Pain & Participation


Woman with knee pain

The objective of the Pain Interference Patterns research project is to understand how pain and environmental conditions, like access barriers, affect community participation of people who report physical, sensory and cognitive impairment. The information will be used to develop strategies for increasing participation in rural communities.

People with disabilities often face barriers to full participation in the
home, education, employment and community activities. Barriers to participation
include a variety of factors including but not limited to:
• Inaccessible transportation
• Inaccessible buildings and public spaces
• Health conditions like depression, circulation problems and pain


Because the majority of individuals with a disability report experiencing pain as a secondary condition, we wanted to know how pain impacted participation in life activities. To help answer this question, we asked individuals with disabilities to complete four surveys over 18 months about their pain levels, environmental barriers, and participation in daily activities.


Of the 564 people who participated in this research study, most reported some kind of impairment, from hearing and vision loss to significant mobility loss. As a whole, the group reported an average daily pain level of 4.68 on a 0-10 pain scale:

 First Face, happy face, no pain, number 0. Second Face, less happy face, a little pain, number 2. Third Face, neutral face, a little more pain, number 4. Fourth face, Slightly sad face, even more pain, number 6. Fifth face, frowning face, a whole lot of pain, number 6. Sixth Face, crying face, worst pain, number 10.


Based on the responses from the first survey we learned community participation can be broken into three categories:

  1. Medical, including doctor, other healthcare and pharmacy visits
  2. Shopping, including grocery stores, shopping malls, and box stores
  3. Free time, including religious activities, socializing outside the home, community activities, exercise, and entertainment

• Individuals who participated more frequently in community activities reported higher rates of pleasure and happiness.
• Married people were less likely to participate in free time activities than their single counterparts.
• People who managed pain with rest had less free time activities.
• People with high pain levels had less medical and free time activities.
• The way people thought about pain was more of a barrier than pain itself, this is known as catastrophic thinking about pain.


Andy Soule: A Paralympic Cross Country SkierAlthough data analysis is still in progress, we are gaining a better understanding of how pain interferes with participation. For more technical information about the participation categories and analyses, please see our research report on Pain Interference Patterns here.