Circumstances of chronic pain onset: relationship to pain description, coping and psychological distress

The present study investigates the relationship of circumstances of chronic pain onset (idiopathic versus post-traumatic) to measures of pain description, coping/pain control attribution, and psychological distress. Patients were selected from an out-patient, university pain clinic and were categorized into idiopathic (n = 32) or post-traumatic groups (n = 55) based on responses to a questionnaire completed prior to clinic appointment. The outcome measures included pain magnitude (Visual Analogue Scale measures of pain intensity and frequency) and pain diffusion (McGill Pain Questionnaire and Pain Map); coping ability and pain control attributional style (Self-Control Schedule and Pain Locus of Control Scale); and psychological distress (Somatization and Global Severity Index subscales of the SCL-90-R). Results revealed that no differences between pain-onset groups were found for the pain magnitude or coping/pain control attribution variables. Compared with the idiopathic pain-onset group, the posttraumatic group obtained higher pain diffusion scores and obtained higher scores on the SCL-90-R subscales. These results with a heterogeneous sample replicate findings of previous studies with event-specific trauma. Patients with pain of traumatic onset employed a more diffuse and overinclusive pain reporting style and higher levels of somatic and generalized psychological distress. The need for early psychological assessment and vocational intervention is likely to be particularly important in patients with pain of post-traumatic origin.