Author ORCID Identifier

https://orcid.org/0000-0003-2004-0301

Year of Publication

2022

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Arts and Sciences

Department/School/Program

Psychology

First Advisor

Dr. Suzanne C. Segerstrom

Abstract

Chronic pain is one of the most common health complaints, yet the limited effectiveness of existing treatment options suggests that chronic pain is still not fully understood. The goals of this study are to identify and organize well-established and emerging psychosocial factors associated with pain interference, clarify the nature of between- and within-diagnostic group differences in psychosocial and demographic factors associated with pain interference, and identify interactions among diagnostic and psychosocial factors associated with pain interference.

Community-dwelling participants (N = 284) completed a one-time survey which included demographic information, information about pain and diagnosis, and five existing measures that assess chronic pain severity, interference, and coping. To derive higher order psychosocial factors common to the chronic pain measures, individual scale items were analyzed using confirmatory factor analysis (CFA). A subsequent principal components analysis (PCA) was performed to achieve parsimonious grouping of psychosocial constructs. Hierarchical ordinary least squares regression models tested the effects of demographics, diagnosis, psychosocial factors, and their interactions on the relationship between pain intensity and pain interference.

CFA did not support the hypothesized psychosocial factor model. The subsequent PCA suggested that a 5-component structure adequately captured most of the variance, accounting for 61% of the total variance. The five emergent psychosocial factors were positive engagement, disengagement, positive thinking, social support, and physical activity. In the regression models, positive engagement showed a remarkably strong negative association with all types of pain interference and disengagement showed a strong positive association with all types of pain interference. Across all diagnoses, greater physical activity was associated with less total pain interference, less interference in daily activities and less interference in social and recreational activities. Positive thinking and social support were differentially associated with higher interference in specific types of interference. Regarding diagnosis, osteoarthritis was associated with less total and work interference. In total interference and interference in social and recreational activities, individuals with Complex Regional Pain Syndrome and multiple conditions exhibited a tapering-off wherein pain interference was not significantly higher among those reporting higher levels of pain. There were no significant interactions between diagnostic group and psychosocial factors.

This study is one of the first to systematically compare multiple types of pain interference across a large variety of clinical pain populations. The results provide discriminant validity for the various types of pain interference and more clearly define the role that diagnosis plays as a covariate in the chronic pain experience. Clinically, the pain coping and response model resulting from this PCA offers an opportunity to reconceptualize how people respond to their pain and sets the foundation for more efficient screening and intervention. Scientifically, variables identified in this study appear to represent a vast majority of nodes in the nomological net of pain interference such that a comprehensive understanding of pain interference may soon be within reach.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2022.272

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