Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1076
Peer-review started: September 26, 2016
First decision: November 9, 2016
Revised: November 20, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 14, 2017
To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.
Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.
The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.
Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.
Core tip: Pain is a very important symptom in patients with Crohn’s disease. Pain level and frequency are measurable with a series of simple questionnaires. We show that pain has demographic associations concerning gender, economic status, birthplace and smoking, as well as psycho-social associations such as disease coping strategies, family support, satisfaction with life, absenteeism and presenteeism related to the workplace, and leisure activity. Understanding these relationships will assist physicians in their approach to patients with pain.