title: Health concerns and somatic symptoms explain perceived disability and idiopathic hand and arm pain in an orthopedics surgical practice: a path-analysis model.
abstract: BACKGROUND
  Upper-limb pain disorders are relatively common, and often result in disability, lost time from work, and significant use of healthcare services.
  
  
  OBJECTIVE
  The authors adapted and tested a cognitive-behavioral model of health anxiety in 100 patients with hand and arm pain in an orthopedics surgical practice, hypothesizing that increased health concerns would relate to increased perceived disability, and investigating whether patients' pain is related to other increased somatic symptoms.
  
  
  METHODS
  Patients with (non-traumatic) hand and arm pain received the Health Anxiety Inventory, the Whitley Index, and the Somatic Symptoms Inventory. Primary analyses were conducted via structural-equation modeling.
  
  
  RESULTS
  There was a strong, positive, and direct relationship between health concerns and perceived disability. Health concerns were significantly and positively related to somatic symptoms, which, in turn, were significantly positively related to perceived disability and to having idiopathic versus discrete pain.
  
  
  CONCLUSIONS
  The health-anxiety model is relevant to the development of nonspecific, vague, and diffuse (idiopathic) hand and arm pain.
authors.affiliation: Department of Behavioral Medicine, One Bowdoin Square, 7th Floor, Massachusetts General Hospital, Boston, MA 02114, USA. avranceanu@partners.org
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: James
authors.initials: J
authors.lastname: Cowan
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
mesh_terms: D001007:Anxiety / Q000523:psychology*; D001132:Arm; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009985:Orthopedics; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010465:Perception; D013001:Somatoform Disorders / Q000523:psychology*; D034941:Upper Extremity / Q000503:physiopathology*