Simple pain measures reveal psycho-social pathology in patients with Crohn’s disease

Table 1 Details of pain questions and scoring¹

Questionnaire	Question about pain	Score in questionnaire	Recoded score
Patient Harvey-Bradshaw Index	Did you have abdominal pains yesterday?	0 None	0
		1 Mild	1
		2 Moderate	2
		3 Severe	3
MOS Short-Form Survey Instrument	How much bodily pain have you had during the past 4 wk?	1 None	0
		2 Very Mild	0
		3 Mild	1
		4 Moderate	1
		5 Severe	2
		6 Very Severe	3
Short Inflammatory Bowel Disease Questionnaire	How often during the past 2 wk have you been troubled by pain in the abdomen?	1 All of the time	3
		2 Most of the time	2
		3 A good bit of the time	2
		4 Some of the time	1
		5 A little of the time	1
		6 Hardly any of the time	0
		7 None of the time	0

¹Pain questions in the three questionnaires with original scoring, and the recoded scores used in the analysis.

Table 2 Demographic parameters and disease characteristics of the Crohn’s disease cohort

Patient characteristic	Total cohort	Internet questionnaire	Hardcopy questionnaire	P value1
	n = 594	n = 370	n = 224
Age (yr)				0.151
mean ± SD	38.56 ± 14.06	36.99 ± 12.65	39.48 ± 14.77
Median (min-max) (IQR)	35 (18-79) (28-47)	35 (18-72) (26 -44)	35 (19-79) (28-49)
Education (yr)				0.043
mean ± SD	14.81 ± 2.93	15.05 ± 2.65	14.66 ± 3.08
Disease duration (yr)				0.234
mean ± SD	11.05 ± 8.73	10.39 ± 8.23	11.45 ± 9.00
Median (min-max) (IQR)	10 (0-47) (4-15.5)	10 (0-41) (3-16)	10 (0-47) (5-15)
Female gender	57.6%	59.78%	56.90%	0.521
Married/living together	58.6%	57.01%	60.16%	0.452
Economic status
Good	29.8%	25.45%	33.15%	0.040
Moderate	49.8%	57.27%	46.58%
Poor	18.9%	17.27%	20.27%
Current cigarette smoking	18.9%	16.97%	21.55%	0.183
Biologic medication	45.1%	44.64%	45.41%	0.856
Surgery, ever	33.3%	32.59%	33.78%	0.765
Hospitalization in past year	25.3%	26.79%	24.32%	0.503
Patient Harvey-Bradshaw Index (P-HBI)	5.76 ± 5.15	6.70 ± 5.69	5.32 ± 4.83	0.002
P-HBI sub-groups
Disease remission (score < 5)	44.60%	66 (40.00%)	199 (55.74%)	0.003
Mild disease (score 5-7)	20.00%	47 (28.48%)	72 (20.17%)
Moderate disease (score 8-16)	19.40%	40 (24.24%)	75 (21.01%)
Severe disease (score > 16)	3.90%	12 (7.27%)	11 (3.08%)

¹Statistical differences between internet and hardcopy source of questionnaires.

Table 3 Scores of the social questionnaires of the Crohn’s disease cohort

Variables	Total cohort	Internet Questionnaire	Hardcopy Questionnaire	P value1
	mean ± SD	mean ± SD	mean ± SD
	Median (min-max) (IQR)	Median (min-max) (IQR)	Median (min-max) (IQR)
MOS Short-Form Survey Instrument
Physical health	42.09 ± 10.76	40.88 ± 10.41	42.72 ± 10.90	0.041
Mental health	41.99 ± 11.33	39.23 ± 11.36	43.42 ± 11.05	< 0.001
Short Inflammatory Bowel Disease Questionnaire, total score	46.33 ± 13.83	42.02 ± 13.38	48.84 ± 13.48	< 0.001
SWLS	22.06 ± 7.64	20.81 ± 7.92	22.82 ± 7.37	0.004
	23 (5-35) (16-28)	21.0 (5-35) (15-27)	24.0 (5-35) (17-29)
GSI	0.98 ± 0.75	1.11 ± 0.80	0.90 ± 0.70	0.002
	0.79 (0-3.92) (0.38-1.47)	0.9 (0.0-3.9) (0.4-1.6)	0.7 (0.0-3.2) (0.4-1.3)
FAD	1.81 ± 0.55	1.90 ± 0.56	1.75 ± 0.53	0.001
	1.75 (1.0-4.0) (1.33-2.17)	1.9 (1.0-4.0) (1.4-2.3)	1.7 (1.0-4.0) (1.3-2.1)
COPE: Emotion-focused strategies	24.23 ± 5.88	24.50 ± 5.77	24.07 ± 5.94	0.340
	24.5 (3-40) (20-29)	25 (6-39) (20-29)	24 (3-40) (20-28)
COPE: Problem-focused strategies	16.10 ± 4.74	16.82 ± 4.51	15.67 ± 4.83	0.004
	16 (3-24) (13-20)	17 (4-24) (14-20)	16 (3-24) (12-19)
COPE: Dysfunctional Strategies	22.28 ± 5.93	23.41 ± 5.86	21.60 ± 5.87	0.000
	22 (6-42) (18-26)	23 (8-41) (20-27)	21 (6-42) (17-25)
WPAI: Absenteeism (%)	8.81 ± 19.26	11.12 ± 20.77	7.36 ± 18.16	0.021
	0 (0-100) (0-8.35)	0 (0-100.0) (0-15.2)	0 (0-100) (0-1.6)
WPAI: Presenteeism (%)	29.16 ± 30.20	31.52 ± 30.44	27.54 ± 30.00	0.119
	20 (0-100) (0-50)	20 (0-100.0) (10.0-55.0)	20.0 (0-100) (0-50)
WPAI: Work productivity loss (%)	29.19 ± 30.38	33.60 ± 31.57	26.50 ± 29.38	0.025
	20 (0-100) (0-50)	21.2 (0-100) (10-60)	20.0 (0-100) (0-40.7)
WPAI: Activity impairment (%)	33.92 ± 30.61	37.60 ± 30.86	31.74 ± 30.30	0.021
	30 (0-100) (10-60)	30 (0-100) (10-60)	20.0 (0-100) (0-50)

¹Statistical differences between internet and hardcopy source of questionnaires. SWLS: Satisfaction with Life Scale; GSI: Global Severity Index; FAD: McMaster Family Assessment Device; COPE: Brief Cope Inventory; WPAI: Work Productivity and Activity Impairment Questionnaire.

Table 4 Comparison of demographic variables with the pain measures in the whole cohort n (%)

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
Education (yr)	15.1 ± 2.9	14.7 ± 2.8	14.8 ± 3.1	13.5 ± 3.1	0.017	14.8 ± 2.7	15.0 ± 2.7	14.6 ± 3.8	14.3 ± 3.1	0.463	15.1 ± 3.0	14.9 ± 2.8	14.7 ± 3.0	13.3 ± 2.5	0.001
Gender					0.005					< 0.001
Female	100 (32.1)	107 (34.3)	87 (27.9)	18 (5.8)		74 (23.7)	156 (50.0)	62 (19.9)	20 (6.4)		103 (33.0)	105 (33.7)	81 (26.0)	23 (7.4)	0.054
Male	103 (45.4)	69 (30.4)	40 (17.6)	15 (6.6)		88 (38.8)	106 (46.7)	25 (11.0)	8 (3.5)		96 (42.3)	76 (33.5)	39 (17.2)	16 (7.0)
Economic status					< 0.001					< 0.001
Poor	22 (19.6)	36 (32.1)	40 (35.7)	14 (12.5)		11 (9.8)	57 (50.9)	33 (29.5)	11 (9.8)		17 (15.2)	36 (32.1)	38 (33.9)	21 (18.8)	< 0.001
Moderate	105 (35.5)	110 (37.2)	65 (22.0)	16 (5.4)		96 (32.4)	150 (50.7)	39 (13.2)	11 (3.7)		112 (37.8)	104 (35.1)	64 (21.6)	16 (5.4)
Good	88 (49.7)	49 (27.7)	35 (19.8)	5 (2.8)		66 (37.3)	78 (44.1)	25 (14.1)	8 (4.5)		79 (44.6)	66 (37.3)	26 (14.7)	6 (3.4)
Birthplace					0.048					0.015
Western	19 (76.0)	3 (12.0)	2 (8.0)	1 (4.0)		12 (48.0)	9 (36.0)	1 (4.0)	3 (12.0)		19 (76.0)	4 (16.0)	1 (4.0)	1 (4.0)	0.013
Asia-Africa	14 (43.8)	12 (37.5)	5 (15.6)	1 (3.1)		7 (21.9)	16 (50.0)	9 (28.1)	0 (0)		13 (40.6)	13 (40.6)	6 (18.8)	0 (0.0)
FSU	15 (44.1)	15 (44.1)	3 (8.8)	1 (2.9)		14 (41.2)	19 (55.9)	0 (0.0)	1 (2.9)		20 (58.8)	9 (26.5)	4 (11.8)	1 (2.9)
Israel	111 (39.9)	92 (33.1)	61 (21.9)	14 (5.0)		90 (32.4)	128 (46.0)	46 (16.5)	14 (5.0)		105 (37.8)	98 (35.3)	56 (20.1)	19 (6.8)
Current smoker					0.052					0.170
No	175 (38.5)	152 (33.5)	104 (22.9)	23 (5.1)		140 (30.8)	220 (48.5)	75 (16.5)	19 (4.2)		172 (37.9)	156 (34.4)	102 (22.5)	24 (5.3)	< 0.001
Yes	29 (25.9)	41 (36.6)	32 (28.6)	10 (8.9)		29 (25.9)	52 (46.4)	21 (18.8)	10 (8.9)		26 (23.2)	43 (38.4)	25 (22.3)	18 (16.1)
Working					< 0.001					< 0.001
No	61 (32.8)	51 (27.4)	51 (27.4)	23 (12.4)		40 (21.5)	86 (46.2)	45 (24.2)	15 (8.1)		60 (32.3)	53 (28.5)	50 (26.9)	23 (12.4)	< 0.001
Yes	152 (39.9)	140 (36.7)	77 (20.2)	12 (3.1)		130 (34.1)	183 (48.0)	52 (13.6)	16 (4.2)		147 (38.6)	143 (37.5)	74 (19.4)	17 (4.5)

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD or n (%). P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire.

Table 5 Comparison of demographic variables with the pain measures - Internet n (%)

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
Education (yr)	15.2 ± 2.5	15.1 ± 2.5	15.0 ± 2.7	14.4 ± 3.4	0.758	14.9 ± 2.7	15.2 ± 2.3	15.1 ± 2.9	13.8 ± 4.2	0.397	15.1 ± 2.9	15.5 ± 2.4	14.9 ± 2.6	13.6 ± 2.8	0.033
Gender
Female	28 (54.9)	37 (62.7)	37 (63.8)	8 (50.0)	0.628	18 (41.9)	62 (65.3)	23 (63.9)	7 (70.0)	0.055	26 (55.3)	37 (60.7)	38 (65.5)	9 (50.0)	0.589
Male	23 (45.1)	22 (37.3)	21 (36.2)	8 (50.0)		25 (58.1)	33 (34.7)	13 (36.1)	3 (30.0)		21 (44.7)	24 (39.3)	20 (34.5)	9 (50.0)
Economic status
Bad	4 (6.9)	12 (16.0)	16 (23.2)	6 (33.3)	0.003	2 (3.9)	18 (15.9)	12 (27.9)	6 (46.2)	0.001	2 (3.8)	13 (15.5)	12 (19.4)	11 (50.0)	< 0.001
Medium	25 (43.1)	13 (17.3)	15 (21.7)	3 (16.7)		21 (41.2)	24 (21.2)	8 (18.6)	3 (23.1)		19 (36.5)	23 (27.4)	11 (17.7)	3 (13.6)
Good	29 (50.0)	50 (66.7)	38 (55.1)	9 (50.0)		28 (54.9)	71 (62.8)	23 (53.5)	4 (30.8)		31 (59.6)	48 (57.1)	39 (62.9)	8 (36.4)
Current Smoker
Not Smoking	52 (91.2)	62 (81.6)	53 (76.8)	14 (87.5)	0.175	44 (84.6)	95 (84.1)	33 (80.5)	9 (75.0)	0.821	46 (90.2)	70 (83.3)	49 (79.0)	16 (76.2)	0.353
Smoking	5 (8.8)	14 (18.4)	16 (23.2)	2 (12.5)		8 (15.4)	18 (15.9)	8 (19.5)	3 (25.0)		5 (9.8)	14 (16.7)	13 (21.0)	5 (23.8)
Working
Not Working	13 (24.1)	21 (29.6)	17 (29.8)	10 (55.6)	0.093	8 (17.0)	31 (31.3)	15 (36.6)	7 (53.8)	0.044	13 (26.0)	18 (24.3)	19 (33.3)	11 (57.9)	0.033
Working	41 (75.9)	50 (70.4)	40 (70.2)	8 (44.4)		39 (83.0)	68 (68.7)	26 (63.4)	6 (46.2)		37 (74.0)	56 (75.7)	38 (66.7)	8 (42.1)

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD or n (%). P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire.

Table 6 Comparison of demographic variables with the pain measures - Hardcopy n (%)

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
Education (yr)	15.1 ± 3.0	14.5 ± 2.9	14.5 ± 3.3	12.5 ± 2.4	0.002	14.7 ± 2.7	14.8 ± 3.0	14.3 ± 4.4	14.6 ± 2.0	0.411	15.1 ± 3.1	14.5 ± 3.0	14.5 ± 3.3	12.9 ± 2.2	0.004
Gender
Female	72 (47.4)	70 (59.8)	50 (72.5)	10 (58.8)	0.005	56 (47.1)	94 (56.3)	39 (76.5)	13 (72.2)	0.002	77 (50.7)	68 (56.7)	43 (69.4)	14 (66.7)	0.067
Male	80 (52.6)	47 (40.2)	19 (27.5)	7 (41.2)		63 (52.9)	73 (43.7)	12 (23.5)	5 (27.8)		75 (49.3)	52 (43.3)	19 (30.6)	7 (33.3)
Economic status
Bad	18 (11.5)	24 (20.0)	24 (33.8)	8 (47.1)	< 0.001	9 (7.4)	39 (22.7)	21 (38.9)	5 (29.4)	< 0.001	15 (9.6)	23 (18.9)	26 (39.4)	10 (47.6)	< 0.001
Medium	76 (48.4)	60 (50.0)	27 (38.0)	7 (41.2)		68 (55.7)	79 (45.9)	16 (29.6)	7 (41.2)		81 (51.9)	56 (45.9)	25 (37.9)	8 (38.1)
Good	63 (40.1)	36 (30.0)	20 (28.2)	2 (11.8)		45 (36.9)	54 (31.4)	17 (31.5)	5 (29.4)		60 (38.5)	43 (35.2)	15 (22.7)	3 (14.3)
Current Smoker
Not Smoking	123 (83.7)	90 (76.9)	51 (76.1)	9 (52.9)	0.026	96 (82.1)	125 (78.6)	42 (76.4)	10 (58.8)	0.178	126 (85.7)	86 (74.8)	53 (81.5)	8 (38.1)	< 0.001
Smoking	24 (16.3)	27 (23.1)	16 (23.9)	8 (47.1)		21 (17.9)	34 (21.4)	13 (23.6)	7 (41.2)		21 (14.3)	29 (25.2)	12 (18.5)	13 (61.9)
Working
Not Working	48 (30.2)	30 (25.0)	34 (47.9)	13 (76.5)	< 0.001	32 (26.0)	55 (32.4)	30 (53.6)	8 (44.4)	0.003	47 (29.9)	35 (28.7)	31 (46.3)	12 (57.1)	0.007
Working	111 (69.8)	90 (75.0)	37 (52.1)	4 (23.5)		91 (74.0)	115 (67.6)	26 (46.4)	10 (55.6)		110 (70.1)	87 (71.3)	36 (53.7)	9 (42.9)

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD or n (%). P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire.

Table 7 Comparison of social questionnaires with the pain measures in the whole cohort

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
GSI	0.6 ± 0.5	1.0 ± 0.6	1.3 ± 0.8	1.8 ± 1.0	< 0.001	0.6 ± 0.5	1.0 ± 0.7	1.4 ± 0.8	1.6 ± 0.9	< 0.001	0.6 ± 0.5	1.0 ± 0.7	1.3 ± 0.7	1.8 ± 0.9	< 0.001
COPE: Emotion-focused Strategies	23.4 ± 5.9	24.7 ± 5.7	25.0 ± 5.8	24.2 ± 7.1	0.045	23.4 ± 5.9	24.6 ± 5.9	24.2 ± 5.7	26.0 ± 5.8	0.154	23.6 ± 5.9	24.8 ± 5.7	24.8 ± 5.5	23.0 ± 7.3	0.059
COPE: Problem-focused Strategies	15.6 ± 4.9	16.1 ± 4.7	16.8 ± 4.4	16.6 ± 4.9	0.249	15.4 ± 5.1	16.1 ± 4.5	16.5 ± 4.5	18.2 ± 4.3	0.042	15.6 ± 5.1	16.2 ± 4.7	17.0 ± 4.1	15.4 ± 4.6	0.067
COPE: Dysfunctional Strategies	20.0 ± 5.5	22.9 ± 5.5	24.0 ± 5.8	25.6 ± 6.6	< 0.001	20.0 ± 5.7	22.7 ± 5.7	24.0 ± 5.9	25.9 ± 5.5	< 0.001	19.9 ± 5.4	22.8 ± 5.4	24.5 ± 6.0	24.6 ± 6.9	< 0.001
FAD	1.7 ± 0.5	1.8 ± 0.6	1.9 ± 0.5	2.1 ± 0.7	0.003	1.7 ± 0.6	1.8 ± 0.5	1.9 ± 0.5	1.8 ± 0.7	0.081	1.7 ± 0.5	1.9 ± 0.5	1.8 ± 0.6	2.0 ± 0.7	< 0.001
SWLS	24.3 ± 6.6	22.0 ± 7.7	19.9 ± 7.5	17.7 ± 9.8	< 0.001	24.5 ± 6.7	22.3 ± 7.1	18.4 ± 8.4	17.9 ± 9.1	< 0.001	24.8 ± 6.4	22.2 ± 7.3	19.2 ± 7.4	16.9 ± 9.8	< 0.001
WPAI: Absenteeism	3.9 ± 11.9	5.9 ± 12.4	18.2 ± 27.2	43.4 ± 37.6	< 0.001	2.8 ± 10.6	8.3 ± 18.6	21.3 ± 25.2	29.4 ± 35.0	< 0.001	1.8 ± 5.5	7.8 ± 18.3	19.1 ± 22.7	38.5 ± 42.2	< 0.001
WPAI: Presenteesism	14.6 ± 22.8	29.9 ± 28.0	44.4 ± 29.7	77.1 ± 26.4	< 0.001	13.0 ± 20.7	29.2 ± 26.1	55.0 ± 32.9	70.7 ± 34.1	< 0.001	10.6 ± 18.2	31.6 ± 27.5	48.2 ± 29.4	69.0 ± 31.1	< 0.001
WPAI: Work productivity loss	15.7 ± 23.3	29.5 ± 26.9	46.4 ± 32.4	80.6 ± 27.1	< 0.001	13.7 ± 20.9	30.0 ± 27.0	58.6 ± 33.2	65.3 ± 35.5	< 0.001	10.2 ± 15.9	32.7 ± 27.9	52.2 ± 30.9	66.6 ± 34.7	< 0.001
WPAI: Activity Impairment	17.1 ± 23.6	32.9 ± 26.4	51.1 ± 27.9	78.3 ± 23.5	< 0.001	14.3 ± 22.0	33.4 ± 25.4	59.8 ± 27.8	76.1 ± 28.8	< 0.001	12.3 ± 19.6	34.9 ± 25.4	52.7 ± 26.2	78.9 ± 24.1	< 0.001

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD. P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire; GSI: Global Severity Index; COPE: Brief Cope Inventory; FAD: McMaster Family Assessment Device; SWLS: Satisfaction with Life Scale; WPAI: Work Productivity and Activity Impairment Questionnaire.

Table 8 Comparison of social questionnaires with the pain measures - Internet

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
GSI	0.7 ± 0.7	1.0 ± 0.7	1.3 ± 0.8	2.1 ± 0.9	< 0.001	0.7 ± 0.7	1.0 ± 0.7	1.5 ± 0.7	1.9 ± 1.1	< 0.001	0.7 ± 0.6	1.0 ± 0.7	1.4 ± 0.7	1.9 ± 1.0	< 0.001
COPE: Emotion-focused Strategies	23.4 ± 6.1	24.8 ± 5.5	25.5 ± 5.6	23.2 ± 6.3	0.158	23.5 ± 6.1	24.8 ± 6.0	24.7 ± 4.6	25.5 ± 5.7	0.655	24.4 ± 5.6	24.3 ± 5.8	25.2 ± 5.7	23.4 ± 6.5	0.525
COPE: Problem-focused Strategies	15.7 ± 4.8	16.8 ± 4.5	17.5 ± 4.0	18.3 ± 4.8	0.096	15.8 ± 5.1	16.7 ± 4.4	17.5 ± 4.0	19.7 ± 4.1	0.051	16.1 ± 4.5	16.7 ± 4.8	17.7 ± 3.8	16.6 ± 5.0	0.384
COPE: Dysfunctional Strategies	20.8 ± 5.8	23.4 ± 5.8	24.4 ± 5.2	27.7 ± 5.4	< 0.001	20.9 ± 5.7	23.2 ± 5.8	25.4 ± 4.9	27.8 ± 5.5	< 0.001	20.9 ± 5.4	22.8 ± 5.5	24.8 ± 5.8	27.4 ± 5.6	< 0.001
FAD	1.8 ± 0.6	1.9 ± 0.5	1.9 ± 0.5	2.2 ± 0.7	0.116	1.8 ± 0.6	1.9 ± 0.5	2.0 ± 0.5	2.1 ± 0.8	0.264	1.8 ± 0.6	1.9 ± 0.5	2.0 ± 0.6	2.1 ± 0.7	0.074
SWLS	24.1 ± 7.7	20.8 ± 7.6	19.4 ± 7.3	15.5 ± 8.5	< 0.001	24.8 ± 7.7	21.2 ± 6.7	16.1 ± 7.6	16.8 ± 10.4	< 0.001	24.1 ± 7.7	21.3 ± 7.3	18.6 ± 7.3	17.2 ± 9.5	< 0.001
WPAI: Absenteeism	5.2 ± 12.1	6.9 ± 12.8	17.3 ± 25.2	38.1 ± 40.7	0.002	3.4 ± 9.7	11.3 ± 21.7	17.1 ± 21.5	46.3 ± 35.8	< 0.001	1.6 ± 4.9	9.1 ± 18.5	18.9 ± 21.1	35.4 ± 50.3	< 0.001
WPAI: Presenteesism	15.2 ± 25.8	27.1 ± 26.2	43.2 ± 26.7	76.7 ± 29.6	< 0.001	12.7 ± 17.9	31.5 ± 27.8	51.4 ± 32.1	80.0 ± 24.5	< 0.001	9.1 ± 13.9	31.4 ± 29.9	44.6 ± 26.4	68.0 ± 35.8	< 0.001
WPAI: Work productivity loss	18.0 ± 26.1	29.2 ± 26.7	47.3 ± 30.3	78.2 ± 32.2	< 0.001	15.5 ± 20.6	32.6 ± 29.3	59.3 ± 32.0	78.5 ± 17.5	< 0.001	9.5 ± 14.4	32.6 ± 29.4	52.2 ± 28.9	62.1 ± 42.4	< 0.001
WPAI: Activity Impairment	16.5 ± 23.1	34.2 ± 26.2	48.6 ± 27.0	80.6 ± 25.7	< 0.001	16.3 ± 21.9	34.2 ± 26.0	62.8 ± 25.4	88.0 ± 18.7	< 0.001	11.5 ± 16.4	34.2 ± 25.6	48.6 ± 25.9	82.5 ± 24.5	< 0.001

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD. P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire; GSI: Global Severity Index; COPE: Brief Cope Inventory; FAD: McMaster Family Assessment Device; SWLS: Satisfaction with Life Scale; WPAI: Work Productivity and Activity Impairment Questionnaire.

Table 9 Comparison of social questionnaires with the pain measures - Hardcopy

Variables	P-HBI					SF-36					SIBDQ
	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value	No pain	Mild pain	Moderate pain	Severe pain	P value
GSI	0.6 ± 0.5	1.0 ± 0.6	1.4 ± 0.7	1.6 ± 1.0	< 0.001	0.5 ± 0.5	1.0 ± 0.7	1.3 ± 0.8	1.4 ± 0.7	< 0.001	0.5 ± 0.5	1.0 ± 0.6	1.3 ± 0.8	1.7 ± 0.8	< 0.001
COPE: Emotion-focused Strategies	23.4 ± 5.8	24.6 ± 5.8	24.5 ± 6.0	25.3 ± 7.9	0.234	23.4 ± 5.9	24.4 ± 5.8	23.8 ± 6.4	26.3 ± 6.0	0.302	23.3 ± 6.0	25.1 ± 5.6	24.4 ± 5.3	22.5 ± 8.3	0.076
COPE: Problem-focused Strategies	15.6 ± 5.0	15.6 ± 4.8	16.1 ± 4.7	14.6 ± 4.4	0.725	15.2 ± 5.2	15.8 ± 4.6	15.8 ± 4.8	17.1 ± 4.3	0.642	15.4 ± 5.3	15.8 ± 4.6	16.4 ± 4.3	14.0 ± 3.8	0.192
COPE: Dysfunctional Strategies	19.8 ± 5.4	22.6 ± 5.3	23.5 ± 6.4	23.1 ± 7.2	< 0.001	19.7 ± 5.7	22.3 ± 5.5	22.9 ± 6.3	24.5 ± 5.1	< 0.001	19.6 ± 5.4	22.8 ± 5.3	24.1 ± 6.3	21.5 ± 7.0	< 0.001
FAD	1.7 ± 0.5	1.8 ± 0.6	1.8 ± 0.5	1.9 ± 0.7	0.088	1.7 ± 0.5	1.8 ± 0.5	1.8 ± 0.6	1.6 ± 0.5	0.224	1.7 ± 0.5	1.8 ± 0.5	1.7 ± 0.5	1.9 ± 0.6	0.016
SWLS	24.4 ± 6.1	22.7 ± 7.6	20.3 ± 7.7	20.2 ± 10.8	0.003	24.4 ± 6.3	23.0 ± 7.2	20.1 ± 8.6	18.6 ± 8.2	0.002	25.1 ± 5.8	22.7 ± 7.4	19.8 ± 7.5	16.5 ± 10.3	< 0.001
WPAI: Absenteeism	3.4 ± 11.9	5.3 ± 12.2	19.2 ± 29.5	57.8 ± 29.1	< 0.001	2.5 ± 11.0	6.4 ± 16.0	25.6 ± 28.4	19.7 ± 33.1	< 0.001	1.8 ± 5.8	6.8 ± 18.3	19.4 ± 24.8	41.1 ± 37.8	< 0.001
WPAI: Presenteesism	14.4 ± 21.4	31.5 ± 29.1	46.0 ± 33.5	78.0 ± 22.8	< 0.001	13.2 ± 22.2	27.5 ± 24.6	58.3 ± 33.8	64.4 ± 39.4	< 0.001	11.2 ± 19.7	31.7 ± 25.8	53.0 ± 32.6	70.0 ± 27.5	< 0.001
WPAI: Work productivity loss	14.8 ± 22.2	29.7 ± 27.2	45.5 ± 34.9	86.1 ± 11.3	< 0.001	12.9 ± 21.2	28.3 ± 25.4	58.0 ± 34.9	57.7 ± 41.9	< 0.001	10.4 ± 16.4	32.7 ± 27.0	52.3 ± 33.7	70.5 ± 29.6	< 0.001
WPAI: Activity Impairment	17.3 ± 23.9	32.1 ± 26.6	53.5 ± 28.6	75.7 ± 21.4	< 0.001	13.4 ± 22.1	32.8 ± 25.1	57.6 ± 29.4	69.4 ± 31.7	< 0.001	12.6 ± 20.6	35.5 ± 25.4	56.3 ± 26.2	75.0 ± 23.8	< 0.001

P-HBI and SF-36 measure pain intensity whereas SIBDQ measures pain frequency. Data are mean ± SD. P-HBI: Patient Harvey-Bradshaw Index; SF-36: Short Form Health Survey; SIBDQ: Short Inflammatory Bowel Disease Questionnaire; GSI: Global Severity Index; COPE: Brief Cope Inventory; FAD: McMaster Family Assessment Device; SWLS: Satisfaction with Life Scale; WPAI: Work Productivity and Activity Impairment Questionnaire.

Table 10 Multinomial logistic regression analysis, stratified by source of questionnaire, of General Severity Index, gender, the three coping strategies and the intensity of pain¹

Characteristic	No pain	Mild pain		Moderate pain		Severe pain
		InternetOR (P value)	HardcopyOR (P value)	InternetOR (P value)	HardcopyOR (P value)	InternetOR (P value)	HardcopyOR (P value)
Pain by HBI
GSI	Ref.	1.74 (0.14)	2.67 (< 0.001)	2.89 (0.01)	6.13 (< 0.001)	8.51 (< 0.001)	11.66 (< 0.001)
Gender (female)	Ref.	1.11 (0.80)	1.63 (0.07)	1.03 (0.95)	3.43 (0.00)	0.76 (0.69)	2.43 (0.14)
Emotion-focused	Ref.	1.01 (0.81)	1.04 (0.21)	1.04 (0.35)	1.06 (0.15)	0.96 (0.56)	1.15 (0.03)
Problem-focused	Ref.	1.04 (0.53)	0.91 (0.02)	1.05 (0.44)	0.91 (0.04)	1.14 (0.19)	0.79 (< 0.001)
Dysfunctional	Ref.	1.04 (0.49)	1.07 (0.04)	1.02 (0.67)	1.04 (0.30)	1.02 (0.76)	1.01 (0.90)
Pain by SF36
GSI	Ref.	2.05 (0.07)	3.22 (< 0.001)	5.87 (< 0.001)	6.20 (< 0.001)	10.12 (< 0.001)	6.69 (< 0.001)
Gender (female)	Ref.	2.22 (0.05)	1.42 (0.18)	2.41 (0.09)	4.29 (< 0.001)	3.60 (0.15)	3.82 (0.03)
Emotion-focused	Ref.	1.01 (0.86)	1.01 (0.76)	1.02 (0.71)	1.04 (0.42)	1.02 (0.81)	1.06 (0.35)
Problem-focused	Ref.	1.05 (0.47)	0.96 (0.32)	1.11 (0.16)	0.96 (0.39)	1.23 (0.10)	0.97 (0.74)
Dysfunctional	Ref.	1.05 (0.38)	1.07 (0.05)	0.98 (0.77)	1.05 (0.28)	1.03 (0.73)	1.07 (0.23)
Pain by SIBDQ
GSI	Ref.	2.39 (0.03)	4.04 (< 0.001)	5.57 (< 0.001)	5.53 (< 0.001)	6.20 (< 0.001)	19.91 (< 0.001)
Gender (female)	Ref.	1.16 (0.72)	1.21 (0.50)	1.43 (0.44)	1.93 (0.07)	0.73 (0.62)	3.06 (0.08)
Emotion-focused	Ref.	0.97 (0.49)	1.06 (0.09)	0.98 (0.72)	1.01 (0.88)	0.97 (0.62)	1.10 (0.14)
Problem-focused	Ref.	1.04 (0.52)	0.91 (0.01)	1.08 (0.23)	0.96 (0.41)	0.88 (0.21)	0.79 (< 0.001)
Dysfunctional	Ref.	1.01 (0.91)	1.06 (0.06)	1.00 (0.99)	1.10 (0.01)	1.11 (0.14)	0.99 (0.83)

¹Statistical differences from the reference value (No pain) are shown. GSI: General Severity Index.