Early maladaptive schema factors, pain intensity, depressiveness and pain disability: an analysis of biopsychosocial models of pain

Abstract

Purpose: To test different biopsychosocial models of pain within two different samples. Method: Early maladaptive schemas, pain intensity, depressiveness and pain disability were assessed using questionnaire data from 271 first visit pain patients and 276 municipal employees as controls. Exploratory factor analysis was used as the early maladaptive schema factor extraction method and path analysis as the model specification and estimation method. Results: Cross-sectionally, early maladaptive schema factors were predictors of depressiveness in both groups. The effect size of depressiveness on pain disability was 11 times that of the pain intensity in the pain patient group. The situation was opposite in the control group, where effect size of pain intensity was 5.6 times that of depressiveness. In subgroups of pain duration, the effect size of pain intensity on pain disability became insignificant when pain duration was more than 2 years in pain patients. Conclusions: The study supported the importance of early emotional adversities in predicting depressiveness especially among pain patients. Depressiveness was the main predictor of pain disability in the pain patient group and as the pain duration increased, the significance of pain intensity on disability vanished. Pain intensity was the main predictor of pain disability in the control group.

Implications for Rehabilitation

• To decrease disability among chronic pain patients is mainly to treat their depressiveness.

• To decrease disability among people with mild pain is mainly to treat their pain intensity.

• The focus of psychotherapy among depressive chronic pain patients should be a pattern of inadequacy, shame, submission, failure, social isolation and dependence.

Keywords::

• Early maladaptive schema
• pain
• disability
• depression
• biopsychosocial

Declaration of Interest: This study was supported by a grant from the Signe and Ane Gyllenberg Foundation, Helsinki, Finland. The funding foundation has not had any role in the writing of the manuscript and in the decision to submit the manuscript for publication.