Background & Aims
Effective management of chronic pain may be complicated by the co-occurrence of personality disorders. One systematic review suggests that 13-28% of chronic pain patients have a personality disorder, although far higher estimates also have been reported (1-3). Clinicians have been recommended to address this co-occurrence when tailoring pain management interventions (4). This practice may be facilitated by adopting time-efficient screening tools. The Level of Personality Functioning Scale – Brief Form 2.0 (LPFS-BF) (5) is a promising screening tool for personality pathology. It consists of 12 items and was developed to screen for personality disorder severity in line with the contemporary diagnostic manuals (i.e., DSM-5 AMPD and the ICD-11). This poster will present the reliability and validity of the LPFS-BF in a chronic pain sample as well as its associations with pain-related variables.
Methods
The data will be retrieved from the Oslo University Hospital Pain Registry (OPR) which receives approximately 1,000 patients annually (4). The LPFS-BF was included in the OPR as a baseline instrument in June 2023. Data collection for the current study will continue until June 2024. As of January 2024, 500 patients have been included. This abstract presents preliminary results on these 500 participants. The LPFS-BF will be studied in terms of internal consistency, factor structure, and concurrent and incremental validity. Rates of the LPFS-BF across ICD-11 chronic pain diagnoses will also be presented. Usual pain intensity and bothersomeness are assessed using 11-point Numeric Rating Scales, quality of life (QoL) is assessed using the EQ-5D-5L (5), and pain-related disability is assessed using a modified version of the Oswestry Disability Index (6, 7).
Results
Mean age was 49 years (SD=17) and 63% were female. Consistent with prior research, a two-factor structure corresponding to the self- and interpersonal domains of the LPFS-BF showed adequate fit: CFI = .98, TLI = .97, RMSEA = .04. Cronbach’s alpha was .86, .83, and .79 for the total scale, self- and interpersonal domains, respectively. In a linear regression model predicting usual pain intensity from pain catastrophizing, negative affect, and LPFS-BF, only pain catastrophizing emerged as a significant predictor: β = .447, p<.001. For pain onset, LPFS-BF was the only significant predictor: β= -.283, p<.001. Both models were adjusted for gender. Mean LPFS-BF scores were 6.4 (SD = 5.7), 4.6 (SD = 3.8), and 1.8 (SD = 2.6) for the total scale, and the self- and interpersonal domains, respectively. This was slightly higher than a German healthy population sample but considerably lower than individuals referred to outpatient personality disorder treatment (9, 10)
Conclusions
These results indicate that the LPFS-BF is a valid and reliable screening tool for individuals referred to chronic pain management in specialized care. The overall personality disorder severity was unexpectedly low when considering the frequently reported co-occurrence of personality disorders and chronic pain in the literature (1, 2). This could be due to a local referral bias resulting in few individuals with personality pathology being referred to the pain clinic from which the data was collected. Future studies employing the LPFS-BF in different chronic pain samples may clarify this. Personality disorder severity assessed by the LPFS-BF had limited utility in predicting pain intensity relative to pain catastrophizing but showed a unique potential in predicting earlier onset of pain.
Co-occurring personality disorders in chronic pain may introduce challenges related to treatment adherence, therapeutic alliance, and increased health care utilization (1, 11-13). Moreover, individuals with personality disorders are prone to adverse health behaviors that have been shown to play etiological roles in chronic pain, such as self-harm, lack of exercise, and medication overuse (11). Identifying clinically relevant personality pathology with an effective screening tool could allow clinicians to make necessary adjustments for optimizing pain management in these patients. Future avenues for exploring the clinical utility of the LPFS-BF in chronic pain include its potential associations with pain-related disability and pain management outcomes.
References
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Presenting Author
Fillip Ferreira Eikeseth
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial