Pain interference and physical function demonstrate poor longitudinal association in people living with pain: a PROMIS investigation

Abstract

A primary goal in managing pain is to reduce pain and increase physical function (PF). This goal is also tied to continuing payment for treatment services in many practice guidelines. Pain interference (PI) is often used as a proxy for measurement and reporting of PF in these guidelines. A common assumption is that reductions in PI will translate into improvement in PF over time. This assumption needs to be tested in a clinical environment. Consequently, we used the patient-reported outcomes measurement information system (PROMIS) to describe the topology of the longitudinal relationship between PI in relation to PF. Longitudinal data of 389 people with chronic pain seeking health care demonstrated that PI partially explained the variance in PF at baseline (r = -0.50) and over 90 days of care (r = -0.65). The relationship between pain intensity and PF was not significant when PI was included as a mediator. A parallel process latent growth curve model analysis showed a weak, unidirectional relationship (β = 0.18) between average PF scores and changes in PI over the course of 90 days of care, and no relationship between average PI scores and changes in PF across time. Although PI and PF seem moderately related when measured concurrently, they do not cluster closely together across time. The differential pathways between these 2 domains suggest that therapies that target both the consequences of pain on relevant aspects of persons' lives, and capability to perform physical activities are likely required for restoration of a vital life.

Figure 1.

Cross-sectional analysis showed that lower pain interference was moderately related to higher physical function at the beginning of care across the entire chronic pain population (r = −0.50, n = 389).

Figure 2.

Cross-sectional analysis showed that lower pain interference was strongly related to higher physical function after 90 days of care across the entire chronic pain population (r = −0.65, n = 305).

Figure 3.

Cross-sectional analysis showed that pain interference (PI) was a mediator of the relationship between pain intensity and physical function (PF). The relationship between pain intensity and PF was insignificant when PI was included as a mediator.

Figure 4.

A parallel process latent growth curve model showed a weak, unidirectional relationship (β = 0.18, P < 0.05) between physical function and pain interference over the course of 90 days of care.