Su1316 Beyond Abdominal Pain: Pain Beliefs, Pain Affect, and Distress As Determinants of Quality of Life in Patients With Chronic Pancreatitis

Abstract

Background: Chronic pancreatitis (CP) is a chronic, gastrointestinal disease whose predominant symptom is pervasive and oftentimes intractable upper abdominal pain. While pain is regarded as a multidimensional experience produced by sensory, affective, and cognitive inputs (Melzack, 2001), little is known about their contribution to pain in CP patients or their association, if any, with health outcomes such as quality of life (QOL). The purpose of this study was to examine how different aspects of pain relate to QOL in CP patients. Subjects: Subjects included 41 CP patients (Male = 58%; M Age = 49 yrs.; Caucasian = 73%) who were referred to a specialty clinic in a tertiary teaching hospital in the southeast part of the US and administered a psychometrically validated test battery that included the Pain Beliefs and Perceptions Inventory, McGill Pain Questionnaire-Short Form, Pain Discomfort Scale (pain affect or emotional unpleasantness of pain), Depression Stress Anxiety Scale, and the EORTCQOLQuestionnaire (QLQC-30). Results: A series of partial correlations (controlling for demographic variables) showed statistically significant relationships between QOL and both the intensity of pain (r = .51, p , . 05) and its emotional unpleasantness (r = -.35, p , . 05). In other words, CP patients who described their pain as more intense and emotionally bothersome reported greater QOL impairment. We also examined the relationship between QOL and 3 discrete types of beliefs that reflect CP patients' own conceptualization of what pain is and what pain means for them. CP patients with greater quality of life impairment tended to blame themselves for pain (r = .36, p , . 05), see pain as more mysterious (r = .37 p , . 05), and characterize the duration of pain as more continuous (r = .37 p , . 05). With respect to non-pain factors, QOL impairment was associated with greater stress (r =. 32, p ,. 05) and depression (r = .35, p ,. 05). A series of hierarchical linear regression was conducted to determine the predictive power of pain and non-pain variables. After controlling for demographic variables, pain intensity (t = -3.51) and perceived self-blame for pain (t = 3.42) were significant predictors of overall QOL. Conclusions: These data are conistent with prior research (Pezzilli et al., 2005) showing that the intensity of pain is an important determinant of QOL in CP patients. Findings dovetail with broader pain research showing that how patients appraise their pain influences their quality of life. Data add to the literature by identifying specific pain-related beliefs of CP patients that are correlated with quality of life impairment. Future research is necessary to determine whether modification of patients' pain beliefs is associated with improvements in CP patients' perception of their quality of life. This study is supported partly by NIH grant DK77738.