Presented at the 2013 AAPM Annual Meeting « Back

A Measure of Pain Tolerability, and its Relationship to Known Risk Factors for Poor Treatment Outcome

John M. Disorbio, EdD, jmdisorbio@earthlink.net¹, Daniel Bruns, PsyD², Dawn M. Jewell, PsyD², Alexander Bruns², (1) APA, Evergreen, Colorado, (2) Health Psychology Associates, Greeley, Colorado

Introduction: The Pain Tolerance Index (PTI) is a measure of the degree to which pain is tolerable. The purpose of this study was to investigate the relationship between this measure and a range of other matters of clinical interest. Methods: A total of 777 patients with pain and/or injury completed the Battery For Health Improvement 2 (BHI 2) test. Using 0-10 pain ratings from this test, PTI was defined as the patients’ perception of the maximum pain they could tolerate and still work, from which was subtracted the highest of all BHI 2 pain reports. This created a measure that ranged from -10 to +10, with higher numbers suggesting greater pain tolerance. IRB approval was received for this protocol. Results: PTI scores were assessed in relation to various risk factors using Chi-square. For patients with low PTI levels (poor pain tolerance), the odds ratio/significance level for other clinical concerns were as follows: self perception of disability (6.100/.000), somatization (3.246/.000), depression (2.902/.000), suicidal ideation (2.632/.000), dysfunctional pain cognitions (2.533/.000), compensation focus (2.384/.000), anxiety (1.510/.043), and entitlement (0.922/.347). Conclusions: This study supports the hypothesis that PTI is a valid clinical construct, which is associated with higher risk of a number of matters of clinical concern. The treatment implications for patients with low PTI are that they may benefit from both medical treatments that reduce pain, and psychological treatments that increase pain tolerance. References: 1) Bruns D, Disorbio JM. Battery for Health Improvement 2 Manual. Minneapolis: Pearson; 2003. 2) den Boer JJ, Oostendorp RA, Beems T, Munneke M, Oerlemans M, Evers AW. A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery. Eur Spine J. May 2006;15(5):527-536. 3) Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Medicine. May-Jun 2009;10(4):639-653.

Funding: None