Responses to illness and health in chronic pain patients and healthy adults.

Although it is clear that health care utilization rates differ among individuals, what is not so obvious is the explanation for the variation in illness responses, nor is it known whether responses to illness are consistent or predictable. This pilot study compared responses to common symptoms and health maintenance activities in 1) healthy subjects with no medical visits in the previous year, 2) patients with chronic headaches with high medical utilization who remained functional at work and home, and 3) patients with nonmalignant chronic pain who were seriously dysfunctional in work and home responsibilities. The chronic pain samples differed primarily in level of functioning with similar outpatient utilization levels; they reported greatly differing response tendencies to common symptoms, with the more functional group endorsing numerous self-help strategies along with medical care seeking. The dysfunctional pain patients responded consistently with only one illness behavior: they went to the doctor. Among all three groups, the severely impaired individuals were most likely to say that they made special efforts to maintain their health; however, there was no single pro-health activity they engaged in more than the other groups. There appear to be attitudinal as well as behavioral differences in response to health and illness issues between these groups of high and low utilizers and, within the high utilizer group, between those who are more or less impaired by their pain.