Contralateral Arm Pain as a Sign of Distress Regarding Symptoms

Abstract

Background: Pain intensity and magnitude of incapability are associated with common unhelpful thoughts about symptoms such as catastrophic thinking and kinesiophobia. To determine whether reports of pain in the upper limb contralateral to a non-trauma condition were associated with unhelpful thoughts, we measured the relationship between pain intensity in the opposite limb and levels of unhelpful thinking. Methods: In a cross-sectional study, 152 new and return patients seeking care of an upper-limb musculoskeletal condition completed measures of upper-extremity-specific magnitude of capability, pain intensity of the involved and contralateral arms, unhelpful thoughts regarding symptoms, symptoms of distress regarding symptoms, and general symptoms of depression. Factors associated with contralateral and ipsilateral pain intensity and upper-extremity-specific magnitude of capability were assessed using multivariable statistics. Results: In bivariate analysis, contralateral arm pain was associated with symptoms of distress regarding pain, but not in multivariable analysis. Accounting for potential confounding in negative binominal regression analysis, greater pain intensity of the affected side was independently associated with greater feelings of distress regarding symptoms and no prior surgery. Greater upper-extremity-specific capability was independently associated with less distress regarding symptoms, married/partnered, men, and no prior surgery. Conclusions: The observation that greater pain intensity in the opposite arm was associated with greater distress regarding symptoms suggests that, in combination with other verbal and non-verbal signs of distress, patient concerns about pain in the contralateral limb can help direct patients and surgeons to evidence-based care strategies for alleviating stress regarding symptoms.