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

Abstract

Aim: To determine whether pain has psycho-social associations in adult Crohn's disease (CD) patients.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Crohn’s disease; Pain; Psycho-social pathology.

Figure 1

Responses to the pain questions by the Patient Harvey-Bradshaw Index, Short Form Health Survey and Short Inflammatory Bowel Disease Questionnaire, for patients completing the questionnaires by internet or hardcopy. Patient Harvey-Bradshaw Index (P-HBI) and Short Form Health Survey (SF-36) measure pain intensity whereas Short Inflammatory Bowel Disease Questionnaire (SIBDQ) measures pain frequency. P values for differences in responses to the pain questions are: by P-HBI P < 0.001, by SF-36 P = 0.081, by SIBDQ P < 0.001.