Social Influences on Individual Differences in Responding to Pain.

This chapter is part of a resource which presents a state-of-the-art account of the psychology of pain from leading researchers. It features contributions from clinical, social, and biopsychological perspectives, the latest theories of pain, as well as basic processes and applied issues. The book opens with an introduction to the history of pain theory and the epidemiology of pain. It then explores theoretical work, including the gate control theory/neuromatrix model, as well as biopsychosocial, cognitive/behavioral, and psychodynamic perspectives. Issues, such as the link between psychophysiological processes and consciousness and the communication of pain are examined. Pain over the life span, ethno-cultural, and individual differences are the focus of the next three chapters

Using the WHOQOL as a generic measure to assess quality of life during cancer

A cancer diagnosis often affects people’s perceptions of their quality of life (QOL). Improvements to QOL during and after treatment are valued as indicators of success, in tandem with reductions in symptoms and side effects. Insights into how cancer patients assess different aspects of their lives can be more rapidly and comprehensively assessed by a well-designed questionnaire than a time-pressured appointment. A printed profile of scores allows a patient to communicate their perceptions to their clinician and inspect the results themselves. These data can also be the basis for drawing up a mutually agreed treatment plan. While QOL questionnaires assessing symptom intensity and bothersome side effects are well established for use in oncology, they are now more likely to be accompanied by a generic assessment like the WHOQOL that assesses other potentially important QOL dimensions like perceptions of social support, access to health care, financial resources, meaning and purpose in life, and sex life, which may also need to be improved during cancer treatments or afterward. Generic QOL instruments are designed for almost all sick and healthy populations. Their use enables QOL scores for different cancers, or different treatments and interventions to be compared using the same generic measure. Cancer can also be compared with other disease groups, to underpin policy decisions during annual budgeting. Here we review the development and application of the WHOQOL suite of instruments over 25 years, with a particular focus on the QOL of people with cancer

Development of a Pain and Discomfort Module for use with the WHOQOL-100

Clinicians and researchers have become increasingly interested in the impact of chronic pain (CP) on quality of life (QoL). This report describes the qualitative stages of developing a pain and discomfort module for persons with CP to be used with the UK World Health Organisation generic measure of quality of life (WHOQOL). The aims were to investigate patients’ perceptions of CP and its effect on QoL, and to generate items to be used in the development of a module appended to the UK WHOQOL-100. At the first stage (Study 1), six focus groups of patients were invited to discuss how living with pain and discomfort affected QoL. At the second stage (Study 2), an international web survey was conducted with English speaking respondents. Ten new facets of QoL were identified by the focus groups: flare-ups, pain relief, anger and frustration, vulnerability/fear/worry, uncertainty, loss/loneliness/feeling alone, positive strategies, communication, guilt and burdening others, and relationship with health care providers. The websurvey confirmed and validated these new facets. Although the WHOQOL-100 is a reliable and valid measure of QoL for use in CP, this study shows that additional areas must be assessed when measuring the impact of CP on QoL

Accepting Low Back Pain: Is It Related To A Good Quality of Life?

Objectives: Whether individuals with chronic low back pain (CLBP) are willing to accept their pain, is of interest to pain management, but how far is the acceptance of pain related to a good quality of life (QoL)? Recently available measures now enable this question to be investigated; these are (1) the Chronic Pain Acceptance Questionnaire (CPAQ) and a revised version, here described as a short-form (SF-CPAQ), and (2) the World Health Organization Quality of Life Assessment (WHOQOL)-Pain, which is composed of the generic WHOQOL-100 profile (25 facets in 6 domains), and 4 additional facets within a specific pain and discomfort module (PDM). Method: Eighty-six CLBP outpatients (62.8% female, mean age 54.3 y, mean pain duration 69.4 mo) completed the CPAQ and WHOQOL-Pain, mailed 2 weeks before a pain clinic appointment. Results: General QoL was positively associated with overall acceptance of pain (CPAQ: r=0.376, P=0.003; SF-CPAQ: r=0.582, P<0.001), and with activity engagement (r=0.455, P<0.001) and pain willingness (r=0.493, P<0.001) specifically. Lower reports of pain were also associated with a better QoL (r=-0.349, P=0.002). Pain level was important in explaining QoL relating to the physical and social domains and pain-related facets assessed by the PDM. Overall, acceptance contributed to explain QoL in the level of independence and environment domains and for pain-related QoL assessed by the PDM. However, pain and acceptance only made a modest contribution to explaining psychologic and social dimensions of QoL. Discussion: The results indicate that present pain level and whether or not pain is accepted play an important role in the QoL of patients with chronic pain. Additionally, the results provide construct validity for the WHOQOL-Pain and SF-CPAQ measures, especially dimensions of pain willingness and activities engagement. The findings have implications for the way health care is delivered, particularly for the role of acceptance-based treatments for individuals with CLBP

A Measure for Quality of Life Assessment in Chronic Pain: Preliminary Properties of the WHOQOL-Pain.

Chronic pain has a considerable impact on patient-reported outcomes such as quality of life (QoL). To assess QoL in people with chronic pain, a pain and discomfort module (PDM) was developed for use with the WHOQOL-100 and its psychometric properties assessed. Sixteen items covered four facets on pain relief; anger and frustration; vulnerability, fear and worry; and uncertainty. Chronic low back pain patients (n = 133) (age 56; pain duration 85 months; 65% female) completed the WHOQOL-100 and PDM, McGill Pain Questionnaire, and SF-12. The PDM showed good internal consistency reliability (α = .88) (alphas .66–.81). Except for anger, all facets associated most strongly with their ‘parent’ domain. Pain and poorer QoL were strongly associated, supporting construct validity. The SF-12 physical health component associated strongly with pain relief, and the mental health score with other facets, indicating good concurrent validity. Discriminant validity tests showed that PDM scores distinguished between ill and well patients, and between those reporting different health statuses. The PDM has fair to good psychometric properties indicating its value as a patient-reported outcome measure for clinical trials