The Journal of Bone and Joint Surgery (American). 2005;87:374-380.
doi:10.2106/JBJS.D.01907
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Shoulder/Elbow Test 8: Spring 2005
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Psychological Factors Associated with Idiopathic Arm Pain

David Ring, MD1, John Kadzielski, BA1, Leah Malhotra, BA1, Sang-Gil P. Lee, MD1 and Jesse B. Jupiter, MD1

1 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, WACC 525 (D.R., J.K., and L.M.) and WACC 527 (S.-G.P.L. and J.B.J.), 15 Parkman Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

Investigation performed at the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Psychological and personality factors may be as important as, or more important than, pathological processes in the experience of pain, particularly in patients whose pain has a vague or uncertain source.

Methods: Validated measures of psychological factors were used to prospectively evaluate fifty-six patients with a single, discrete pain complaint and fifty-one patients with vague, diffuse idiopathic arm pain. Pain was assessed with use of 10-point Likert scales, the Pain Anxiety Symptoms Scale, the Pain Catastrophizing Scale, the Wahler Physical Symptom Inventory, the Body Consciousness Questionnaire, and the Multidimensional Health Locus of Control Scale.

Results: Patients with idiopathic arm pain reported more severe pain at rest (p = 0.02) and with repeated movements (p = 0.01); exhibited higher levels of cognitive anxiety (p = 0.008); demonstrated greater helplessness (p = 0.002), pain magnification (p = 0.007), and overall catastrophic coping mechanisms for dealing with pain (p = 0.005); and showed a tendency for increased somatic complaining (p = 0.07). A multiple logistic regression model identified the total score on the Pain Catastrophizing Scale as the sole predictor of idiopathic pain complaints.

Conclusions: Pain complaints without a clear physical cause are common and are frustrating for both patients and physicians. Awareness of the psychological factors associated with idiopathic arm pain may lead to more effective interventions designed to improve coping mechanisms while at the same time limiting the use of meddlesome and potentially harmful diagnoses and treatments.


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Letters to the Editor:

Read all Letters to the Editor

Management of idiopathic pain in the arm.
Bertram M. Kummel, M.D.
JBJS Online, 7 Mar 2005 [Full text]
Update on Patients With Idiopathic Arm Pain
David Ring, M.D., et al.
JBJS Online, 12 Dec 2006 [Full text]
Dr. Ring responds to Dr. Kummel
David Ring, M.D.
JBJS Online, 30 Nov 2006 [Full text]