Pain and Disabilities

Pain is a common secondary condition in women with spinal cord injury, multiple sclerosis, stroke, and post-polio.

Chronic pain has been found to impact functioning and complicate disability on many levels.. Although more research is needed, the following information summarizes what is known about the prevalence and effects of chronic pain on women with disabilities or on interventions that may help.

Preliminary findings from one study on women with physical disabilities reported at least an 80 percent prevalence rate for pain as a secondary condition for each of the following disabilities: spinal cord injury, spina bifida, post polio, cerebral palsy, neuromuscular disorders, and traumatic brain injury. In addition, 67 percent of women with multiple sclerosis reported problems with pain.

In one qualitative study, people with various physical disabilities (spinal cord injury, acquired amputation, and cerebral palsy) described pain as part of daily living that influences their lifestyle decisions. Pain was further described as being experienced in multiple locations, with distinct sensations, and different implications. Pain was also described as very personal with little understanding from family and friends.

A qualitative study of 18 women with physical disabilities found that pain comprised one of the major factors that impeded the ability of the women to engage in health-promoting behaviors.

Another study found that women with functional limitations due to a variety of chronic conditions averaged 12 secondary conditions in the past year. These included, fatigue, immobility, physical de-conditioning, spasticity, and joint pain, followed by depression, chronic pain, access problems, weight problems, and isolation. These secondary conditions were also found to adversely affected health status and quality of life for women with physical disabilities.

Little research has examined the psychosocial impact of pain specifically on women with disabilities. However, some research has been conducted on pain as a secondary condition in people with disabilities (majority male).

At a physiological level, chronic pain promotes a stress response characterized by fatigue, neuroendrocrine dysregulation, dysphoria, myalgia, and impaired mental and physical performance which can foster negative thinking and create a vicious cycle of stress and disability.

Most pain research has been on people with spinal cord injuries. Results show:

• Pain has been found to result in psychological distress and limitations in activities above and beyond the impact of spinal cord injury.
• One study found psychosocial factors (but not physiological factors) to be associated with pain severity among people with spinal cord injuries.
• Numerous studies on people with chronic pain have found catastrophizing to be associated with increased pain and physical and psychological dysfunction.

Catastrophizing is ---(how study defines it?) One study conducted on people with chronic pain associated with spinal cord injury (30 percent women) found catastrophizing to be significantly related to greater pain intensity, psychological distress, and pain-related disability.

Pain treatments should be evaluated for efficacy with specific disabilities. In some cases, medication may be contraindicated.

Medication to treat pain among people with disabilities can be problematic due to complications with medication for the underlying disability.

Many practitioners support intensive multidisciplinary (holistic - treating body, mind, and spirit) treatment approaches for pain and found this biopsychosocial approach to be the most successful (Gonzales et al., 2000; Guzman et al., 2001). However others still hold to a biomedical perspective, focusing only on medical interventions.

Aromatherapy has been suggested as a treatment for pain for people with multiple sclerosis.

Cognitive-behavioral therapies have proven to be effective treatment for people with chronic pain in general, and research has begun focusing on this treatment for pain among people in which pain is a secondary condition or a symptom of their primary disability. To date no studies have addressed the gender- and disability-specific needs related to pain among women with disabilities.

Increased levels of self-efficacy or belief in one's ability to cope are associated with reduced levels of pain. Cognitive-behavioral stress management training has been shown to reduce pain and other factors indirectly via changes in self-efficacy, coping, and helplessness.

It is clear that a pressing need exists for the development and evaluation of a pain self-management intervention for women with disabilities, focusing on cognitive-behavioral strategies such as self-efficacy and active coping techniques.