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.
DahlhamerJMLucasJZelayaC, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morb Mortal Wkly Rep2018; 67: 1001–1006.
3.
NeesFLöfflerMUsaiKFlorH.Hypothalamic-pituitary-adrenal axis feedback sensitivity in different states of back pain. Psychoneuroendocrinology2019; 101: 60–66.
4.
McWilliamsLACoxBJEnnsMW.Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain2003; 106: 127–133.
5.
de HeerEWGerritsMMJGBeekmanATF, et al. The association of depression and anxiety with pain: a study from NESDA. PLoS One2014; 9: e106907–e106912.
6.
BairMJWuJDamushTMSutherlandJM, et al. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med2008; 70: 890–897.
7.
VlaeyenJWSLintonSJ.Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain2000; 85: 317–332.
8.
SmithJAOsbornM.Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Heal2007; 22: 517–534.
9.
NicolaMCorreiaHDitchburnGDrummondP. Invalidation of chronic pain: a thematic analysis of pain narratives. Disabil Rehabil2019; 1–9.
10.
CampbellJDTrapnellPDHeineSJ, et al. Self-concept clarity: measurement, personality correlates, and cultural boundaries. J Pers Soc Psychol1996; 70: 141–156.
11.
CampbellJD.Self-esteem and clarity of the self-concept. J Pers Soc Psychol1990; 59: 538–549.
12.
BoelenPA.Self-identity after bereavement: Reduced self-clarity and loss-centrality in emotional problems after the death of a loved one. J Nerv Ment Dis2017; 205: 405–408.
13.
CozzolinoPJBlackieLERMeyersLS.Self-related consequences of death fear and death denial. Death Stud2014; 38: 418–422.
14.
KooleSLGreenbergJPyszczynskiT.Introducing science to the psychology of the soul: experimental existential psychology. Curr Dir Psychol Sci2006; 15: 212–217.
15.
LandauMJGreenbergJSullivanD, et al. The protective identity: evidence that mortality salience heightens the clarity and coherence of the self-concept. J Exp Soc Psychol2009; 45: 796–807.
16.
BurkeBLMartensAFaucherEH.Two decades of terror management theory: a meta-analysis of mortality salience research. Pers Soc Psychol Rev2010; 14: 155–195.
17.
ReedIIDWilliamsonREWickhamRE.Memento Mori: understanding existential anxiety through the existential pathway model. J Theor Soc Psychol2020; 79.
18.
MorleyS.Psychology of pain. Br J Anaesth2008; 101: 25–31.
19.
CrombezGEcclestonCVan DammeS, et al. Fear-avoidance model of chronic pain: the next generation. Clin J Pain2012; 28: 475–483.
20.
ClaesNVlaeyenJWSLauwerierEMeuldersMCrombezG.Goal conflict in chronic pain: day reconstruction method. PeerJ2018; 6: e5272–e5278.
21.
KarolyPRuehlmanLS.Motivational implications of pain: chronicity, psychological distress, and work goal construal in a national sample of adults. Heal Psychol1996; 15: 383–390.
22.
KarolyPOkunMARuehlmanLS, et al. The impact of goal cognition and pain severity on disability and depression in adults with chronic pain: an examination of direct effects and mediated effects via pain-induced fear. Cogn Ther Res2008; 32: 418–433.
23.
HardyJKCroffordLJSegerstromSC.Goal conflict, distress, and pain in women with fibromyalgia: a daily diary study. J Psychosom Res2011; 70: 534–540.
24.
CeulemansKKarsdorpPAVlaeyenJWS.Effects of responsibility and mood on painful task persistence. J Behav Ther Exp Psychiatry2013; 44: 186–193.
25.
PetersenSvan den BergRAJanssensT, et al. Illness and symptom perception: a theoretical approach towards an integrative measurement model. Clin Psychol Rev2011; 31: 428–439.
26.
Van DammeSKindermansH.A self-regulation perspective on avoidance and persistence behavior in chronic pain: New theories, new challenges?Clin J Pain2015; 31: 115–122.
27.
PyszczynskiTKesebirP.Anxiety buffer disruption theory: a terror management account of posttraumatic stress disorder. Anxiety Stress Coping2011; 24: 3–26.
28.
AbdollahiAPyszczynskiTMaxfieldM, et al. Posttraumatic stress reactions as a disruption in anxiety-buffer functioning: dissociation and responses to mortality salience as predictors of severity of posttraumatic symptoms. Psychol Trauma Theory, Res Pract Policy2011; 3: 329–341.
29.
VailKEMorganAKahleL.Self-affirmation attenuates death-thought accessibility after mortality salience, but not among a high post-traumatic stress sample. Psychol Trauma Theory Trauma2018; 10: 112–120. doi:10.1037/tra0000304
30.
VailIIKGoncyEAEdmondsonD.Anxiety buffer disruption: worldview threat, death thought posttraumatic stress symptom samples. Psychol Trauma Theory Trauma2019; 11: 647–655.
31.
ErdfelderEFaulFBuchnerA.GPOWER: a general power analysis program. Behav Res Methods, Instruments, Comput1996; 28: 1–11.
32.
Tomás-SábadoJGómez-BenitoJLimoneroJT.The death anxiety inventory: a revision. Psychol Rep2005; 97: 793–796.
33.
DER, II WilliamsonREWickhamRE.The Existential Phenomenological Questionnaire. Portland, OR: Society for Personality and Social Psychology, 2019.
FairbankJCCouperJDaviesJB, et al. The Oswestry low back pain disability questionnaire. Physiotherapy1980; 66: 217–273.
36.
FritzJMIrrgangJJ.A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. Phys Ther2001; 81: 776–788.
WaddellGNewtonMHendersonISomervilleDMainCJ.NA Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain1993; 52: 157–168.
40.
MuthenLKMuthenBO. Mplus 2018.
41.
EndersC.Applied missing data analysis. New York: Guilford Press, 2010.
Michigan State University. Oswestry Low Back Pain Disability Questionnaire.
46.
BoonstraAMStewartREKökeAJA.Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: Variability and influence of sex and catastrophizing. Front Psychol2016; 7: 1–9.
47.
NicholasMKCostaDSJBlanchardM, et al. Normative data for common pain measures in chronic pain clinic populations. Pain2019; 160: 1156–1165.
48.
VowlesKEMcCrackenLMMcLeodCEcclestonC.The chronic pain acceptance questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain2008; 140: 284–291.
49.
EdmondsonDChaudoirSRMillsMA, et al. From shattered assumptions to weakened worldviews: trauma symptoms signal anxiety buffer disruption. J Loss Trauma2011; 16: 358–385.
50.
PyszczynskiTSolomonSGreenbergJ.A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory. Psychol Rev1999; 106: 835–845.
51.
GreenbergJArndtJSchimelJ, et al. Clarifying the function of mortality salience-induced worldview defense: renewed suppression or reduced accessibility of death-related thoughts?J Exp Soc Psychol2001; 37: 70–76.
52.
Edo-GualMMonforte-RoyoCAradilla-HerreroA, et al. Death attitudes and positive coping in Spanish nursing undergraduates: a cross-sectional and correlational study. J Clin Nurs2015; 24: 2429–2438.
53.
OnuDUIfeagwaziCMChukwuorjiJC. Does posttraumatic growth buffer the association between death anxiety and quality of life among people living with HIV/AIDS? J Clin Psychol Med Settings. DOI:10.1007/s10880-020-09708-6
HutaVZuroffDC.Examining mediators of the link between generativity and well-being. J Adult Dev2007; 14: 47–52.
56.
HayesJSchimelJArndtJFaucherEH.A theoretical and empirical review of the death-thought accessibility concept in terror management research. Psychol Bull2010; 136: 699–739.
57.
PincusTMorleyS.Cognitive-processing bias in chronic pain: a review and integration. Psychol Bull2001; 127: 599–617.
