The pain locus of control orientation in a healthy sample of the Italian population: sociodemographic modulating factors

Journal of Cultural Diversity, Summer, 2002 by Valeria Bachiocco, Mario Tiengo, Carmen Credico

Abstract: We studied the pain locus of control orientation of the Italian population and the possible influence of the ethnocultural background and sociodemographic characteristics on this attributional style. An Italian version of the Pain Locus of Control (PLOC-It) scale was administered to 144 healthy subjects, divided into two ethnocultural areas (North vs South) and stratified by age (per decade 21-60), gender (female and male) and educational level (3). The Powerful Other subscale had the highest mean score, followed by the Internality and Chance subscales. ANOVA revealed significant effects of ethnocultural area and educational level on Internality (F=724, p<0.001; F=5.05, p<0.05) and of age on Chance (F=13.6, p<0.001). There was a significant three-way interaction between area, gender and educational level on Powerful Other (F=3.67, p<0.05). Further studies should be performed in populations of various countries to better identify the attributional styles related to the different cultures and the absolute sociodemographic determinants of the pain locus of control orientation.

Keywords: Pain Locus of Control, Italy, ethnocultural area, sociodemographic factors.

**********

A subject can attribute the control over pain to himself, to fate or chance, or to people who might hold such power, i.e. medical professionals, family members, friends, etc. This dimension is defined the "pain locus of control" (Toomey, Mann, Abashian & Thompson-Pope, 1991). Those authors found that such an attribution strongly affects the pain experience, influencing its intensity, quality and periodicity (Toomey et al., 1991), as well as the individual's ability to cope with it (Toomey, Seville, Mann, Abashian & Wingfield, 1995; Toomey, Seville & Mann, 1995). Lau (1982) has proposed that personality, life experiences and ethnocultural affiliation are the sources of this system of beliefs. The last factor is a source because a person learns values, attitudes and behavioral norms to interpret, express and respond to pain within the social milieu in which he/she grows up (Linton & Gotestam, 1985; Shoben & Borland, 1954; Craig & Niedermayer, 1974; Zoborowski, 1952; Bates & Edwards, 1992), and this cognitive patterning reflects the culture of the ethnic group of membership (Bates & Edwards, 1992). In site of numerous studies proving the impact of the ethnocultural background Pn the gain experience (Zoborowski, 1952; Zoboroswki, 1969; Zola, 1966; Weisenberg, 1975; Weisenberg, 1977; Knox, Shum & McLaughlin, 1977; Lipton & Marbach, 1984; Bates, Edwards & Anderson, 1993; Bates, 1987), few authors have focused on the mechanisms underlying this influence (Tait, De Good & Caron, 1982; Bates et al., 1993; Bates, 1987). Bates (1987) and Bates et al (1993) studied the role of the locus of control orientation and found that this attributional style is closely related to both the ethnic identity and the pain severity.

In any subject, the cultural component of the locus of control style is, theoretically, antecedent to a pain experience and, as mentioned above, is shared by the ethnic group to which he/she belongs. Thus, it can be known a priori and its characteristics can be considered in assessing a pain patient and establishing his/her treatment; indeed, the agreement between a patient's beliefs and the philosophy of treatment is desirable (Lipchik, Milles & Covington, 1993).

Some studies of chronic pain patients (Buckelew, Shutty, Hewett, Landon, Morrow & Frank, 1990; Tait et al., 1982; Bachiocco, Tiengo, Pagnoni & Toomey, 1995) and healthy subjects (Tait & DeGood, 1981; Galanos, Strauss, & Pieper 1994) have shown that sociodemographic factors also modulate the individual locus of control attribution. However, in view of the interference of illness and pain on a subject's sense of control (Nagy & Wolfe, 1983; Robinson-Whelen & Storandt, 1992; Wallston, Wallston, Smith & Dobbins, 1987), it is necessary to implement studies in which these factors are investigated in conditions that are as unbiased as possible (i.e. in healthy and pain-free subjects). Therefore, we planned a study in which an Italian version of the Pain Locus of Control scale (PLOC-It) (Bachiocco, Tiengo, Pagnoni & Toomey, 2000) was administered to a healthy sample of the Italian population. Because of differences in ethnocultural identity and in the control ideology between northern and southern Italians (Bevilacqua, 1997), the sample was equally divided into two subsamples from these ethnocultural areas. The aims of the study were to identify: i) the basic attitude of the Italian population, and ii) the influence of ethnocultural a-ffiliation (northern vs southern) and of sociodemographic characteristics on the pain locus of control orientation.

Methods

A 2 x 2 x 4 x 3 balanced design was used to analyze the associations among the three dimensions rated by the PLOC-It scale (Internality, Powerful Other, Chance) and four basic sociodemographic factors: gender, age (four decades: 21-30, 31-40, 41-50, 51-60), educational level (three levels: middle school, high school, university degree) and ethnocultural background (North vs South). Thus we enrolled a sample of 144 healthy persons, so that each of the 48 strata (gender x age x educational level x area) in the design would include 3 subjects.