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Pain among women: Prospective population studies from a biopsychosocial perspective on pain
Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on the role of different psychosocial factors in the course of pain over time in a general population sample of women in Sweden. The main aim was to identify and quantify such factors as predictors of pain, pain-related disability and quality of life within a biopsychosocial framework for the understanding of the pain experience over time.  The studies were based on baseline (BL) and follow-up (FU) measures with 12 months apart among 2,300 women living in Sweden, and included physical and psychological health and socio-economic status.

Study I investigated associations between socio-economic status (SES) at baseline and pain and pain-related disability at follow-up, and additionally a possible mediating role of depressive symptoms in such associations. The results indicated that educational level, financial strain and occupational level were associated with pain over time. Symptoms of depression were related to all pain-and SES factors, and might be understood as a mediating factor within this context. The results of Study II showed a link between symptoms of burnout at baseline and several pain-locations. Additionally, among women with pain, the characteristics of the pain experience and pain-related disability were associated with level of burnout over time. Study III focused on the sub sample of women reporting pain at follow-up, and examined possible predictors of their perceptions of quality of life (QOL). Several psychosocial factors were associated with QOL, and seemed to be more important predictors than the characteristics of pain in terms of intensity and frequency. These factors were burnout, emotional distress, and social support. Study IV was an attempt to sum up the results of the previous studies by analysing predictors of the course of pain, i.e. by comparing women that developed pain from BL to FU with those that remained pain-free and to compare women with sustained pain with those who recovered from pain during the assessment period. These analyses showed symptoms of posttraumatic stress (PTSD) to be associated with reporting emerging pain, while pain variables, educational level and social support were related to sustained pain.

The results of the four studies in this thesis indicate that psychosocial factors and their interplay with the characteristics of pain can be identified and described in a female sample, with a broad definition of pain, and that these factors play a central role in the experience of pain and its impact on the everyday life of these women. There may be several possible paths leading to the development of persistent pain among women and the identification of risk factors is complicated by never-ending interactions between biological, psychological and social processes. At an early stage, prior to pain development, several risk factors may cluster together (e.g. SES, depression), and work as indicators of, e.g. dysfunctional coping in relation to pain. In the first contact with health care and among primary care personnel the identification of such indicators is crucial so as to find women at risk for prolonged pain conditions. General indicators might then be more easily distinguishable than certain individual behaviour characteristics widely accepted as risk factors for pain and disability (e.g. fear-avoidance). To spread the knowledge of general factors in the first line of health care is therefore of great importance in preventive work.

Finally, the results demonstrated that many women report pain with characteristics that to a great extent affect their lives and through interactions with psychological and social health might have grave consequences for perceptions of quality of life.

 

Place, publisher, year, edition, pages
Östersund: Mid Sweden University , 2012. , 65 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 122
Keyword [en]
psychosocial factors, pain, socio-economic status, quality of life, burnout, women
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:miun:diva-16065ISBN: ISBN 978-91-87103-07-0 (print)OAI: oai:DiVA.org:miun-16065DiVA: diva2:514689
Public defence
2012-04-27, F234, Mittuniversitetet, Östersund, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2012-04-12 Created: 2012-04-10 Last updated: 2012-08-01Bibliographically approved
List of papers
1. Pain among women: Associations with socioeconomic factors over time and the mediating role of depressive symptoms
Open this publication in new window or tab >>Pain among women: Associations with socioeconomic factors over time and the mediating role of depressive symptoms
2012 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 3, no 2, 62-67 p.Article in journal (Refereed) Published
Abstract [en]

Background and aims: Lower socioeconomic status (SES), based on economic situation, education and occupation, has been associated with greater morbidity and mortality in a wide range of diseases, and socioeconomic inequalities have been found in several chronic pain populations. Sincewomen are overrepresented in several clinical pain conditions, there is a need to understand the influence of SES among women with pain. In a previous cross-sectional study, socioeconomic- and work conditions were associated with pain among women from the general population of Sweden. In the present study, based on baseline and follow-up measures from 2300 of the same sample, we examined associations between painvariables, socioeconomic status and work conditions over time by means of multiple logistic/linear regression analyses. Additionally, a possible mediating role of depressive symptoms on the relationship between SES and pain was examined. Methods: The study was a prospective panel survey with two measurements 12 months apart among 2300 women with and without pain from the general population in Stockholm (aged 18-64). Logistic and linear regression analyses were used to identify associations between SES and pain outcomes. Results: Results revealed that pain is a rather stable condition with large impact on daily functioning among many women. Certain SES variables (educational level, financial strain, occupational level) were related to pain and pain related disability prospectively. Financial strain and to be a blue-collar worker were related to the incidence of pain among all women, while educational level was related to worse pain outcomes among women with pain in terms of pain intensity,pain frequency, number of pain locations and pain-related disability. Symptoms of depression were associated with pain incidence and with painvariables (intensity, number of pain locations and pain-related disability) and with lower SES. Conclusions: Financial strain and occupational level were here identified as risk factors for the incidence of pain, and could be interpreted as increasing both physical and psychological stress and thereby work both as predisposing the individual to pain and to perpetuate the development of a pain condition. Educational level was associated with the course of pain in terms of pain duration and pain-related disability which may indicate that once affected by pain, lower educational level may be related to less functional coping strategies in the adaptation to the pain condition. Depressive symptoms could be understood as a mediator of the relationship between SES and pain among women in terms of limiting the individual's strategies to handle pain in a functional manner by increasing passive behavior patterns such as avoidance. Implications: The interplay between SES and symptoms of depression should be regarded in preventive interventions and in treatment of pain among women. An overall risk-profile in terms of psychosocial and biological factors needs to be assessed early on within pain treatment for women. Increased knowledge of socioeconomic risk factors for long term pain, e.g. low educational level, is needed on all levels among all professionals within the healthcare system in order to facilitate effective communication in the treatment of womenwith pain. © 2012 Scandinavian Association for the Study of Pain.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Pain, socioeconomic status, depressive symptoms, educational level, pain-related disability
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-16064 (URN)10.1016/j.sjpain.2012.02.006 (DOI)2-s2.0-84859336972 (Scopus ID)
Available from: 2012-04-10 Created: 2012-04-10 Last updated: 2017-08-11Bibliographically approved
2. Does burnout predict changes in pain experiences among women living in Sweden?: A longitudinal study
Open this publication in new window or tab >>Does burnout predict changes in pain experiences among women living in Sweden?: A longitudinal study
Show others...
2009 (English)In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 25, no 4, 297-311 p.Article in journal (Refereed) Published
Abstract [en]

The study investigated the associations between burnout—conceptualized as a syndrome of emotional exhaustion/physical fatigue and cognitive weariness—and pain parameters (overall pain, pain sites, intensity and frequency, and perceived disability) among 2,300 women living in Stockholm County. The study was a longitudinal panel survey with two assessments by means of questionnaires, 1 year apart. After adjustment for socio-demographic and work characteristics, smoking, psychological distress, physical health and basal pain parameters, T1 levels of burnout and/or their change scores were the most important predictors of overall pain, neck–shoulderpain, back pain and disability. Pain frequency was related to increases in tension and listlessness.

The results indicated that burnout contributes to the onset and maintenance of pain and to the functional impairment that it causes. Further studies are needed to evaluate the extent to which pain and burnout, may be mutually reinforcing.

 

National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-9544 (URN)10.1002/smi.1281 (DOI)000270756800003 ()2-s2.0-70449511816 (Scopus ID)
Projects
Smärta, vidmakthållande orsaker och konskevenserPsychological illhealth, consequences, determinants and intervention
Available from: 2009-08-26 Created: 2009-08-26 Last updated: 2017-12-13Bibliographically approved
3. The influence of psychosocial factors on Quality of Life among women with pain: A prospective study in Sweden
Open this publication in new window or tab >>The influence of psychosocial factors on Quality of Life among women with pain: A prospective study in Sweden
2011 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 20, no 8, 1215-1225 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To identify/quantify predictors of QOL among women with pain over time. Methods: The study comprised 2,300 women aged 18-64 years with and without pain. A longitudinal panel survey with two waves of measurement, 1 year apart, by means of questionnaires was used. Multiple linear regression analyses were used to identify and quantify predictors of QOL. Results: After controlling for socio-demographics, physical health, and baseline pain parameters, QOL, psychological factors, and pain-related disability at base line, as well as their changer scores, predicted differential aspects of social, psychological, and physical QOL, respectively, over time. Aspects of social support were central for the social dimension of QOL and to a lower degree for the psychological dimension. Change scores of burnout and distress were related to all dimensions of QOL. Conclusions: QOL seems to be a rather stable characteristic influenced not only by pain but also related to psychosocial factors over time. Addressing such factors seems central in treatment interventions aiming at improving QOL among individuals with pain

Keyword
Burnout; Emotional distress; Pain; Psychosocial factors; Quality of life; Social support; Women
National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-12763 (URN)10.1007/s11136-011-9860-4 (DOI)000295136500007 ()21290190 (PubMedID)2-s2.0-80053996538 (Scopus ID)
Available from: 2010-12-14 Created: 2010-12-14 Last updated: 2017-12-11Bibliographically approved
4. The role of psychosocial factors in the course of pain - A 1-year follow-up study among women living in Sweden
Open this publication in new window or tab >>The role of psychosocial factors in the course of pain - A 1-year follow-up study among women living in Sweden
2011 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 14, no 6, 493-503 p.Article in journal (Refereed) Published
Abstract [en]

The understanding of the associations between psychosocial factors and persistent pain and their impact on the course of pain among women is crucial to identify risk populations and prevent long-term pain from developing. The aim of the study was to investigate the course of pain among women and the psychosocial factors associated with it. The study was a 1-year follow-up (FU) among 2,300 women in the general population of Sweden. Sociodemographic and psychosocial factors were analyzed in relation to the course of pain, assessed as the presence of pain during the last 3 months at baseline (BL) and at FU. Thirty-three percent of the women with no pain at BL and 77% of those with pain at BL reported pain at FU. Compared to the pain-free women, those who developed pain at FU reported lower social support and physical quality of life (QoL) and worse mental health. Women with sustained pain were older and reported worse mental health, lack of social support, and lower levels of QoL compared to those who recovered from pain. In the multiple logistic regression analyses, only post-traumatic stress symptoms were associated with the development of pain at FU. Number of pain locations and pain duration at BL and physical QoL were associated with sustained pain. Moreover, social support was identified as a protective factor against sustained pain. Pain is persistent or recurrent in a general female population. The results indicate that psychosocial factors do not work as primary predictors in the course of pain and might be better understood through indirect processes by limiting the individual's resources for handling pain in a functional manner.

Keyword
Pain; Post-traumatic symptoms; Prospective; Quality of life; Social support; Women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-14885 (URN)10.1007/s00737-011-0244-0 (DOI)000297847100006 ()22080241 (PubMedID)2-s2.0-84855671896 (Scopus ID)
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2017-12-08Bibliographically approved

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