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Sharma S.1, Pathak A.1, Jha J.1, Jensen M.2
1Kathmandu University School of Medical Sciences, Department of Physiotherapy, Dhulikhel, Nepal, 2University of Washington, Department of Rehabilitation Medicine, Seattle, United States
Background: Biopsychosocial models of chronic pain hypothesize important roles for psychological factors
(e.g., pain catastrophizing, resilience) as contributing to pain and its impact. However, various contextual factors such as income and education could potentially play a moderating role in the associations between psychological factors and function in individuals with chronic pain. This may be particularly true in a country like Nepal where the population has very low education levels and the annual income is extremely low, on average.
(e.g., pain catastrophizing, resilience) as contributing to pain and its impact. However, various contextual factors such as income and education could potentially play a moderating role in the associations between psychological factors and function in individuals with chronic pain. This may be particularly true in a country like Nepal where the population has very low education levels and the annual income is extremely low, on average.
Purpose: The primary aim of the study was to examine the associations between measures of catastrophizing and resilience and measures of psychological and physical function in a sample of individuals with chronic pain from Nepal. We also sought to understand the role that education level and income may have in these relationships.
Methods: A cross-sectional study was conducted on 144 individuals with chronic musculoskeletal pain from a tertiary care hospital (n = 44) and a rural community (n = 100) in Nepal. Demographic and pain history data were collected, and measures of psychological factors (catastrophizing [Pain Catastrophizing Scale], resilience [Connor Davidson Resilience Scale]) and function (anxiety [Beck Anxiety Inventory], depression [Beck Depression Inventory], and physical function [Patient Specific Functional Scale]) were administered.
Results: The results of regression analyses indicated that both education (β = 0.31, p = .002) and income
(β = -0.21, p = .037) contribute significantly to the prediction of physical function. However, neither catastrophizing nor resilience contributed to the prediction of physical function. Although pain intensity, education and income did not significantly predict anxiety, catastrophizing (β = 0.55, p .001) (but not resilience) did. Catastrophizing also evidenced a direct association with depression (β = 0.53, p .001). In addition, a significant Income X Resilience interaction effect emerged in the prediction of depression, such that those with lower income showed a weak negative association and those with higher income showed a stronger association between resilience and depression (rs = -0.22 and -0.39, ps = NS and .001, respectively).
Conclusion(s): In a sample of individuals with chronic pain from a developing country, education and income level are more important than psychosocial factors as predictors of physical function. Catastrophizing appears to be more important than resilience and socio-demographic factors as predictors of anxiety and depression. Resilience may play a greater role in depression for individuals who have relatively more versus less financial resources.
Implications: The findings support catastrophizing as central factor associated with psychological function in individuals with chronic pain from Nepal, replicating findings from research in developed countries. Individuals from Nepal with chronic pain may therefore benefit from interventions designed to reduce catastrophizing (e.g., cognitive therapy, neurophysiological pain education, mindfulness), although these interventions may need to be adapted to fit the unique cultural and socio-demographic context in Nepal. Treatments that improve resilience may improve depression in those with relatively higher income in Nepal more than those with lower income. Other interventions, perhaps those that address education level and income, may be needed to improve function in this population.
Funding acknowledgements: The research was supported by Developing Country Collaborative Research Grant by International Association for the Study of Pain (IASP)- 2015.
Topic: Pain & pain management
Ethics approval: Institutional Review Committee, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
All authors, affiliations and abstracts have been published as submitted.
