Chronic pain experiences. Studies of perception, evaluation and responses to pain in patients with rheumatoid arthritis and musculoskeletal pain

The major purpose of the studies was to provide a comprehensive description of the chronic pain experience including the perception of, evaluation of, and responses to pain in individuals with chronic pain associated with the musculoskeletal system. Questionnaires were used for data collection in all studies, and most of variables derived from the first study were studied in study II-V.In Study I differences between 31 women with fibromyalgia syndrome (FS) and 30 women with rheumatoid arthritis (RA) were investigated with regard to factors affecting pain perception and pain responses. The FS patients scored all variables less favorable than the RA patients. They felt more unsure, mistrusted, helpless, weaker and unsatisfied with received support from others. The FS patients also felt more limitations in daily activities and in work situation. They were more occupied by the pain, had more psychosomatic symptoms, more sleeping problems, and reported a more pessimistic view about their future than the RA patients. In Study II pain characteristics were evaluated with two different instruments (VAS and RAI) in the RA patients. To characterize the pain sensation, the word ache was most frequently chosen. Usual pain intensity was rated more than twice as intense than the present pain intensity. There were high correlation between VAS and RAI (r=.86), indicating that the instruments evaluated the same components of the pain.In Study III pain intensity and health locus of control orientation were compared in FS and RA patients. The FS group rated both actual and earlier pain intensity as more intense than the RA group. Both groups were externally oriented, but the FS group was statistically significantly more so than the RA group. In the FS patients there were also significant relationships between the variables extreme external orientation and severe usual pain intensity (p <.03).In Study IV pain and coping were described and the relationships between pain, coping and analgesic medication intake were determined in 68 RA patients. The sensory and affective components of pain were scored quite similar. Most frequently used coping strategies were coping self-statements. Reinterpretation of pain and catastrophizing were used least frequently. There were no significant relationships between coping strategies and pain intensity. In contrast, all coping strategies were significantly correlated to analgesic intake.In Study V the influence of pain intensity, pain preoccupation and future expectation on perceived health were determined in 92 patients with non-specific chronic pain in the musculoskeletal system. Both linear and logistic regression statistics were used. Results from the linear model showed that usual pain, pain preoccupation and future expectation accounted for 38 % of the variance in perceived health. The logistic regression showed only pain intensity and pain preoccupation to significantly influence perceived health.In conclusion, chronic pain is a complex experience that influences all aspects of life. Therefore, the individual s chronic pain experience must be systematically assessed with the purpose to create a relationship of a multidimensional rehabilitation team, the health care system, the patient and his/her family or significant others