Examining pain-related distress in relation to pain intensity and psychological distress


  • Nancy Wells,

    Corresponding author
    1. Vanderbilt University Medical Center, Nashville, TN
    • TT-0102 Medical Center North, Vanderbilt University Medical Center, Nashville, TN 37232-2424.
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    • Director of Nursing Research and Research Professor.

  • Sheila H. Ridner

    1. Vanderbilt University School of Nursing, Nashville, TN
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    • Assistant Professor.

  • This article is based upon a paper presented at the National Cancer Nursing Research Conference, San Diego, CA, February 2003. The authors thank Carole Ann Bach, PhD, RN, and Larry Lancaster, EdD, RN, for their helpful review of this manuscript.


Despite frequent use of the term symptom distress in the pain literature, symptom distress is often confused with symptom intensity and psychological distress, contributing to inadequate assessment of symptoms and less than ideal symptom management. In this article we address these issues and propose a hybrid model, combining Price's interaction of pain sensation, pain unpleasantness, and secondary pain affect model with an information processing model. Recommendations on methods and techniques to reduce this confusion would assist healthcare professionals and researchers to better distinguish among these terms as they manage patient symptoms and design symptom management studies. Thus, the purpose of this article is to examine the terms symptom distress, symptom intensity, and psychological distress using pain as the example symptom. © 2007 Wiley Periodicals, Inc. Res Nurs Health 31:52–62, 2008