Psychological Profile of a Group of Chronic Pain Patients in a Hand Surgery Clinic

The psychological profile of chronic pain patients is unclear in the current literature. Some evidence suggests there is a personality type that is prone to develop a chronic pain condition; other studies suggest there is no such evidence. This study showed that major depression was a consistent associated finding in this group with chronic pain.

Thirty-five patients were randomly selected for a pool of patients with chronic pain who had been seen in a specialty clinic over a 5-year period. There were 26 females and 9 males. Criteria for inclusion were presence of a neuropathic condition and chronic pain present for a period longer than 1 year. Diagnoses included CRPS I and II (15 patients) and myofascial pain (20 patients). Evaluation consisted of a detailed history and physical examination, sensory motor evaluation, electrodiagnostic, and imaging studies. Physical fitness was assessed initially and monitored throughout the study period. Pain scales were assessed initially, and in every subsequent visit. Body mass index was also recorded. Pain questionnaires and a psychological battery were also administered. The psychological battery consisted of MPI, SEL-90, BAPSI, Oswestry pain questionnaire, BPR, behavioral health questionnaire, pain survey, MBHI, MCI-2.

Ulnar entrapment at the elbow and cervical radiculopathy were the neuropathic conditions most frequently seen. The most frequent psychological diagnosis was major depression in over 90% of the patients. The group had a mean BMI of 30. Statistical analyses were performed using the contingency coefficient C.

The most common cause of chronic pain was secondary to a neuropathic condition (p < .001). Associated findings were major depression and deconditioning (p < .001). Litigation (24%), worker's compensation (96%), and symptom magnification (96%) were also commonly associated. The study indicated that major depression is a consistent finding in this patient population, and depression should be treated in order to increase the chances of a successful outcome.