Kan accept og katastrofering prædiktere oplevede begrænsninger i funktionsniveauet hos kroniske smertepatienter?

Background and aims:
Nearly 20% of the adult population in Denmark suffers from chronic pain, defined as frequent or constant pain for more than 6 months. Chronic pain is a complex phenomenon that interferes with a person’s ability to engage in various everyday life activities and induces increased perceived pain related disability.
Studies have shown that presence of pain is not a sufficient condition for increased disability, because pain related cognitions like acceptance and catastrophizing could mediate the person’s perception of both pain and disability.
Existing literature shows conflicting evidence regarding acceptance and catastrophizing’s ability to predict pain related disability. This study aimed to examine these two cognitive factors ability as predictive factors regarding pain related disability in chronic pain patients.

Methods:
A combined prognostic design was applied. A cohort of 1608 chronic pain patients (female: n = 1106, mean age: 50.3±14.7, mean pain duration (years): 11±10.5) attending the interdisciplinary Pain Center at Odense University Hospital, Denmark during January 2018 to December 2019 were included in the study. Data was generated before first consultation and after ended treatment through full-length validated self-reported questionnaires.
Prognostic models were calculated using linear regression, and statistically significant predictive factors regarding disability at baseline and at follow-up were identified and presented with their 95% confidence intervals (CI).

Results:
A total of 1603 chronic pain patients were included in the final cohort, since five respondents did not meet the age criteria (≥18 years). All responds answered the questionnaires at baseline and 273 also answered at the follow-up questionnaires. Comparation of the two groups of respondents showed no considerably differences. Statistically significant predictive factors regarding disability were found to be: acceptance (-0.20 95% CI [-0,24; -0.17]), pain duration (0.06 95% CI [0.004; 0.11]) and pain intensity (1.60 95% CI [ 1.30; 1.88]) regarding disability at baseline, and acceptance (- 0.09 95% CI [-0.17; -0.0002]) and disability at baseline (0.59 95% CI [0.44; 0.73]) regarding disability at follow-up. Catastrophizing were not found to be a statistically significant predictive factor on neither disability at baseline (-0.007 95% CI [-0.07; 0.05]) nor at follow-up (-0.02 95% CI [-0.15; 0.11]).

Conclusions:
Acceptance and catastrophizing both correlated with pain related disability, thus that a low degree of acceptance and a high degree of catastrophizing were associated with the highest degree of pain related disability. The results are supported by previous studies and emphasize the need to include cognitive factors like acceptance and catastrophizing in pain management and treatment regarding chronic pain patients attending a Pain Center. Acceptance did statistically significantly predict both pain related disability at baseline and at follow-up, and catastrophizing were not found to be a predictive factor for neither disability at baseline nor at follow-up.

Implications:
To better address pain related disability, the prognostic models developed in this study could benefit the chronic pain patient’s everyday life. Identifying the chronic pain patients who might experience the highest degree of pain related disability could result in a more cost-effective care. Care could then be distributed focusing on the patients experiencing the highest degree of pain related disability. In addition, further studies regarding validity, usability and potential benefits of the prognostic models are needed.