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Understanding Behavior and Activity Level Linked with Chronic Pain
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Posted on: 11/30/1999
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People with chronic low back pain often have to learn to live with it because all efforts to get rid of it or control it have failed. Psychologists who study chronic pain patients attempt to understand what's going on in an effort to find better ways to treat pain or help patients manage their chronic pain.
There seem to be two different ways people with chronic low back pain respond to their situation. They either avoid activities that might cause pain or they persist in being extremely active despite their pain. Pain experts suggest these behaviors called avoidance and persistence are the result of self-discrepancy.
Even without pain, you have probably experienced self-discrepancy at times in your life. Some people refer to this as the "split-mind." You perceive yourself one way but think you should be (or think) different. There are several different ways self-discrepancy plays a role in our lives.
There's the actual self or how you really are in your natural state. That is compared with your ideal or perfect self -- the way you would like to be. Then there's the "ought" self (i.e., I ought to be ...you fill in the blank here). And finally, the "feared" self. The feared self is the one you are most afraid of being like or becoming (i.e., becoming someone you do not want to be).
Any of these discrepancies or conflicts can result in emotional distress such as anxiety, depression, and pain. In addition to emotional experiences, the person may develop these other behaviors mentioned earlier (avoidance or persistence).
In this study from the Netherlands, the researchers try to explain avoidance and persistence in terms of self-discrepancy and behaviors designed to "self-regulate" (or change). They proposed that people who engage in "I ought to do or be this way" kind of thinking are more likely to be driven to be their "ideal" or "perfect" self. Their behavior would tend toward persistence. And fear-based behaviors are more likely to result in avoidance.
The 83 patients included all had chronic low back pain lasting at least three months. Anyone who was pregnant or had a known psychologic problem was not allowed to participate. Everyone in the study filled out various surveys and questionnaires designed to measure self-discrepancy. The tools used have been tested and found to be valid, accurate, and reliable measures of ideal, ought, and feared sides of ourselves.
Other factors were measured using surveys specific to depression, anxiety, activity patterns, disability, pain intensity, and health-related quality of life (QOL). All of the survey tools were self-report (patients answering questions about themselves and how they think, feel, and act.
Any good study analyses patient characteristics to see if there are any differences based on age, sex (male versus female), education, or income level. In this study, none of those patient variables had an effect on results. So they turned their attention to their real area of interest: self-discrepancies and emotional and activity patterns.
They found that patients who perceived themselves close to who they wanted to be were happier and less depressed. On the other hand, patients who saw themselves more like the person they didn't want to be or were afraid of becoming had higher levels of anxiety and depression. Patients in the "ought-to-be" category weren't really more depressed than anyone else.
On the behavior side of the equation, there weren't major links between self-discrepancy and patterns of behavior (avoidance or persistence). Avoidance was associated with a lower quality of life and greater disability. The patients who saw themselves as becoming the person they feared or didn't want to be increased their avoidance of activities that might increase pain.
Further analysis of the data did show that people who engage in "ideal-other" thinking are more likely to demonstrate persistence behavior. No matter whether they felt close or far away from what they thought was "ideal" for themselves, they worked hard or demonstrated behaviors referred to as overdoing it.
In terms of working with chronic pain patients, this study makes some interesting points. One is that patient behaviors (whether towards avoidance or overdoing it) have underlying reasons. One of these reasons is the role of self-discrepancy as either a protective or motivating factor. It might be helpful to guide patients to achieve personal goals with an understanding of how emotions and behavior are driven by how patients see themselves.
Persistence behavior doesn't seem to have any negative effect on outcomes, disability, or quality of life. Therefore, it might be best to gear future research efforts around preventing (or stopping) avoidance behaviors. The final outcome may be to improve function, decrease disability, and increase quality of life for people who suffer from chronic pain, especially chronic low back pain.
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References:
Hanne P. J. Kindermans, et al. "Being" in Pain: The Role of Self-Discrepancies in the Emotional Experience and Activity Patterns of Patients With Chronic Low Back Pain. In PAIN. February 2011. Vol. 152. No. 2. Pp. 403-409.
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