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Vulnerability, Resilience and Pain associated Symptoms in two Groups of Patients with Chronic Pain- a Pilot Study

Artikel i vetenskaplig tidskrift
Författare Birgitta Peilot
Paulin Andréll
Johan Gottfries
Clas Mannheimer
Publicerad i ECRONICON open access
Volym 11
Nummer/häfte 11
Sidor 01-19
Publiceringsår 2019
Publicerad vid Institutionen för kemi och molekylärbiologi
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 01-19
Språk en
Länkar https://www.ecronicon.com/ecne/pdf/...
Ämnesord Anxiety, Attachment, Chronic pain, Depression, Multidimensional Pain Inventory (MPI) , Multivariate data analysis. Sense of Coherence (SOC), Vulnerability factors
Ämneskategorier Klinisk medicin


Objective. To compare pain and pain associated symptoms, vulnerability factors and factors of resilience in two groups with chronic pain. Design. An explorative and hypothesis generating pilot study. Setting. Consulting psychiatry and occupational health care Participants. 30 consecutive patients in consulting psychiatry with chronic pain, who had not responded to conventional pain treatment, and 42 consecutive patients with chronic pain in occupational health care. Interventions. All patients referred to consulting psychiatry were offered treatment with cognitive therapy (CT). The patients in occupational health care were offered patient-centered treatment and follow-up. Main otutcome measures. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8-11 months. PROM included Relationship Scales Questionnaire (RSQ ) for attachment pattern, Sense of coherence (SOC), Multidimensional Pain Inventory (MPI) for pain and dysfunction, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pines´scale for burnout and Short-Form 36 (SF-36). Statistical tests were conducted at a 5% significance level. Subgroup identification was accomplished by means of Multivariate data analysis (MVDA). Results. Both patient groups had vulnerability factors in terms of insecure attachment (RSQ), a low SOC and dysfunctional subgroups according to MPI. The occupational health care group reported higher SOC (p=0.02) and less anxiety (p=0.002), depression (p=0.01) and burnout (p<0.001) than the psychiatry group. These findings were further interpreted by using multivariate analyses. Hereby an overlapping between the two patient groups was obtained, indicating that there were patients within the occupational health care group with higher vulnerability than expected. The results of this study also indicated that a strong SOC per se did not seem to protect against chronic pain but may have a positive impact on HRQoL and the ability to handle pain. Conclusion. The impact of vulnerability factors on pain management and rehabilitation in patients with chronic pain in primary care might be underestimated. Thus SOC as well as MPI and RSQ could be important tools for assessing vulnerability and resilience in chronic pain. The role of SOC as well as attachment pattern. in chronic pain could be an aim of further research Strengths and limitations of the study * This study is a small hypothesis generating pilot study and the results need to be validated in further studies of vulnerability and resilience in new groups of patients with chronic pain * In order to compensate for many variables and a limited number of observations explorative modellings with MVDA were performed. * The same therapist/physician (BP) treated both patient groups.

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