The role of identity in chronic pain cognitions and pain-related disability within a clinical chronic pain population

Abstract

Objective Chronic pain has a significant impact on functioning and results in the disruption of one’s assumed life trajectory, potentially altering their self-perceived identity. The present research is designed to determine whether identity-related issues are associated with common chronic pain cognitions and pain-related disability, which may help inform understanding of clinical chronic pain populations. Method Ninety-eight adult chronic pain patients were assessed at a local pain clinic during a regularly scheduled appointment focusing on pain management. Multivariate hierarchal regression was used to determine whether issues related to identity and death anxiety were associated with pain catastrophizing, pain acceptance, and pain-related disability, above and beyond pain severity, fear-avoidance, and age. Results Self-concept clarity was significantly related to pain catastrophizing and pain acceptance, above and beyond death anxiety, pain severity, fear-avoidance, and age. Death anxiety was associated with pain catastrophizing, pain acceptance, and pain-related disability above and beyond pain severity, fear-avoidance, and age. Conclusions To the best of our knowledge, the present study is the first examination of self-concept clarity and death anxiety as they relate to pain catastrophizing, pain acceptance, and pain-related disability. These descriptive results support the inclusion of identity and death anxiety within the pain experience and could serve as a foundation for future directions relevant to clinical applications.

Introducing the integrated model of co-occurring chronic pain and posttraumatic stress disorder: Adding meaning-making and existential concepts to current theory.

“…However, at least two studies showed mixed results regarding pain catastrophizing and its role in mutually maintaining chronic pain and PTSD. These results are important because other research shows that pain catastrophizing is associated with death anxiety and self-concept (Reed, Cobos, Nagpal, et al, 2021). Therefore, examining pain catastrophizing within the context of the mutual maintenance model may be helpful.…”

“…Existential anxiety is particularly heightened after experiencing adverse events (Koole et al, 2006). Therefore, it is no surprise that both chronic pain and PTSD are associated with increased existential anxiety, such as loss of self-concept (Dezutter et al, 2015; Fischer et al, 2020; Reed, Cobos, Nagpal, et al, 2021; Vail et al, 2019). However, current models of co-occurring chronic pain and PTSD do not recognize existential anxiety as a component of the comorbidity.…”

“…Death anxiety appears to be a transdiagnostic process for individuals with either chronic pain or PTSD (Iverach et al, 2014; Menzies et al, 2021; Reed, Cobos, Nabity, et al, 2021). For patients with chronic pain, recent research suggests that it is not pain severity, per se, that is associated with death anxiety, but the perceived disability that results from chronic pain (Reed, Cobos, Nagpal, et al, 2021). Nevertheless, research on chronic pain and death anxiety is nascent, and pain severity likely plays a role.…”

“…Distress may also result from recognizing that the current self is different from the past self (M. Hughes et al, 2019). Importantly, clarity of self-concept is correlated with both painrelated disability and how patients process their pain (e.g., higher pain acceptance and lower pain catastrophizing; Reed, Cobos, Nagpal, et al, 2021). Trauma-specific cognitions may contribute to identity disruption, particularly cognitions around self-blame and negative views of the self.…”

Whole Health Use and Interest Across Veterans With Co-Occurring Chronic Pain and PTSD: An Examination of the 18 VA Medical Center Flagship Sites

“…Separately, these disorders are associated with negative changes in social relationships, sense of purpose, identity, and spiritual concerns. [38][39][40][41][42][43][44][45] Core WH services may have a particular impact on issues surrounding personal meaning and purpose, setting personal health goals, and focusing on issues that are typically not medically focused. Thus, holistic approaches to care, either as stand-alone treatments or in adjunct with more conventional treatments, may offer particular advantages and benefits for many patients.…”