Perception of fault in patients with chronic pain

The beliefs and expectancies of chronic pain patients have been shown to be critical cognitive facilitators or impediments to the recovery process. In the present study patients presenting to an outpatient pain center were classified according to their response to the questionnaire item "Who do you think is at fault for your pain?". Patients were then grouped according to the responses 'employer', 'other', or 'no one'. The resulting 3 groups of patients did not differ in current pain intensity or activity limitation, but the fault conditions, relative to the no-fault patients, reported greater concurrent mood distress and behavioral disturbance, as well as poorer response to past treatments, and lessor expectations of future benefits. The negative effects were more pronounced in the Employer-Fault group, than for the Other-Fault group (primarily 'doctors' and 'other drivers'). On balance, the present data suggest that attribution of blame may be an under-recognized cognitive correlate of pain behavior, mood disturbance, and poor response to treatment.