Background & Aims
Chronic pain is not just pain; it is a disease that causes holistic disturbances in cognition, attention, behavior, mood, and quality of life, requiring a multi-faceted biopsychosocial assessment. Sense of coherence (SOC) is a core concept of salutogenesis, the ability of a person to make effective use of resources when faced with stressful situations, and is a cognitive characteristic that is an indicator of resistance to stress. We reported in a previous preliminary study that SOC can predict improvement in Pain Catastrophizing Scale (PCS) after 6 months of treatment with a cutoff value of 110. In the treatment of chronic pain patients, high SOC has been reported to improve mental status and enhance treatment efficacy, but it is unclear what biopsychosocial factors contribute to SOC in chronic pain. This study will investigate what factors are involved in SOC in chronic pain patients and how SOC affects the course of treatment.
Methods
The participants were patients who visited the Department of Psychosomatic and General Internal Medicine, Pain Center, Kansai Medical University Hospital, who had treated for more than 6 months, and who answered the SOC questionnaire at the first visit, Short-Form McGill Pain Questionnair (SF-MPQ), PCS, Visual Analog Scale (VAS), Pain Vigilance and Awareness Questionnaire (PVAQ), Chronic Pain Acceptance Questionnaire (CPAQ), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and EuroQol 5-Dimension 5-Level (EQ5D-5L) at the first visit, 3, and 6 months later. Sixty-five (10 males and 55 females) patients answered the questionnaires without any deficiencies; they were classified into high SOC and low SOC groups using 110 of SOC as the cut-off point, and the results of the three times of the eight questionnaires between the two groups were compared by two-way analysis of variance.
Results
The mean value of SOC was 118.5±29.3, with 40 in the high group and 25 in the low group. There was no interaction between the two SOC groups on the SF-MPQ, PCS, VAS, PVAQ, CPAQ, HADS, PDAS, and EQ5D-5L. Significant main effects were found for the PCS subscale of Magnification (Ma), the CPAQ subscale of Activity Engagement (AE), HADS Anxiety and Depression, and EQ5D-5L, all of which were more severe in the low SOC group.
Conclusions
Since SOC is a measure of stress tolerance and chronic pain is a major stressor, we expected patients with higher SOC to have a better prognosis, but the lack of interaction suggests that the effect of SOC on prognosis is not significant, at least after 6 months of treatment. Ma, for which a main effect was observed, caused anxiety about pain and led to avoidance, while AE was a cognitive factor involved in the behavioral aspect of performing activities of daily living regardless of pain. Depression in chronic pain patients is thought to be brought about by life disability resulting from behavioral avoidance, and patients with higher SOC may have lower life disability and depression due to less magnification, anxiety, and behavioral avoidance, resulting in a higher quality of life. A limitation of this study is that we cannot assess the impact of SOC in patients with up to moderate disease because our pain center sees many patients with intractable chronic pain.
References
Aguilar-Latorre A, et al., Association between sense of coherence and depression in patients with chronic pain?A systematic review and meta-analysis. PLoS ONE 18(1): e0279959, 2023
Presenting Author
Yasuyuki Mizuno
Poster Authors
Yasuyuki Mizuno
MD
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial