No moderating impact of a medically unexplained etiology on the relationship between psychological profile and chronic pain, 2018, McNaughton et al

Abstract

Objectives
The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability.

Methods
N = 471 chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups.

Results
Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ2 (3) = 0.45, p = 0.93 and χ2 (3) = 7.07, p = 0.07 respectively).

Conclusion
These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in individuals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms.


Citation:
David T. McNaughton, Julia M. Hush, Alissa P. Beath, Blake F. Dear, Michael P. Jones,
No moderating impact of a medically unexplained etiology on the relationship between psychological profile and chronic pain, Journal of Psychosomatic Research, Vol 115, 2018,
https://doi.org/10.1016/j.jpsychores.2018.10.017.
https://pubmed.ncbi.nlm.nih.gov/30470323/

(Paywalled)

 

Are they suggesting that knowing the source of one's pain decreases that pain? But not knowing the source increases it?

I'm not convinced.

I find the wording of this abstract confusing.

Supposing that someone knew what caused their pain, it should seem obvious to even the meanest intelligence that the greater the pain the greater the distress it would cause. But BPS researchers always want to turn that around and make psychological distress the cause of all pain.

 

Yep it is basically just spelling out the logic of the words then really isn't it - if you actually ascribed to those basic things of reality: like logic, reality, meaning.

Someone with a lot of pain is someone with a lot of pain. Medically Unexplained actually means 'medicine available to that person can't/won't get to the bottom of it'.

Weird that isn't it that the pain is the same whether someone's exact same severity of RA has been diagnosed or not, if you take away the 'treatment' part that addresses the symptoms. Or that 2 people presenting with the same leg fracture have the same pain before and after the x-ray. Or even if they are refused an x-ray.

As this is 2018, and the whole business-model has taken off so much since then I guess there hasn't been much more research asking such direct questions, lest their whole BS be 'blown out' if you ask such common-sense questions and get the answers science (which isn't inference under conditions where forced communication techniques embedded like NLP, CBT are used to 'close deals', but deduction-induction-deduction) and logic of the world says 'why do you even need to check these things'.

You'd have to be pretty deluded (wayyyyy beyond god-complex) to think your lack of any experience in whatever it is you are talking down to someone on (they don't know what it is because they refuse to allow it to be looked into anyway so...) will change things. I just don't understand why the world isn't laughing at these people. It is spoon-bending that they've sold as healing the world nonsense off the back of denigrating those 'they claim they intend to help' as 'being poor witnesses'.

Just because some people want to manipulate the meaning of that term to something that says something about the patient (ie bigotry to cover for inadequacy and infer 'deservingness') doesn't mean it changes a jot about what is going on in the reality and logic-world all the patients have to live in vs the dream-world the other bunch do.

It's like people who are so utterly stupid they think people with an allergy or a vulnerability need to be taught a lesson by undermining their safety measures that for no logical reason [or indeed any reason that affects them at all so I never get it, the weirdos] those losers think mightn't be needed 'because it is in their mind' other than visceral dislike programmed into them by nonsense propaganda.

Chuck a peanut in their dinner, or cough on them when you have tonisilitis and when the point you prove is you made them terribly ill still ignore that as an experiment result type people (sadly I've noticed what a huge proportion of people that is). Noone calls out that is what this whole 'medically unexplained' (but we won't look into it based merely on demographics and gut feeling about whether we like you actually), assume the pain needs to be visualised away business-model nonsense as basically the same thing. With fake words of benevolent paternalism to cover up what's going on underneath.

 

Yep. They've inverted the wording/cause and effect for their own sly purposes. None of this is science or medicine or psychology in the science sense it is linguistics and usage of intellectual dishonesty/sophism to 'reframe' reality/lead the witness.

If you think: those with greatest pain = more likely to be those with greatest psychological distress (exampled by crying and screaming out in pain) there is no revelation. Indeed if there was no association on these these people should be looking at their very internal validity of the measurement scales to say 'what is the psychological one really measuring then, be honest'.

I have a big issue with lack of honesty and integrity in people or systems, whether due to self-delusion or not there is always self-interest there (along with self-denial I struggle to believe when they claim 'good intention' cliches), and their choice to put it this way around I absolutely agree is simply a sign of that being lacking as far as I'm concerned.

Given this will include people with e.g. an appendix about to burst or a fractured leg and the scale is measuring 'signs of pain like crying' you'd like to think some honest bystanders, or at least those with the non-medically 'unexplained' (sorry doctor is out today is all that really means at its most reliable) would call it a blinking cheek for opportunists to be sniffing around trying to weaponise labels on said people by thinking they were entitled to invert the causal sequence in the sentence.

It's like writing Billy got beaten up by Jimmy which caused him a broken leg with a lot of pain and to be upset (that Jimmy would do such a thing) to: Billy was experiencing both psychological distress and pain .... a doctor finding out the cause of his physical pain (broken leg) makes little difference [nonsense if the timescale is enough the broken leg is actually treated]

What a leap forward in 'medicine' this bunch are offering. That {the above scenario] would be just reframing truth in order to frustrate access to appropriate medical care at the same time as hiding the fact that has happened and hugely psychologically 'attacking' an individual by denying reality to be seen by anyone. Hence 'weaponising' psychology (which is not of the 'mental health giving/saving' variety).

 

Yes, the result without their wording says exactly that: more pain = more likelihood of psychological distress, whether the doctor was out that day/refused to look at someone based on their hair colour or not

But their wording has tried to invert the causal logic. Which is very obvious when you note that as the pattern/association was identical for 'medically explained' can easily be noted (as is in no way muddied by their pretence of medically unexplained meaning something about the patient).

With someone with a broken leg or appendicitis in said group they've tried to infer there isn't a causal direction that is obvious of worse pain from injury/illness = more likely to be distressed, and turn it into

 

The term " medically unexplained" is arrogant. As if everything is known about disease and injury. The term is a lame and cruel excuse to figuratively toss the patient in the garbge.

 

and is sold as a first point of call diagnosis by certain individuals for whatever % they get away with quota-ing to the gatekeepers as 'you should be seeing and diagnosing'

 

Yes, this term has been hijacked. Agreed, it could, and should be benign, just factual. However, it has morphed into a derogatory label.