Alexithymia and depression in the recovery of chronic pain patients: a follow-up study

Background: Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare.

Aims: The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied.

Methods: The baseline data was collected from chronic pain patients (n?=?154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided.

Results: At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome.

Conclusions: Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.     

Determinants and impact of alexithymia on quality of life in Parkinson's disease

IntroductionAlexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease.MethodsSubjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model.Results98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p < 0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL.ConclusionsAlexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.     

Relation entre alexithymie et impulsivité dans un échantillon d’adolescents scolarisés de la région de Sfax,Tunisie

ObjectivesThe study of alexithymia in adolescence seems particularly interesting for various reasons. First, physical, psychological and social changes create new experiences of emotional reactivation. Second, the adolescent period coincides with the maturation of the hormonal, neuronal, and cognitive systems that underlie the development of emotional regulation. Finally, evidence suggests that alexithymia may have detrimental consequences in adolescents, including substance use disorders, depression, anxiety, behavioral disorders and self-injury. Also, alexithymia is associated with impulsivity because of a deficit in the cognitive processing of emotions with tendencies to act rather than talking about feelings. The purpose of the current study is to estimate the prevalence of alexithymia in a sample of school-aged adolescents in the Sfax region (Tunisia) and to evaluate its links with impulsivity.Materials and methodsCross-sectional study involving 474 students from public institutions in the Sfax region. Participants completed, after consent, an epidemiological fact sheet, the Toronto Alexithymia Scale (TAS-20) and the Barratt Impulsiveness Scale (BIS-11).ResultsThe average age of the students was 14.77 ± 1.75 years with extremes ranging from 13 to 18 years old. The sex ratio was 0.96. The prevalence of alexithymia was 35.86% and that of impulsivity 39%. The analytical study showed that alexithymic adolescents had a higher degree of impulsivity (27.4% vs 11.8%, p = 0.001) with a positive correlation between TAS20 and Barratt scores (p < 10⁻³ ; r = 0,33).ConclusionOur study shows that alexithymia is common in our adolescents and is associated with impulsivity. The prevention of alexithymia seems essential to reduce the frequency of impulsive behavior.     

Does alexithymia expose to mental disorder symptoms in late adolescence? A 4-year follow-up study

ObjectiveTo investigate the possible causal link between alexithymia and the emergence of anxiety and depression symptoms, as well as alcohol consumption in a sample of late adolescents.MethodThe nonclinical sample comprised late adolescents (n= 315), including both females (n= 256) and males (n= 59). The follow-up period was 4 years, and at baseline, the mean age of the subjects was 19 years (range 17−21 years). Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), depression symptoms with the short form of the Beck Depression Inventory (RBDI), anxiety with the State-Trait Anxiety Inventory (STAI) and alcohol consumption with the Alcohol Use Disorders Identification Test (AUDIT). The three TAS-20 subscales were assessed separately. Linear and cumulative logistic regression analyses were used for the evaluation of associations, and the analyses were adjusted with the corresponding baseline scores.ResultsThe TAS-20 total and subscale scores did not predict the RBDI or AUDIT scores at follow-up. However, the TAS-20 subscale “difficulty identifying feelings” was significantly associated with both STAI-State (P= .007) and STAI-Trait (P= .004) scores at follow-up.ConclusionsAlexithymic features may be individual predictors of later anxiety symptoms. The significant differences between the various dimensions of alexithymia should be considered in future studies.     

The match-mismatch model of emotion processing styles and emotion regulation strategies in fibromyalgia

ObjectiveIndividuals differ in their style of processing emotions (e.g., experiencing affects intensely or being alexithymic) and their strategy of regulating emotions (e.g., expressing or reappraising). A match–mismatch model of emotion processing styles and emotion regulation strategies is proposed and tested. This model specifies that for people high on affect intensity, emotion expression is more adaptive than reappraisal, whereas for alexithymic people, reappraisal is more adaptive than expression. The present study tested this model in 403 women with fibromyalgia (mean age 46.5 ± 12.3 years).MethodsIn a cross-sectional design, we assessed affect intensity (Berkeley Expressivity Questionnaire), alexithymia (Toronto Alexithymia Scale-20), cognitive reappraisal (Emotion Regulation Questionnaire), and emotion expression (Emotional Approach Coping Scales), as well as the impact of fibromyalgia (Fibromyalgia Impact Questionnaire).ResultsMultiple regression analyses with interaction terms indicated that among people high on affect intensity, emotion expression – but not cognitive reappraisal – was associated with less fibromyalgia impact. No support was found for the hypothesis that among alexithymic people, cognitive reappraisal would be more adaptive than emotion expression.ConclusionFindings suggest that for women with fibromyalgia who experience their emotions intensely, an emotional disclosure or expression intervention may be beneficial. This hypothesis requires verification in experimental studies.     

Characterization of alexithymia in clinically isolated syndrome

BackgroundIn multiple sclerosis (MS), the prevalence of alexithymia, defined as an inability to identify and describe emotions, is close to 50% but the prevalence of this symptom in clinically isolated syndrome (CIS) is unknown. Characterizing alexithymia at an early stage of the disease can help to clarify psychobehavioural disturbances in CIS patients.MethodsForty CIS patients, who fulfilled the MRI criteria for dissemination in space, were matched with 40 healthy subjects. They completed self-assessment scales for alexithymia, depression, anxiety, apathy and empathy. Cognitive functions were assessed using a battery of neuropsychological tests.ResultsThe mean delay (± standard deviation) between the occurrence of CIS and inclusion in the study was 3.9 (2.8) months. The frequency of alexithymia was higher in CIS patients than in controls, with a prevalence of 42% (P < 0.0001). Alexithymia correlated with anxiety and depression but not with cognition. Alexithymia was dependent only on depression (P = 0.003).ConclusionAlexithymia, characterized by difficulty identifying feelings, is present in patients in the early stage of MS, and seems to be strongly associated with depression. Difficulty in social interaction could be a risk of future affective disorders.     

Alexithymia in adolescents with borderline personality disorder

ObjectiveThe aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.MethodsThe study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N = 140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.ResultsThe ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.LimitationsSince BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.ConclusionsBPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.     

Tolérance à la détresse et expérience de la douleur chronique

IntroductionChronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities.AimsThe first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities.MethodThis is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale.ResultsEighty participants were recruited (57 % women, mean age = 33.09; standard deviation = 12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß = ?0.04; 95% CI): ?0.07–?0.01; t (78) = ?3.06, p < 0.01) or pain interference in everyday functioning (ß = ?0.07; 95% CI: ?0.10–?0.03; t (78) = ?3.97, p < 0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity.ConclusionTolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.     

How can the Alexithymia and Behavioural Inhibition predict the perceived pain intensity in patients with chronic pain?

ObjectiveThis study investigates the mediating role of behavioral inhibition system in the relationship between alexithymia and perceived pain intensity in patients with chronic pain, and the moderating role of anxiety in the relationship between behavioral inhibition system and the perceived pain intensity in such patients.MethodsThe research was conducted on 440 patients with chronic pain who were referred to pain centers in Tehran. Participants were asked to answer Toronto Alexithymia Scale (TAS-20), The Inhibition/Activation System Scale (BIS/BAS), Numerical Rating Scale (NRS) for perceived pain intensity, and Depression, Anxiety, and Stress Scale (DASS).ResultsThe results indicated that behavioral inhibition system plays a mediating role in the relationship between alexithymia and perceived pain intensity in patients with chronic pain. Anxiety plays a moderating role in the relationship between the behavioral inhibition system and perceived pain intensity, as well.ConclusionThe relationship between alexithymia and the perceived pain intensity is not a simple linear one, but is mediated by behavioral inhibition system. Also, anxiety determines the effect of the behavioral inhibition system on the perceived pain intensity of the patients.     

Alexithymia in chronic pain patients

Prior studies of alexithymia in chronic pain patients have used unvalidated alexithymia measures or have not controlled for treatment-seeking status. In this study, we compared 30 patients with chronic pain and patients seeking treatment for two other problems: nicotine dependence (n = 32) or moderate obesity (n = 25). Alexithymia was assessed with the well-validated Toronto Alexithymia Scale (TAS) and also with the Alexithymia Provoked Response Questionnaire (APRQ). On both alexithymia measures, chronic pain patients were more alexithymic than nicotine dependent and obese patients; the latter two groups did not differ. Chronic pain patients had greater psychopathology on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and both alexithymia measures correlated positively with certain types of psychopathology. We conclude that alexithymia is increased among patients with chronic pain, that this relationship is not confounded by a treatment-seeking bias, and that alexithymia may contribute to both chronic pain and psychopathology.     

Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures

ObjectiveThe first objective of this study was to determine the prevalence rate of alexithymia (dysregulation and unawareness of emotion) in patients with psychogenic non-epileptic seizures (PNESs) and epileptic seizures (ESs). The second objective was to identify the predictors of alexithymia in patients with PNESs.MethodsWe studied 66 consecutive patients with PNESs and 35 patients with ESs with the Toronto Alexithymia Scale-20. The prevalence of alexithymia was determined in both groups. In order to identify the risk factors of alexithymia in PNES, the Trauma Symptom Inventory-II (TSI-II), the MMPI 2-RF, a clinical history, and demographic variables were studied.ResultsOur study revealed a prevalence of alexithymia in PNES and ES of 36.9% and 28.6%, respectively (not a significant difference). Upon examining the group with PNES, we found a significant correlation between alexithymia and Anxious Arousal (r = .497, p < .000), Intrusive Experiences (r = .541, p < .000), Dissociation (r = .421, p < .001), and Defensive Avoidance (r = .444, p < .000) from the TSI-II. Minnesota Multiphasic Personality Inventory-2-RF RCd (r = .512, p < .000), RC1 (r = .346, p < .017), RC2 (r = .355, p < .017), RC3 (r = .467, p < .001), and EID (r = .567, p < .000) also correlated significantly with alexithymia. However, stepwise regression analysis only retained Intrusive Experiences and Defensive Avoidance from the TSI-II and the cynicism RC3 scale from the MMPI 2-RF.ConclusionSymptoms of psychological trauma and cynicism in patients diagnosed with PNESs were associated with alexithymia. These findings are encouraging, as they assist in better understanding the condition and in treatment design for this subset of patients.     

Factores predictores de la calidad del sueño en pacientes con migraña crónica

IntroductionOne of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality.MethodsA total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires.ResultsA direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036).ConclusionsThe predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.     

L’efficacité thérapeutique du Montage Composite Réceptif à visée Projective (MCR-P) contre la dépression en psychiatrie

ObjectivesThe Receptive Projective Composite Montage (RPCM) is a short-term therapy associating musicotherapy and clinical psychology in order to improve the psychiatric treatment of depression. This study aims at showing the therapeutic efficiency of the RPCM on depression and anxiety symptoms and on the in-patient's alexithymia level. Furthermore, this study explores the explanatory processes of the therapeutic effects in order to bring an additional dimension to this approach.MethodThe sample consists of 23 patients diagnosed with depression, aged between 27 and 73 (average age = 49.91 ± 10.47) who receive psychiatric treatment. Participants have been categorized into two experimental groups: the therapeutic group who received 3 sessions of RPCM (n = 13) and the control group who received psychiatric treatment only (n = 10). These two groups allowed us to achieve a test re-test method over three weeks with a comparative group. The evaluation tools are the Beck's Depression Inventory (BDI) for the evaluation of depression, the Hospital Anxiety and Depression Scale (HADS) for the anxiety level and the Toronto Alexithymia Scales-20 (TAS) for the alexithymia level.ResultsOver a three-week therapy with the RPCM, in-patients from the therapeutic group have a significantly lower level of depression, anxiety and alexithymia after therapeutic process (P = .002; P = .001 and P = .009 respectively). Moreover, depression scores of experimentals groups are significantly different during second evaluation (P = .006). Finally, therapeutic group depression and anxiety scores have a medium effect size (d = .5).Discussion and conclusionWith these results, the RPCM seem to be a tool with beneficial effects on the in-patient's symptomatology of depression. The RPCM can be used as a support technique in order to maximize the treatment of depression. We recommend using a minima three RPCM section at the start of internment by a trained therapist. More experimental and complementary studies are necessary to confirm these results.     

Multiple sclerosis relapses and depression

ObjectiveThe expression of clinically significant depression symptoms during and post multiple sclerosis (MS) relapse was investigated. The point prevalence of possible depression during a confirmed MS relapse and at 2 and 6 months post-relapse was examined and the influence of disability on the time course of depression symptoms post-relapse determined.Methods132 sequential patients were recruited from an open access relapse clinic. Clinical data including disability (Expanded Disability Status Scale: EDSS) and depression symptoms (Hospital Anxiety and Depression Scale depression subscale: HADS-D) were recorded at 0, 2 and 6 months post-relapse.ResultsPrevalence of possible depression (HADS-D score of ≥ 8) was 44.5% during relapse, reducing to 29.2% at 2 months and 34.4% at 6 months post-relapse. HADS-D scores were significantly lower at follow-up than during relapse. Possible depression at relapse was significantly related to a higher likelihood of possible depression at 2 month follow-up (OR 12.12) and improvement in EDSS was related to a lower likelihood (OR 0.51). EDSS at relapse (OR 1.47) and possible depression at relapse (OR 11.87) were significantly associated with possible depression 6 months post-relapse.ConclusionsHigh rates of possible depression were observed during relapse. Although depression scores reduced significantly post-relapse, rates of possible depression at follow-ups remained high. The results suggest that although improvements in disability may influence depression symptoms over the short-term, once depression symptoms are elevated at relapse then depression symptoms become persistent. Further studies are required on the relationship between relapses and depression and whether targeted psychological interventions are beneficial.     

Relationship between insomnia and pain in major depressive disorder: A sleep diary and actigraphy study

ObjectivesInsomnia and pain are frequent complaints during the course of a major depressive episode. We analyzed the association between insomnia and pain symptoms using subjective and objective sleep measures.MethodsThis is a prospective, naturalistic follow-up study in a university-based psychiatric unit. Ninety-one Chinese patients were enrolled during an acute episode of major depressive disorder (mean age = 48 years, 73 women); 82 of them were reassessed 3 months later using the same assessment on sleep, pain, depressive, and anxiety symptoms. Clinician-rated insomnia symptoms were obtained using the insomnia items of the Hamilton Rating Scale for Depression. Subjective sleep disturbances were assessed using the Insomnia Severity Index (ISI). Detailed sleep pattern was acquired using sleep diary and actigraphy. Pain intensity was evaluated using a verbal rating scale, a visual analog scale, and a multidimensional pain scale.ResultsCross-sectional analyses found that insomnia symptoms and quantitative sleep parameters were related to pain symptoms. The correlations between sleep and pain scores were more significant after 3 months of pharmacotherapy as compared to baseline. After controlling for the severity of anxiety and depression, the ISI total score and actigraphy-derived wake after sleep onset and total sleep time remained significant in predicting pain.ConclusionThis study supports specific role of subjective sleep disturbances and actigraphic measures in predicting pain symptoms in major depressive disorder. Further studies using a micro-longitudinal design are necessary to find out the causal relationship between sleep and pain in depressed patients.     

Pensamiento catastrófico ante el dolor: presencia en una población de migrañosos

IntroductionCatastrophic thought refers to a negative cognitive and emotional response to pain, and is thought to contribute to pain chronification. We aimed to evaluate pain catastrophising PC in a population of patients with migraine.MethodsWe collected sociodemographic data and clinical data on migraine from patients attended at a tertiary hospital headache unit between January and June 2015. PC was measured with the Spanish-language version of the Pain Catastrophizing Scale (PCS). We compared presence of PC in patients with episodic and chronic migraine, and its correlation with clinical impact (measured by the Headache Impact Test-6 [HIT-6] scale), comorbid depression and anxiety (measured with the Hospital Anxiety and Depression Scale [HADS]), and the presence of medication overuse.ResultsThe study included 96 patients (16 men and 80 women); 67 (69.8%) were diagnosed with chronic migraine and 29 (30.2%) with episodic migraine. Migraine impact was at least moderate (HIT-6 ≥ 56) in 85.4% of cases, and 24% exceeded the cut-off point for anxiety and 9.4% for depression. A total of 34.4% presented PC. Patients with chronic migraine scored higher than those with episodic symptoms on the HADS for anxiety (P < .001) and depression (P < .001) and on the HIT-6 (P < .001).ConclusionsPC is common among patients with migraine. It is related to migraine severity and to comorbid anxiety and depression. PC does not appear to increase the likelihood of migraine chronification or medication overuse.     

The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain

Study objectivesTo assess the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with non-malignant chronic pain.MethodsTwenty-eight subjects with chronic neck and back pain were stratified according to gender, age, and ethnicity, then assigned to one of the two treatment groups: CBT-I or a contact control condition.InterventionEight weeks of CBT-I including sleep restriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia.Measurements and resultsOutcomes included sleep diary assessments of sleep continuity, pre–post measures of insomnia severity (ISI), pain (Multidimensional Pain Inventory), and mood (BDI and POMS). Subjects receiving CBT-I (n = 19), as compared to control subjects (n = 9), exhibited significant decreases in sleep latency, wake after sleep onset, number of awakenings, and significant increase in sleep efficiency. The diary findings were paralleled by significant changes in the ISI (p = 0.05). Significant improvement (p = 0.03) was found on the Interference Scale of the Multidimensional Pain Inventory. The groups did not significantly differ on mood measures or measures of pain severity.ConclusionsCBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.     

A hypothetical model of pain perception in patients with chronic pain: The predictive role of unconscious,emotional, behavioral and meta-cognitive factors

ObjectiveChronic pain has a great prevalence in the society of adults, which causes important problems for health and quality of life. The present study aims to investigate a hypothetical model of pain perception in patients with chronic pain, considering the role of unconscious, emotional, behavioral and meta-cognitive factors.MethodsA total of 391 patients (155 males, 236 females) who referred to the pain centers in Tehran suffering from chronic musculoskeletal pain, participated in the study. Participants were asked to complete the Defense Style Questionnaire (DSQ-40), Toronto Alexithymia Scale (TAS-20), The Inhibition/Activation System Scale (BIS/BAS), Meta-Cognitions Questionnaire (MCQ-30), and Numeric Rating Scale (NRS).ResultsThe results revealed that the model could anticipate the intensity of pain in patients with chronic pain. Immature defence style, behavioral inhibition system, alexithymia, and meta-cognitive beliefs predicted the intensity of pain in patients with chronic pain.ConclusionEvaluation of results indicated that the perception of the intensity of pain in patients with chronic pain is affected by unconscious, emotional, behavioral and meta-cognitive factors.     

A hypothetical model of pain perception in patients with chronic pain: The predictive role of unconscious,emotional, behavioral and meta-cognitive factors

ObjectiveChronic pain has a great prevalence in the society of adults which causes important problems for health and quality of life. The present study aims to investigate a hypothetical model of pain perception in patients with chronic pain, considering the role of unconscious, emotional, behavioral and meta-cognitive factors.MethodsA total of 391 patients (155 males, 236 females) who referred to the pain centers in Tehran suffering from chronic musculoskeletal pain, participated in the study. Participants were asked to complete the Defense Style Questionnaire (DSQ-40), Toronto Alexithymia Scale (TAS-20), The Inhibition/Activation System Scale (BIS/BAS), Meta-Cognitions Questionnaire (MCQ-30), and Numeric Rating Scale (NRS).ResultsThe results revealed that the model could anticipate the intensity of pain in patients with chronic pain. Immature defense style, behavioral inhibition system, alexithymia, and meta-cognitive beliefs predicted the intensity of pain in patients with chronic pain.ConclusionEvaluation of results indicated that the perception of the intensity of pain in patients with chronic pain, is affected by unconscious, emotional, behavioral and meta-cognitive factors.