SOCIODEMOGRAPHIC, MEDICAL, TREATMENT AND PSYCHOSOCIAL CORRELATES OF PAIN IN SCOLIOSIS

Abstract

Background: Despite people with idiopathic scoliosis (PwIS) experiencing pain (typically radicular that is often unrelated to clinical factors) of significantly greater frequency and severity to matched controls and the general population¹, a paucity of attention has been devoted to elucidating psychosocial correlates of pain in this population. Therefore, the aim of this study was to investigate the predictive value of clinical and psychosocial factors for the pain experiences of PwIS in the UK.

Methods: A questionnaire-based design was used to examine associations between pain experiences, sociodemographic, medical, treatment and psychosocial factors (stressors, coping styles, coping functions, perceived body image [PBI], acceptance of scoliosis [AoS], health-related quality of life [HRQoL] and Health Locus of Control [HLoC]). A sample of 126 PwIS (88% female) with a mean age 39.0 years. Mean age at onset, Cobb angle before and treatment was 16.6 years, 57.9°, and 36.4° respectively. The number with thoracic, thoracolumbar, double major and lumbar curves was 26 (41.3%), 16 (25.4%), 16 (25.4%) and 5 (7.9%) respectively. Sixty one (48.4%) had undergone some form of surgery. Pain experiences (presence [yes, no], intensity, description and location/distribution of pain) were assessed with the McGill Pain Questionnaire (MPQ). Medication use and factors reported by PwIS to increase and reduce their pain were assessed with open-ended questions.

Results: The majority (85%) of PwIS reported pain and 56% reported using medication for pain due to scoliosis. Logistic regression revealed that medication use was associated with undergoing surgery, increased sleep disturbances and reporting that medication decreased their pain. Presence of pain was correlated with education stressors, coping functions (emotional regulation and avoidance), AoS and HRQoL. Predictors of MPQ measures were predominately psychosocial factors. Pain intensity was predicted by pre-treatment Cobb angle, PBI, HRQoL, absence of stress due to inadequate hospital services and reporting abdominal pain. Total pain on the MPQ was associated with absence of bereavement stressors, increased satisfaction with appearance before adolescence, HRQoL, not taking medication and reporting abdominal pain.

Conclusion: The findings indicate that psychosocial interventions have the potential to impact positively on the prevalence of pain, analgesic usage and satisfaction with healthcare in PwIS. The findings also highlight a need to develop clinical guidelines for the multidisciplinary management of scoliosis that adequately address the medical and psychological aspects of this condition.