Unique contributions of body diagram scores and psychosocial factors to pain intensity and disability in patients with musculoskeletal pain

STUDY DESIGN: Retrospective cross-sectional cohort of military patients with musculoskeletal pain. BACKGROUND: Body diagrams are used to document symptoms and can also serve as a proxy to assess psychological inffuence. However, literature to support this is confficting. OBJECTIVES: To (1) examine the unique contribution of pain and nonpain symptom distribution to magnitude of self-reported pain intensity and disability, and (2) assess the moderating inffuence of psychological factors and body diagram score on concurrent pain intensity and disability. METHODS: Pain, numbness, and tingling were denoted on a body diagram at initial evaluation. Fear-avoidance beliefs, pain catastrophizing, and region-specifc self-reported disability measures were collected. The contributions of pain and nonpain symptom distribution to pain intensity and disability were assessed to determine which body diagram symptom scoring method (pain only, nonpain, or composite) was appropriate for subsequent analyses. Hierarchical linear regression analyses were then used to determine the moderating effects of the Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire and the body diagram score on concurrent pain and disability. RESULTS: The Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire explained between 16% and 17% of the variance in pain intensity, and 8% of variance in disability (all, P<.001). The composite symptom score explained an additional 4% to 5% variance in concurrent disability and pain intensity (all, P<.001). The Pain Catastrophizing Scale moderated the relationship between body diagram score and pain intensity. The positive relationship between composite symptom score and concurrent pain intensity is stronger for patients with low catastrophizing. CONCLUSION: The clinical utility of body diagrams with low symptom distribution may be improved by concomitant assessment of pain catastrophizing and warrants further longitudinal investigation.