The "self" in pain : exploring the role of coping style in chronic pain adjustment

Abstract

The devastating impacts of chronic pain include not only disability and emotional distress, but also challenges to patients’ sense of self. Patients experience self-discrepancy when they believe that they can no longer fulfill their hopes or responsibilities. While the impact of self-discrepancy on patients’ chronic pain adjustment has been widely examined, the underlying mechanism is still unclear. The present study therefore aimed to first examine the causal relationship between self-discrepancy and pain outcomes in healthy participants. Then, the study was extended to investigate whether different coping styles, namely psychological inflexibility, pain catastrophizing and rumination, mediate the association between self-discrepancy and pain outcomes.

Psychological inflexibility implies the inability to stay in contact with the present moment and to adjust value-based behaviors according to contextual needs. Pain catastrophizing is defined as the exaggerated threat of pain experience. Rumination means the repetitively self-focused attention on depressive mood. Pain outcomes involve pain interference, emotional distress and pain acceptance. The present study proposed that the three coping styles serve as significant role throughout the process of pain outcomes being affected by self-discrepancy.

In study 1, healthy participants underwent experimental manipulations on self-discrepancy (self-discrepancy inducing vs. no self-discrepancy inducing) and pain induction (cold pressor task vs. no pain condition). Pain intensity, pain tolerance and affects were measured prior to and after the manipulation. Study 1 confirmed that self-discrepancy induction on healthy participants attenuates the pain tolerance in a later pain induction task. Study 2 recruited patients with chronic pain from a public hospital. The participants were invited to take part in a semi-structured interview regarding their levels of self-discrepancy and to fill in self-report questionnaires regarding their coping styles and pain outcomes. Mediation analyses largely confirmed the mediating role of the three coping styles (i.e., psychological inflexibility, pain catastrophizing and rumination) in the relationship between self-discrepancy and pain outcomes.

The current study provides additional insight into the mechanism underpinning the impact of self-discrepancy on patients’ pain adjustment and offers clinical implications regarding the use of psychological treatments for chronic pain management, such as acceptance commitment therapy and cognitive-behavioral therapy.