title: Educational achievement and chronic pain disability: mediating role of pain-related cognitions.
abstract: OBJECTIVE
  This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain.
  
  
  METHODS
  a multidisciplinary pain rehabilitation program located within a university hospital.
  
  
  METHODS
  Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6).
  
  
  METHODS
  Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index.
  
  
  CONCLUSIONS
  After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.
authors.affiliation: Anesthesiology and Psychology, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan 48109, USA. randyr@umich.edu
authors.forename: Randy S
authors.initials: RS
authors.lastname: Roth
authors.forename: Michael E
authors.initials: ME
authors.lastname: Geisser
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000453:epidemiology* / Q000523:psychology; D002908:Chronic Disease; D003071:Cognition; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008954:Models, Biological; D010146:Pain / Q000145:classification / Q000453:epidemiology* / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D010555:Personality Inventory; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013223:Statistics as Topic