Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables

Cognitive-behavioral models of chronic pain emphasize the importance of situation specific as well as more general cognitive variables as mediators of emotional and behavioral reactions to nociceptive sensations and physical impairment. The relationship of situation-specific pain-related self-statements, convictions of personal control, pain severity, and disability levels was assessed in samples of chronic back pain and rheumatoid arthritis patients. Both the more general and the situation-specific sets of cognitive variables were more highly related to pain and disability than disease-related variables. This association was found in the back pain patients who displayed only marginal levels of organic findings as well as the rheumatoid arthritis sample who had a documented basis for their pain. The combination of both situation-specific and general cognitive variables explained between 32 and 60% of the variance in pain and disability, respectively. The addition of disease-related variables improved the predictions only marginally. These results lend support to the importance of cognitive factors in chronic pain syndromes.Support for this research was provided to the first author by DFG (German Research Foundation) Grants Fl 156/1-1 and Fl 156/2-1 and to the second author by NIH Grant RO1 AR NS 38698-01.