The role of health anxiety among patients with chronic pain in determining response to therapy.

Heather D Hadjistavropoulos,Gordon Jg Asmundson,Allisson Quine,Diane L Lachapelle

doi:10.1155/2002/564743

Abstract

Considerable research suggests that health anxiety (HA) influences the response of patients with chronic pain to pain and treatment. The present investigation extends the current understanding of HA and explores whether it affects how patients respond to a common therapeutic intervention, namely instructions to reduce pain behaviour. Sixty-five patients with chronic pain completed measures of pain, anxiety and cognition following an active occupational therapy session in which they were specifically instructed either to inhibit or reduce pain behaviour, or to carry out the session as they normally would. Regression analyses revealed that those with higher levels of HA experienced greater anxiety, somatic sensations and catastrophic cognitions during therapy than those with lower levels of HA. The regression analyses also revealed a consistent trend for an interaction between HA and instructional set; when those with higher HA reduced their pain behaviour, they subsequently reported greater anxiety, and more somatic sensations and catastrophic thoughts than when they carried out the session as they normally would. In contrast, only those with lower HA had a tendency to benefit from reducing pain behaviour, reporting lower state anxiety and fewer somatic sensations during the session than those who did not reduce their pain behaviour. The results suggest that HA should be taken into consideration during treatment.

Highlights

Anxiété relative à l'état de santé chez les patients souffrant de douleurs chroniques et réaction au traitement
No correlation was observed between Health anxiety (HA) and pain behaviour ratings made by patients and those made by the investigator, confirming that all patients responded to the instructions to the same degree
Figure 3) Catastrophizing as a function of health anxiety and instructions to inhibit pain behaviour observations suggest that patients experience substantial anxiety and demonstrate considerable pain behaviour within this context

Summary

Introduction

Anxiété relative à l'état de santé chez les patients souffrant de douleurs chroniques et réaction au traitement. Health anxiety (HA) is the fear of or excessive worry about having a serious illness or disease, typically based on the misinterpretation of bodily signs and symptoms [1,2] Such signs and symptoms most often include pain, gastrointestinal distress and cardiorespiratory complaints [3]. For patients with higher HA, attending to sensations results in lower anxiety and pain than engaging in distraction, whereas patients with lower HA show the reverse pattern [10] On this basis, it appears that the use of specific coping strategies, such as attention to sensations and distraction, differentially affects patients and, treatment processes, depending on the level of HA. Whether HA affects other aspects of the treatment process, such as treatment focused on pain behaviour, remains to be determined

Methods

Results

Conclusion