Predicting subjective disability in chronic pain patients

Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient's life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. Disability is not predicted by pain severity in patients with headaches or back pain, Psychological variables, especially coping strategies, are far more influential. Coping explains more variance in disability in the headache sample than in the chronic low back pain group, whereas depression is more relevant for the degree of disability in the back pain sample. In this study, we present a critical analysis of possible interpretations of our results. We point to an overlap of concepts underlying some of the variables used; this overlap also considerably invalidates conclusions drawn from a multitude of studies done in this field, including the one presented, We strongly argue for a conceptual clarification, and consequently for the revision of assessment instruments, before further empirical work in this area is done.