The authors wrote, “Among people with bleeding disorders (PwBD), pain is a major problem, and pain treatments are often ineffective. Understanding of psychological factors involved in pain processing is limited. Maladaptive pain attitudes are associated with worse pain outcomes, and adaptive pain attitudes are associated with better outcomes in high pain conditions, but relationships between pain attitudes and pain outcomes are so far unexplored among PwBD.”
For this study, the researchers hypothesized that adaptive pain attitudes would align with less severe pain and less use of pain medication, while maladaptive pain attitudes would align with more severe pain and more use of pain medication.
The researchers utilized a Survey of Pain Attitudes (SOPA) containing two adaptive scales (Control and Emotion) and five maladaptive scales (Disability, Harm, Medication, Solicitude, Medical Cure) to measure pain attitudes. Additionally, eligible participants included adults with bleeding disorders who had pain and were enrolled in Community Voices in Research. A total of 72 participants completed an online survey with an average age of 48 years. Utilizing logistic regression, cross-sectional correlations between pain attitudes and pain outcomes (pain and prescribed pain medication use) were explored.
The cohort included 58% of patients with hemophilia A, 10% with hemophilia B, 19% with von Willebrand disease, and 1% to 3% with other bleeding disorders, including factor VII, factor X, factor XIII, and platelet disorders. Moreover, 33% of patients had a prescription for pain medication, including 23.6% with an opioid prescription, 24% of patients with one to two joint bleeds in the past 6 months, and 15% with three or more joint bleeds.
The researchers indicated that the pain attitude of “Disability” referred to patients who thought they were disabled by pain, “Harm” referred to patients who considered that pain was an indication that they were damaging themselves, and “Medication” referred to patients who thought that medication was an appropriate treatment for chronic pain.
The results revealed that the experience of severe pain was meaningfully more likely among patients whose response to the SOPA survey indicated a pain attitude of Disability (adjusted odds ratio [aOR], 2.10; 95% CI, 1.31-3.35), Harm (aOR, 1.91; 95% CI, 1.14-3.20), or Medication (aOR, 1.52; 95% CI, 1.02-2.27).
The authors noted that after modification for covariates, greater Control attitudes were correlated with lesser odds of more severe pain, and greater Disability, Harm, and Medication attitudes were all correlated with greater probabilities of more severe pain and with greater odds of any prescribed pain medication and opioid pain medication usage.
The authors wrote, “Our findings suggest a relationship between pain attitudes and the experience of pain, along with medication use in PwBD.”
The authors concluded that their results largely support their hypothesis, with most adaptive SOPA scales showing lower odds of pain intensity and use of pain medication and the most maladaptive SOPA scales exhibiting higher odds of pain intensity and use of pain medication.
Lastly, the authors suggested that attitudes about pain and beliefs play a role in the experience of pain, and the use of pain medication in PwBD, through corroboration from other studies, is warranted.
The authors wrote, “Our findings suggest that modification of pain attitudes presents a possible avenue for interventions to improve pain outcomes and increase patient satisfaction with pain management.”
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