Table Of ContentThe Changing Nature of Pain
Complaints over the Lifespan
The Plenum Series in Adult Development and Aging
SERIES EDITOR:
Jack Demick, Suffolk University, Boston, Massachusetts
ADULT DEVELOPMENT, THERAPY, AND CULTURE
A Postmodem Synthesis
Gerald D. Young
THE AMERICAN FATHER
Biocultural and Developmental Aspects
Wade C. Mackey
THE CHANGING NATURE OF PAIN COMPLAINTS OVER
THE LIFESPAN
Michael R. Thomas and Ranjan Roy
THE DEVELOPMENT OF LOGIC IN ADULTHOOD
Postformal Thought and Its Applications
Jan D. Sinnott
HANDBOOK OF AGING AND MENTAL HEALTH
An Integrative Approach
Edited by Jacob Lomranz
HANDBOOK OF CLINICAL GEROPSYCHOLOGY
Edited by Michel Hersen and Vincent B. Van Hasselt
HANDBOOK OF PAIN AND AGING
Edited by David I. Mostofsky and Jacob Lomranz
HUMAN DEVELOPMENT IN ADULTHOOD
Lewis R. Aiken
PSYCHOLOGICAL TREATMENT OF OLDER ADULTS
An Introductory Text
Edited by Michel Hersen and Vincent B. Van Hasselt
The Changing Nature of Pain
Complaints over the Lifespan
Michael R. Thomas
and
Ranjan Roy
University of Manitoba
Winnipeg, Manitoba, Canada
Springer Science+ Business Media, LLC
Library of Congress Cataloglng-ln-PublIcatIon Data
Thomas, Michael R. (Michael Ray), 1945-
The changing nature of pain complaints over the lifespan / Michael
R. Thomas and Ranjan Roy.
p. cm. — (The Plenum series 1n adult development and aging)
Includes bibliographical references and Index.
ISBN 978-1-4899-1892-5
1. Chronic pain. 2. Pain—Psychological aspects. 3. Pain in old
age. 4. Pain in children. I. Roy, R. (Ranjan) II. Title.
III. Series.
RB127.T495 1998
616' .0472—dc21 98-41541
CIP
ISBN 978-1-4899-1892-5 ISBN 978-1-4899-1890-1 (eBook)
DOI 10.1007/978-1-4899-1890-1
© Springer Science+Business Media New York 1999
Originally published by Plenum Press, New York in 1999
Softcover reprint of the hardcover 1st edition 1999
http: / /www.plenum.com
10987654321
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical,
photocopying, microfilming, recording, or otherwise, without written
permission from the Publisher
Preface
This book has evolved over a very long time. The two of us started our
collaborative work in chronic pain nearly twenty years ago. In retro
spect, our research activities have spanned virtually the entire adult
lifespan. It is this realization that led to our thinking about the possi
bility of a book that would focus on epidemiological and psycho
social aspects of chronic pain problems at various life stages during
adulthood. We finally decided to write this book some two years ago.
The book consists of eleven chapters divided into four parts and
an epilogue: (1) Introduction to issues oflife qansition and life events
with emphasis on common childhood chronic pain conditions, a
foundation chapter; (2) pain issues in early adulthood; (3) pain issues
in the middle years; and (4) pain issues in old age.
Chapter 1 provides an overview of life transition theories and
then examines two rather common chronic pain conditions: recur
rent abdominal pain and headache in children from both epidemio
logical and psychosocial viewpoints. Part n consists of three chapters
on adolescents and young adults. Chapter 2 considers the psychologi
cal and familial issues in Juvenile Rheumatoid Arthritis. Chapters 3
and 4 focus on our work with a nonclinical pain population of young
adults. Chapter 3 reviews common chronic pain conditions in that
population, and Chapter 4 is concerned with the family functioning
of this group.
Part ill contains three chapters on the middle-age chronic pain
population. Chapter 5 deals with the epidemiology of chronic pain
during this life stage, Chapter 6 covers the transitional issues during
midlife and their relationship to chronic pain, and Chapter 7 exam
ines the pros and cons of family support for chronic pain patients.
v
vi Preface
Part IV, also containing three chapters, is concerned with the elderly.
Chapter 8 addresses the epidemiology of chronic pain in the elderly,
Chapter 9 examines the role of psychopathology in chronic pain in
the elderly, and Chapter 10 deals with family and social issues. Fi
nally, Chapter 11 gives us an opportunity to indulge in personal views
and perspectives.
It is our sincere hope that this book will fill a gap in the literature
and provide the reader with an overview of the intricate nature of the
relationship between life transitions and chronic pain.
Contents
PART I. INTRODUCTION
1. Life Transition Perspective and Chronic Pain:
An Overview . .. . .. . . . . . .. . . . . .. . . . . . .. . .. . .. .. . . . . . 3
Recurrent Abdominal Pain .......................... 7
Family and Life Events Issues ....................... 9
Abdominal Pain .................................... 9
Family Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Psychological Issues ................................ 17
Family Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Summary.......................................... 19
n.
PART PAIN ISSUES IN ADOLESCENTS
AND YOUNG ADULTS
2. Coping with Chronic Pain during Adolescence:
Juvenile Rheumatoid Arthritis URA) in Perspective 23
Impact of Chronic Illness in an Adolescent on
the Family ....................................... 25
Epidemiology of IRA .. . . .. . . . . . .. . . .. . .. . . . .. . . . . . . . 26
Psychopathology and Psychosocial Problems . . . . . . . . . . 29
Family Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Summary.......................................... 39
vii
viii Contents
3. Common Chronic Pain Conditions in a Nonclinical
Population of Young Adults ......................... 41
Prevalence by Pain Location ......................... 46
Family Patterns of Pain Found in Young Adults ....... 49
Explanations for Reported Pain Distributions . . . . . . . . . . 50
Sympathy and Distribution of Pain Complaints. . . . . . . . 52
Parenting Styles with High Corporal Punishment
as a Factor in Pain Reports in Young Adults ........ 55
Memory as a Factor Influencing Prevalence of Pain
Reports in Young Adults .......................... 56
Conclusions ........................................ 58
4. Chronic Pain and Family Function in College Students 61
Literature Review .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
The Studies ........................................ 65
Discussion ......................................... 81
m.
PART PAIN ISSUES AND MIDDLE AGE
5. Epidemiology of Chronic Pain and Related Issues
in the Middle Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chronic Pain and Middle Age ....................... 85
Theories of Pain Mechanisms Relating to Fibromyalgia 86
Definition and History of Fibromyalgia ............... 90
Epidemiology of Fibromylagia ....................... 93
Comorbidity between Psychological Disturbance and
Fibromyalgia ..................................... 93
Diagnosis and Assessment of Fibromyalgia . . . . . . . . . . . . 95
New Directions in the Treatment of Fibromyalgia ...... 98
Conclusions ........................................ 101
6. Transitional Issues during the Middle Years: Stress
and Strain and Chronic Pain ........................ 103
Theories of Midlife Transition ....................... 104
Life Events and the Middle-Aged Chronic Pain Patient 110
Summary .......................................... 122
Contents ix
7. Families of Chronic Pain Patients: Help or Hindrance? 123
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Impact of Chronic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Social Support ..................................... 132
Discussion ......................................... 138
PART Iv. PAIN ISSUES AND THE ELDERLY
8. Epidemiology of Chronic Pain in the Elderly ......... 143
Demographic Context for the Elderly with Pain ....... 145
Pain Prevalence in the Elderly. ... . . . . ... ... . .. . . . . . . 147
Sensory Threshold Shifts for Pain and Prevalence
in the Elderly .................................... 148
Changes in the Prevalence of Pain Reports
as a Function of Age Cohort....................... 151
Summary .......................................... 153
9. Role of Psychopathology in Chronic Pain
in the Elderly ...................................... 155
Psychological Factors in Chronic Pain among
the Elderly ....................................... 156
Somatization Disorder. . . . . .. ... . . . . . . .. . . . ... . . . . . . . 157
Hypochondriasis and Delusional Disorders Somatic Type 158
Depression and Chronic Pain in the Elderly . . . . . . . . . . . 159
Gender, Pain, and Depression in the Elderly .......... 161
Anxiety and Chronic Pain in the Elderly. . . . . . . . . . . . . . 162
Role of Memory Impairment as a Factor in Chronic
Pain............................................. 163
Cognitive Impairment and Pain in the Institutionalized
Elderly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Role of Dementia in Chronic Pain in the Elderly ...... 167
Conclusions ........................................ 168
10. Social and Family Issues and the Elderly Chronic Pain
Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Case Illustration .................................... 172
Life Events.... . . . . ... . . . . . . .. . . .... . . . . .. . . . ... . . . . 174
