Understanding the relationship between pain, impairment and physical disability

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Understanding the relationship between pain, impairment and physical

disability

http://www.medicalnewstoday.com/medicalnews.php?newsid=29574

24 Aug 2005

The association between pain, impairment and disability is frequently

observed in clinical practice but the relationship is not as straight-

forward as just one to one; for example some patients may have severe

pain but little impairment. Consequently, a group of investigators

from University of Bergen in Norway set about trying to establish a

more concrete idea of the interaction between these relative

dimensions to quality of life.

They recruited 223 patients with musculoskeletal pain who had been

sick-listed for an average of 3.3 consecutive months, onto the trial.

Participants (65% women) had an average age of 43 years. Each patient

was assessed on three separate occasions to measure pain intensity,

disability and physical impairment. A combined score was then

calculated to establish the relative degree of each problem and allow

relationships between the dimensions to be quantified. The first

examination took place before the start of a four week intensive

multidisciplinary treatment program. The second exam was carried out

on completion of the program (n=213) and the final exam was performed

six months later (n=193). Pain intensity was measured using a visual

analogue scale (VAS), disability was recorded using the established

Disability Rating Index (DRI) self assessment questionnaire and

impairment was judged via 16 validated movement tests from the Global

Physiotherapy Examination.

The strongest relationship was demonstrated between pain intensity

and disability with r equalling .50, .69 and .78 for each exam,

respectively. This closely matches clinical observation where degree

of pain is frequently seen to restrict a patient's ability to perform

certain tasks. However, measurements before the trial showed no

significant relationship between pain intensity and impairment (r=13)

and only a small association post-test and at 6 months (r=.29 and .42

respectively). Similarly the overlap between loss of specific

movements (impairment) and disability was comparatively small

although still statistically significant (r=.27, .30, .34).

Overall, the investigators highlight the direct and strong

relationship observed between pain and disability but are quick to

point out that each dimension was demonstrated to influence the other

to some significant degree and so clinically, none should be

considered in isolation.

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