Risk Factors for Pain Interference Among Individuals with Chronic Pain

Background and Purpose: Chronic pain interferes with nearly every aspect of daily functioning, making it the leading cause of disability in the United States. Current research recommends treatments that address biological, psychological, and social components of chronic pain. However, our disease-centric medical model prioritizes acute reductions in pain intensity rather than whole-person care and pain management. Therefore, the present exploratory study sought to examine how various biopsychosocial risk factors impact past-week pain interference among adults with chronic pain.

Methods: This study utilized secondary data from the Midlife in the United States (MIDUS) 2 project, a national, longitudinal study of middle-aged Americans. A subsample of participants with chronic pain (N=1461) was selected for this study. The dependent variable of pain interference was assessed using a constructed variable comprising five self-report ratings of pain’s impact on general activity, mood, relations, sleep, and enjoyment in the past week. Total scores ranged from 0 to 50, and the Cronbach’s alpha among the study sample was 0.91. Independent variables were sex, racial origins, education, past-year wages, marital status, frequency of worrying, self-acceptance, rate of control over life, social integration, acceptance of others, lifetime discrimination, depression, BMI, number of chronic conditions, and purpose in life. Factors significantly related to pain interference at the bivariate level were entered into a multivariate model.

Results: The majority of participants were White (91.8%), female (58%), and married (68%). Participant ages ranged from 34 to 84 years (M=57.86, SD=12.28). Nearly a third (30.2%) of participants received no income or were in debt during the past year, with a further third (33.5%) receiving between $1 and $32,499. Regarding mental health, 27.7% reported experiencing a depressive episode in the past year and 33.2% reported worrying half the days or more. Participants reported a mean pain interference score of 15.76 (SD=7.23). Results of the multiple linear regression indicated that the regression model significantly predicted pain interference (F (16, 1040) = 26.78, p < .001) with an R² of 0.29. Increased frequency of worrying (b=0.57, p=.044), number of chronic conditions (b=1.31, p<.001), social integration (b=0.22, p=.016), experiencing a depressive episode (b=1.81, p=.021), and BMI (b=0.22, p<.001), as well as reduced age (b=0.12, p<.001), purpose in life (b=-0.18, p=.006), and having no income or being in debt (b=2.82, p=.002) were associated with greater pain interference.

Conclusions and Implications: These findings support existing literature demonstrating that pain interference is impacted by multiple psychological, biological, and social factors. More pain management approaches that reflect the multidimensional nature of individuals with chronic pain are needed. Offering behavioral health treatment options alongside analgesic medications could improve outcomes. Furthermore, the finding concerning social integration being related to pain interference suggests that healthcare providers should fully assess individuals with chronic pain before providing treatment recommendations. Social workers are uniquely positioned to provide comprehensive pain management services, given the discipline’s embracement of the biopsychosocial model. Due to the cross-sectional nature of this study, which included an overwhelmingly White sample, more research into the bidirectional interaction between pain and other biopsychosocial factors is crucial.