Psychological Distress and Adaptation to Chronic Pain: Symptomatology in
Dysfunctional, Interpersonally Distressed, and Adaptive Copers

J of Musculoskeletal Pain, Vol. 9(3) 2001, pp. 51-67

Christina Hellström, Bengt Jansson

Christina Hellström, PhD, is Research Fellow, and Bengt
Jansson, PhD, is Assistant Professor of Psychology, Department of
Psychology, Göteborg University, Sweden. Address correspondence to:
Christina Hellström, Department of Psychology, Göteborg University, Box
500, SE-405 30 Göteborg, Sweden.

This study was supported by the Swedish Council for Social Research
[Project No. 97-03691, The Royal Academy of Science, and the Foundation
of Wilhelm and Martina Lundgren. The authors acknowledge Leif Peterson,
chief clinical psychologist at the Hospital of National Insurance in
Tranås for valuable help.

Submitted: August 22, 2000.
Revision accepted: February 23, 2001.


ABSTRACT.
Objectives: To investigate psychological symptomatology and distress in
subgroups of chronic pain patients with different adaptation styles.

Methods: Subjects were 660 patients with chronic musculoskeletal pain who
were tested by the combined use of the two large and much used
psychological inventories -  Multidimensional Pain Inventory and the
Symptom Checklist-90-Revised.

Results: The results showed significant differences between the three
adaptation profiles, dysfunctional, interpersonally distressed, and
adaptive copers. Adaptive copers were equally and less distressed than a
sample from a normal population.

Conclusion: This study calls attention to the risk of blind faith of the
"objectiveness" of psychometric scales and of the use of them as the sole
basis for designing treatments. More attention seems to he needed to get
more information about the `healthy' group of adaptive copers by extended
clinical judgment. 


KEYWORDS. Chronic pain, psychological distress, adaptation profiles, the
Multidimensional Pain Inventory, Symptom Checklist-90-Revised


INTRODUCTION
An abundance of research findings has demonstrated that chronic pain
patients report elevated levels of psychological distress and anxiety
(1,2,3,4,5). There has also been growing recognition in clinical practice
that some pain patients seem to manage chronic pain in more adaptive ways
than other subgroups of pain patients and even to stay rather well in
psychological respects. In the last few decades, several studies have
demonstrated differences of personal coping and adaptation styles in
chronic pain (6,7,8). Yet there is still need of both broad and detailed
investigation of the variation of psychological symptomatology and
psychological distress in patients with different adaptation styles in
chronic pain.

An empirically derived pain patient taxonomy of adaptation styles was
presented by Turk and Rudy (6,7), based on scale scores from the
[West-Haven-Yale] Multidimensional Pain Inventory [MPI] (9). The MPI is a
comprehensive instrument developed to evaluate psychosocial and
cognitive-behavioral factors related to pain. Turk and Rudy (6)
identified three unique subgroups of chronic pain patients, labelled 1.
`dysfunctional,' who report that their pain interfered to a great extent
with their lives, 2. `interpersonally distressed,' who report an
unusually high level of interpersonal distress, and 3.
`minimizers/adaptive copers' who report lower levels of pain severity and
psychological distress. These results were corroborated by Jamison et al.
(8) who demonstrated the validity of the three patient profiles based on
data from large patient samples. Several studies found strengthened
evidence for the robustness of these profiles (5,10,111,12,13,14), but
their clinical applicability and validity in new psychological respects
may still need verification.

More recently, the utility of the Symptom Checklist 90-Revised [SCL-90-R]
(15) for measuring the psychological symptomatology associated with
chronic pain has been examined. These studies, however, have suggested
somewhat conflicting results. Puca et al. (16) compared a group of 540
patients attending an outpatient headache clinic, with the normal
population sample from Derogatis (l5). These patients scored
significantly higher on all subscales than the normal sample did. Jamison
et al. (8) used SCL-90 as external validation of the MPI clusters. These
three profiles differed significantly on SCL-90 total score, but analyses
of the results of the separate subscales were not documented. Studies
have demonstrated that chronic pain sufferers report elevated levels of
depression, anxiety, and somatization (17,18,19,20,21). Investigating
patients with complex regional pain syndrome dystonia, van der Laan et
al. (22) concluded, however, that specific psychological profiles as
measured by SCL-90-R, are not present in this condition. By use of
SCL-90-R, Ham et al. (23) examined psychological distress in 31 patients
with post-traumatic headache. These patients scored significantly higher
on all SCL-90-R measures compared to a control group without chronic
headache or other pain.

The diversity of variables and the conflicting data of these studies, as
well as the significance of the research area of coping with chronic pain
motivate further investigation as to how psychological distress is
associated with different adaptation profiles in chronic pain. The
present study aims to extend extant research by the combined use of the
two large and widely used inventories, MPI and SCL-90-R, in one single
study. The purpose is to investigate whether the MPI-profiles differ with
respect to psychological distress as reflected by SCL-90-R in chronic
pain. It is hypothesized that adaptive copers score lower on the symptom
dimensions than dysfunctional and interpersonally distressed patients do,
but they score higher than a normal population without pain.


© 2001 by The Haworth Press, Inc. All rights reserved.