Academic literature on the topic 'Attachment style and chronic pain syndrome'

Abstract Objective. To examine the role of adult attachment style in the daily affective experiences of older adults with physician-confirmed knee osteoarthritis (OA). Methods. As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 292 persons over the age of 50 completed a baseline interview including the Revised Adult Attachment Scale (RAAS; Collins, 1996). Dimensional RAAS attachment scores were coded into the secure, preoccupied, fearful, and dismissing groups (Bartholomew & Horowitz, 1991). Positive affect (PA), negative affect (NA), and pain were assessed using an experience sampling methodology consisting of 4 daily phone calls over 7 days. These analyses used ANCOVAs to examine 28-call means and SDs for PA, NA, and pain. Results. After controlling for demographics, results indicated significant group differences in average PA, NA, and pain. Pairwise comparisons indicated that participants endorsing a stable attachment style reported significantly more PA and less NA than those with a fearful attachment style. Group differences for pain were marginal and less clear cut. Significant differences also emerged for variability of NA and pain. Individuals with a secure attachment style were significantly less variable in NA than those in the fearful and preoccupied groups. For pain variability, the preoccupied group showed more variability than those with secure or dismissive styles. Implications. Results contribute to a growing understanding of how individual attachment style may underlie the day-to-day affective experience of chronic pain. (Supported by R01-AG041655, D. Smith and P. Parmelee, PIs.)

The present study investigated the relationship between attachment style with adjustment and resiliency in chronic pain patients and probable mediating role of resiliency between attachment and adjustment. Adult Attachment Inventory; Depression‚ Anxiety‚ Stress Scale (DASS_21) Resiliency Scale (CS_RISC) and Roland–Morris Disability Questionnaire (RDQ). Data were analyzed using parson’s correlation and regression. Results revealed that avoidant and ambivalent attachment styles negatively correlated with adjustment (positively correlated with depression, anxiety and stress) and positively with resiliency. Secure attachment wasn’t correlated with none of them. Resiliency didn’t mediate the impact of attachment style on adjustment. These findings suggest that insecure attachment style is a vulnerability factor for adjustment with chronic pain and predicts lower resiliency in these patients. Briefly present the conclusions and importance of the results. Concisely summarize the study’s implications. Please do not include any citations in the abstract.

Introduction. One of the total hip arthroplasty complications is a chronic pain syndrome at different time period. Pain occurs inapproximately 27% ofpatients asdiscomfort and 6% - as persistent pain. Material and methods. We analyzed the results of total hip arthroplasty in140 patients with chronic pain syndrome (85 women and 55 men, mean age 53.4±0.5 years), operated in 2013-2016. As a basic diagnostic causes’s criteria we used hip joint X-ray, methods of ultrasound, magnetic resonance imaging and electroneuromyography. All established pathological processes that trigger the pain were divided into X-ray positiveandX-ray negative. Results. The influence of the following trigger factors ofpain was observed: body weight, age and musculoskeletal system state. Thus, the greatest number of complications and development of pain was seen in patients with excessive body weight or obesity. Spinal column pathology in lumbosacral section led to the reduction in the quality of patient life after total hip arthroplasty. Age up to 50 years and active life style promoted various reactions of bone remodeling in the area of implant pressure. Conclusion. The frequency of complications after surgery leading to chronic pain in our study was consistent with global indexes, and in some cases, was lower.

AIM: To investigate the possible contribution of attachment anxiety (AA) to satisfaction with the outcome of surgery. METHODS: Sixty-three patients with chronic sinusitis who were scheduled for FESS with septoplasty were asked to complete a panel of self-report measures assessing attachment style, quality of life, mental health, and degree of facial pain and nasal obstruction. The questionnaires were filled out two weeks before surgery and one month after surgery. One surgeon performed all procedures. RESULTS: Participants were divided into two groups according to AA scores: high anxiety in attachment and low anxiety in attachment. Postoperatively, the group as a whole showed significant improvement in quality of life, positive thoughts and improvement in pain and sinus congestion. The high AA group reported a significantly lower quality of life than the low AA group. There was an inverse correlation between AA and well-being before and after surgery, and between AA and pain amelioration after surgery. A positive correlation was noted between AA and mental distress. CONCLUSIONS: Even a basic personality factor such as AA can significantly impact patient satisfaction with surgery outcome. Surgeons performing surgery should bear in mind that success is partly related to the patient`s mental state and personality.

Using detailed clinical material from her treatment of three patients referred by physiatrist John E. Sarno, for psychological treatment of chronic pain, Dr Anderson illustrates a relationship between dissociated/repressed affect and the development of chronic musculoskeletal back pain. Sarno, conversant with the fundamentals of psychoanalysis, theorised that the somatic pain, which he termed tension myoneural syndrome (TMS), served as a distraction from emotions that were unbearable. That is, the pain served as a psychological defense or survival tactic. In treatment, the adverse impact of overwhelming physical and emotional experiences on attachment and emotion regulation are identified and discussed. Detailed clinical process, which includes the use of trauma treatment techniques, illuminate how psychological treatment can be used to help patients identify and tolerate feelings associated with early life stress, leading to relief from the somatic pain. Anderson, informed by the psychosomatic theories of Krystal and McDougall and by contemporary attachment theorists, advances the position that the physician as diagnostician functions symbolically as the "parent" who links mind and body, thereby reducing the patient's fear of pain and creating a secure attachment bond. In this secure attachment relationship, the physician "authorises" the patient to experience emotions that were previously disavowed. In the relationship with an empathic relational psychoanalyst, the patient's pain resolves as s/he builds a capacity to identify and tolerate emotions and learns how to use emotions, particularly anger, to enhance relationships and improve their quality of life.

<p style="text-align: justify;">The purpose of the work was to study the psychological mechanisms of the formation of an intrapsychic response to chronic back pain. The hypothesis was the assumption that the internal image of the disorder in patients with chronic back pain differs depending on the subjective perception of pain. Operationalization of the internal image of disorder was carried out in accordance with a four-level concept (sensitive, motivational, emotional, and intellectual levels). Psychodiagnostic tools were used: "McGill's Pain Questionnaire (Kastiro I.V., 2012), "Restoration of the locus of control" questionnaire (Belova N.A., 2002), expert assessment of compliance on a five-point scale, "Psychological factors of attitude to illness and treatment" questionnaire (Rasskazova E.I., 2016). In total, 84 patients aged 54.5&plusmn;14.4 years were examined, including 52 (61.9%) women and 32 (38.1%) men who were at the inpatient stage of medical rehabilitation for dorsopathies with moderate chronic pain syndrome. The pain has lasted for 12.9&plusmn;13.4 years. As a result of the study, it was found that the groups of patients with mixed and nociceptive pain differ from each other in the structure of the internal image of the disorder: patients with mixed pain have no relationship between the motivational and emotional levels with the sensitive &ndash; the level of primary processing of sensory information.</p>

Background: Occipital neuralgia is defined as paroxysmal shooting, or stabbing pain in the posterior part of the scalp, in the distribution of the greater and lesser occipital nerves. Occipital neuralgia may present only as an intermittent stabbing pain, but different opinions exist on its cause and diagnostic criteria.Current Concepts: According to the latest version of headache classification, only paroxysmal stabbing pain is included in the diagnostic criteria, and persistent aching pain is excluded. Pain intensity was also limited to severe cases. It has therefore become difficult to classify existing occipital neuralgia, whose main symptom is persistent pain rather than paroxysmal stabbing pain. Occipital neuralgia is classified as either idiopathic or secondary. Secondary occipital neuralgia is caused by structural lesions innervating the trigeminocervical complex (TCC) in the upper spinal cord, the dorsal root of second cervical cord, and the greater occipital nerve (GON).Discussion and Conclusion: Although idiopathic occipital neuralgia has no cause, the entrapment of the GON in the tendinous aponeurotic attachment of the trapezius muscle at the superior nuchal line has recently been proposed as an etiology. Chronic, irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the TCC receiving convergent input from trigeminal and occipital structures. TCC sensitization induces referred pain in the facial trigeminal area.

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Psychology
Full Text

Wound-related pain is complex, integrating the experience of noncyclic acute wound pain, cyclic acute wound pain, and chronic wound pain (Krasner 1995). More than 80% of chronic wound patients report pain during wound dressing change. A constellation of physical and psychological factors may be involved in the mediation of pain during wound dressing change. A burgeoning body of evidence suggests the intricate relationship between anxiety and pain. In this study, the attachment framework was examined to determine how personal views of self (attachment anxiety) and others (attachment avoidance) may affect pain during dressing change. Attachment styles are systematic patterns of expectations, emotional reactivity, strategies for distress management and social behaviour that are based on an individual’s belief about the self and others. Internal working models are cognitive-affective schemas that guide the attachment patterns. Purpose: The purpose of this study was to explore the relationship of attachment style and pain during dressing change in an older population. In particular the study focussed on the role that anxiety, anticipatory self reported pain, and behavioural expression of pain play in this relationships. Method: A questionnaire was used in this cross-sectional study to classify 96 older subjects into four different categories of attachment styles. Subjects were asked to rate their levels of anticipatory pain and actual pain levels at different times during wound care using a numerical rating scale. Results: The results indicated that subjects experienced more pain during dressing change than at baseline. Secure subjects reported less pain and anxiety than subjects with other attachment styles. Results of regression analysis indicated that anxiety mediated the relationship between attachment and pain. Conclusion: The results of this study also support the role that attachment plays in the experience of pain in older adults. Clinicians must be cognizant of the impact of personality, anxiety, and anticipation of pain on the actual pain experience.