Graduate Thesis Or Dissertation
 

Exploration of Existing and Novel Pain Attitudes in Relation to Pain Among People with Bleeding Disorders

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https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/v979v950t

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  • Introduction: For people with bleeding disorders pain is often a daily challenge. Despite many advancements to the standard of care in recent decades, including more effective treatments, and more effective medication schedules, pain remains highly prevalent in people with bleeding disorders: existing pain treatment practices have not adequately addressed pain in this population. Complex interactions between biological and psychosocial factors can influence pain. Despite knowing both are important, biological factors are often the focus of pain treatments, and psychological factors are less commonly addressed in people with bleeding disorders. Attitudes and beliefs about pain have been associated with pain outcomes in many other chronic pain conditions, but not in people with bleeding disorders. In numerous high pain conditions, maladaptive pain attitudes have been linked with worse pain outcomes, while adaptive pain attitudes have been linked with better pain outcomes. A similar construct, pain having utility to future health, has not been explored in pain literature for any conditions. I developed and tested measurement tools for novel pain attitudes constructs related to pain utility, and explored them alongside traditional measures of pain attitudes encompassing adaptive and maladaptive pain attitudes in people with bleeding disorders. I investigated the use of pain attitudes survey tools in relation to pain outcome measures (recent pain and pain medication use) in people with bleeding disorders. Methods: I developed the Utility of Pain Survey tool to measure belief in pain utility. Development occurred in four phases: content development, expert validity review, patient validity review, and pilot test. Two main constructs were hypothesized, cause obscuring (the degree to which pain causes are obscured by negative thoughts about pain) and usefulness (the degree to which pain is thought of as useful). Pain attitudes were measured using an existing tool, the Survey of Pain Attitudes, which contains two adaptive scales (Control and Emotion) and five maladaptive scales (Disability, Harm, Medication, Solicitude, and Medical Cure). Adults with pain, 18 years and older, with a bleeding disorder, were eligible for studies. Willing participants (n=72) completed an online pain attitudes survey and answered questions about pain. The relationship between pain attitude scales and pain outcomes (recent pain and pain medication use) was investigated with logistic regression models. Results: A two-factor structure was observed for pain utility statements (factor 1: cause obscuring, factor 2: usefulness). After adjustment, maladaptive statements (cause obscuring) were associated with higher average pain and greater pain medication use, while adaptive statements (usefulness) were associated with lower average pain and lower pain medication use. For Survey of Pain Attitudes, one adaptive scale (Control) was associated with most pain outcomes tested. Higher Control was associated with a lower odds of pain medication use and lower pain. After adjustment, three maladaptive scales were associated with pain outcomes tested. Increased Disability, Harm, Medication was associated with increased pain medication use and higher pain. In both pain attitudes scales, generally, maladaptive statements (cause obscuring, Disability, Harm, Medication) were more strongly associated with outcomes than adaptive statements (usefulness, Control). Conclusions: I found compelling evidence of a relationship between pain attitudes and pain outcomes in people with bleeding disorders. Established scales of the Survey of Pain Attitudes (Control, Disability, Harm, Medication) were shown to explain recent pain and pain medication use, while the novel Utility of Pain Scale was shown to have promise in explaining pain in people with bleeding disorders. While pain utility attitudes show potential, further refinement of the Utility of Pain Survey is needed. Research must be undertaken to corroborate the findings of this dissertation and may further justify the implementation of interventions to reform maladaptive attitudes while supporting adaptive attitudes in people with bleeding disorders. The potential connection between pain attitudes and pain outcomes presents a sensible avenue for further study in terms of intervention.
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  • Pending Publication
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  • 2021-06-03 to 2022-01-04

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