Psychological Factors Associated with Idiopathic Arm Pain

Abstract

<h3>Introduction</h3> Psychological and personality factors may be as important as, or more important than, pathological processes in the experience of pain. This is especially true in those who have a vague or uncertain pain source. The authors tested the hypothesis that patients who had pain with a discrete and easily identified cause would differ from patients who had vague, diffuse pain with no clear source (idiopathic pain) when evaluated with use of validated measures of several psychological factors, including pain, anxiety, catastrophizing, a tendency for somatic complaints, body consciousness, and locus of control. Patients were seen for a single routine office evaluation by one of three hand surgeons and then classified into one of three groups based on the clinical impression. One group was the discrete pain cohort group comprising those who had a single, discrete, identifiable cause of upper limb pain. Another was the idiopathic pain cohort group comprising those who had vague, diffuse complaints. The third group included patients who did not fall into either group and were excluded from the study. There were 56 discrete pain patients and 51 with idiopathic pain. There was no significant difference between the groups with regard to employment status. The idiopathic pain cohort had significantly more single individuals, and the discrete pain cohort had significantly more married individuals. Psychiatric comorbidity was present in 27.5% of the idiopathic pain cohort and in 12.5% of the discrete pain cohort. Measurements included a 10-point Likert pain scale, the Pain Anxiety Symptoms Scale, the Pain Catastrophizing Scale, the Wahler Physical Inventory, the Body Consciousness Questionnaire, and the Multidimensional Health Locus of Control Scale. <h3>Results</h3> Patients with idiopathic pain had more extreme complaints about pain than patients with discrete pain. They had significantly more pain with repeated movement and at rest. Patients with idiopathic pain had greater anxiety about their pain than those with discrete pain. They also had less-adaptive personality traits and demonstrated significantly greater helplessness than those with discrete pain. <h3>Discussion</h3> This study demonstrated several differences in the psychological characteristics of patients with idiopathic versus discrete pain. Patients with idiopathic arm pain reported their pain as more severe; exhibited higher levels of cognitive anxiety and fear of pain; demonstrated more helplessness, magnification, and overall catastrophic coping mechanisms for dealing with pain, and showed a tendency for increased somatic complaining. The strongest single factor in the study was related to catastrophizing. This is defined as the tendency to react to pain by perceiving progressively worse and worse outcomes related to a specific worry. Also, while it may be suggested that idiopathic arm pain may be a somatic representation of psychological distress, or may represent a heightened sensitivity to bodily sensations, a major factor in the present study of idiopathic arm pain was the poor coping mechanisms of the patients. Treatment of idiopathic arm pain can be very frustrating for the patient, the doctor, and the therapist. Physicians should be aware that psychological factors limiting appropriate coping mechanisms may be the reason that the patient is seeking help. Physicians may unknowingly encourage illness behaviors by the way they react to their patients. An honest assessment of the uncertainty of the diagnosis and the influence of psychological factors may help the patient address the necessary issues.