Anesthesiology, Perioperative and Pain Medicine
Victoria R. Falso, BA, Jenna M. Wilson, PhD, Carin A. Colebaugh, BS, K. Mikayla Flowers, PhD, Robert R. Edwards, PhD, and Kristin L. Schreiber, MD, PhD
Kristin L. Schreiber, MD, PhD
Individuals with chronic pain experience variable degrees of pain interference. The biopsychosocial model includes pain-modulatory factors which may inform meaningful categorization, or clustering, of individuals to help predict pain outcomes. In this observational, longitudinal study conducted shortly after the onset of social distancing (2020), patients with chronic pain completed validated assessments of depression, stress, sleep disturbance, pain catastrophizing, and pain intensity. These five pain modulators were used to empirically cluster patients using a two-step hierarchical approach. We then investigated the degree of pain-related interference experienced by these subgroups approximately 1 year later (2021). We found that patients clustered empirically into three groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and moderate pain intensity; 2) pain intensity predominant (PIP), characterized by high pain intensity, but moderate psychosocial distress; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and pain intensity. At the 1-year follow-up, the clustered subgroups significantly differed in the amount of pain interference experienced, such that patients in the PSP and PIP clusters reported greater pain interference than patients in the LES cluster. Assessing an individual’s subgroup membership could inform clinical decision-making, direct targeted therapeutic interventions, and inform a more personalized approach to managing pain.
Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because their psychological characteristics also differ. The COVID-19 pandemic introduced a prolonged period of social isolation, which can impact how burdensome pain feels. In this study, Massachusetts residents with chronic pain completed an initial online survey during the early weeks of the pandemic (May, 2020) and a follow-up survey one year later (May, 2021). We asked patients about their stress, sleep, depression, negative thoughts about pain, and pain intensity. Using scores on these various questionnaires, we categorized patients into three distinct subgroups: Group 1 reported high psychological distress, but moderate pain intensity; Group 2 reported high pain intensity, but moderate psychological distress; and Group 3 reported low psychological distress and pain intensity. We then measured how much pain interfered with patients’ daily activities approximately one year later (2021) and explored whether the 3 groups had different experiences. Interestingly, patients in Groups 1 and 2 reported worse pain interference than patients in Group 3. In the future, this kind of brief assessment of pain-relevant characteristics might help identify a patient’s subgroup, which could help inform a more personalized approach to managing their pain.