than mental pain.”

And so, says this writer, meet patients where they are. If you genuinely listen, patients will feel “heard,” and may then feel comfortable letting you in on their psychological pain.