Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 1076-1089
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1076
Simple pain measures reveal psycho-social pathology in patients with Crohn’s disease
Shmuel Odes, Michael Friger, Ruslan Sergienko, Doron Schwartz, Orly Sarid, Vered Slonim-Nevo, Terri Singer, Elena Chernin, Hillel Vardi, Dan Greenberg, Israel IBD Research Nucleus
Shmuel Odes, Terri Singer, Department of Gastroenterology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84105, Israel
Michael Friger, Ruslan Sergienko, Elena Chernin, Hillel Vardi, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84105, Israel
Doron Schwartz, Department of Gastroenterology and Hepatology, Soroka Medical Center, Soroka Medical Center, Beersheba 84101, Israel
Orly Sarid, Vered Slonim-Nevo, Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheba 84105, Israel
Dan Greenberg, Department of Health Systems Management, Faculty of Health Sciences Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
Author contributions: Odes S, Sergienko R, Schwartz D, Sarid O and Slonim-Nevo V contributed to study conception and design; Odes S, Sergienko R, Singer T, Schwartz D, Chernin E and Vardi H made contributions to acquisition of data; Odes S, Friger M and Sergienko R contributed to analysis and interpretation of data; Odes S and Sergienko R contributed to drafting of manuscript; all authors revised and made final approval of manuscript.
Supported by a generous grant from The Leona M. and Harry B. Helmsley Charitable Trust.
Conflict-of-interest statement: None to declare.
Data sharing statement: The principal author may be contacted at odes@bgu.ac.il for enquiries pertaining to the data-set. All data are anonymous.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shmuel Odes, MD, Department of Gastroenterology, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer Sheba 84105, Israel. odes@bgu.ac.il
Telephone: +972-522700752 Fax: +972-86233083
Received: September 23, 2016
Peer-review started: September 26, 2016
First decision: November 9, 2016
Revised: November 20, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 14, 2017
Processing time: 142 Days and 0.7 Hours
Abstract

AIM

To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.

METHODS

Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.

RESULTS

The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.

CONCLUSION

Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Keywords: Crohn’s disease; Psycho-social pathology; Pain

Core tip: Pain is a very important symptom in patients with Crohn’s disease. Pain level and frequency are measurable with a series of simple questionnaires. We show that pain has demographic associations concerning gender, economic status, birthplace and smoking, as well as psycho-social associations such as disease coping strategies, family support, satisfaction with life, absenteeism and presenteeism related to the workplace, and leisure activity. Understanding these relationships will assist physicians in their approach to patients with pain.