Editorial comment on Helen Richardson’s and Stephen Morley’s study on “Action identification and meaning in life in chronic pain”
-
Katja Boersma
und
Steven J. Linton
In this issue of the Scandinavian Journal of Pain, Helen Richardson and Stephen Morley report on a thought provoking study investigating the utility of a new concept in the context of chronic pain called ‘action identification’ [1]. The concept of action identification is of a cognitive nature and refers to the variation in level of abstraction with which individuals prefer to describe their daily activities. The idea is that there is individual variation in the degree to which people prefer to describe their daily activities varying from concrete and void of meaning to abstract and related to meaningful life goals. The hypothesis being entertained by Richardson and Morley is that, in chronic pain patients, this level of abstraction may have been negatively influenced by pain interference and could partly explain the experience of a lack of meaningfulness in life. Their study is basic and combines the construction of a questionnaire to measure the construct, relevant to patients suffering pain, with a preliminary test of the premises of its underlying theory ‘action identification theory’. Basic relationships between the measure of action identification and pain intensity, pain interference, depression, acceptance and optimism are investigated. They find that the measure fulfilled basic psychometric requirements of content validity and reliability. They further find that this new measure is related to a sense of meaning in life as well as optimism. This study conveys the message that the concept of action identification and its related theory may be a helpful addition to explain the intricate relationship between pain interference, goal pursuit, and wellbeing in chronic pain patients.
Chronic pain can seriously interrupt patients’ daily activities and obstruct the pursuit of life goals that are considered meaningful. Being confronted with chronic pain taxes coping abilities. It requires chronic pain patients to make adjustments in their goal setting, on a day to day basis, as well as on a more abstract and overarching level of what is valued in life, and strived for, and how this may be achieved. The flexibility with which patients adapt their goal setting varies greatly from person to person and has been the subject of much debate and study. It is well known that people react very differently to discrepancies in current and desired outcomes, on a cognitive, emotional as well as a behavioural level [2]. A question that remains important is how to describe and explain these individual differences and how to help pain patients who are stuck with resolving coping problems.
Some theoretical models have been very helpful in explaining and dealing with how patients cope with meaning in life. For example, the fear avoidance model and the misdirected problem solving model outline the mechanisms of fear and worry in the development of disability and emotional distress [3,4], and provide a path for intervention [5,6]. However, there is still a lot of room for improvement and a need for new ideas on how to understand the variability in the adjustment that chronic pain patients display. Recent promising developments revisit influential coping models and highlight concepts that can be summarized under the overarching umbrella of self-regulation theories [7,8]. These theories focus on ‘how’ and ‘when’, rather than ‘what’ people are thinking, feeling and doing. These theories highlight, for example, ‘level of construal’ of thoughts as a new and potentially important aspect of cognitive processing and behavioural adjustment. Level of construal refers to whether thinking patterns are concrete and specific, or whether they are abstract and generalized. There is evidence that it is adaptive, not in the least in novel or difficult situations, to shift mental problem solving and behavioural action to a concrete and procedural level [8]. Not doing so leads to increases in the risk for negative mood and pervasive rumination. As described in a recent article, pain catastrophizing can be seen as such a form of thinking that is overly abstract, and inflexibly related to goal pursuit [9].
However, in order to experience meaning and purpose in life, it is also pivotal to have broad and abstract guiding principles and valued direction. This has been shown to be related to behavioural consistency and stability as well as positive emotion [8]. This highlights a second potentially important aspect of cognitive processing, namely ‘context sensitivity’ [10]. It suggests that the inflexibility of the level in which actions are cognitively construed across time and situations, whether it is overly concrete, or overly abstract, may be importantly related to emotional and behavioural adjustment. In essence the concept of context sensitivity suggests that successful adaptation not only requires a repertoire of regulation strategies but also a sensitivity to when the context may require change of approach as important aspects of successful adaptation [7]. Therefore, it may be that chronic pain patients who display problems in adjustment to chronic pain have problems with self-regulatory flexibility [11,12]. This means that the problem with adjustment to pain may not be that pain patients have and apply ‘maladaptive’ strategies per se but rather that they apply their strategies inflexibly across time and situations.
Richardson and Morley take an important first step in delineating ‘how’ pain patients think by developing a novel measure to assess on what level of abstraction patients prefer to describe daily activities. Their study is one example of an effort to explicate how these regulatory processes may work on a cognitive and behavioural level. In Richardson and Morley’s study, the focus is on how daily activities are construed where concrete description are thought to contain less meaning while more abstract descriptions are thought to be more related to purpose and direction. This then, may interact with the interference that pain may cause on these action and possibly lead to a decreased sense of meaning and a subsequent problem in adjustment. The application of these new theoretical ideas to chronic pain is helpful in order to develop ideas that further our understanding of why some pain patients get stuck, and more importantly how we may help patients develop a sense of purpose and direction in the context of chronic pain.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2015.04.024.
-
Conflict of interest: None declared.
References
[1] Richardson H, Morley S. Action Identification and meaning in life in chronic pain. Scand J Pain 2015;9:1–10.Suche in Google Scholar
[2] Morley S. Psychology of pain. Br J Anaesth 2008;101:25–31.Suche in Google Scholar
[3] Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317–32.Suche in Google Scholar
[4] Eccleston C, Crombez G. Worry and chronic pain: a misdirected problem solving model. Pain 2007;132:233–6.Suche in Google Scholar
[5] Linton SJ, Boersma K, Traczyk M, Shaw W, Nicholas M. Early workplace communication and problem solving to prevent back disability: results of arandomized controlledtrial among high-risk workers and their supervisors. J Occup Rehabil 2015, http://dx.doi.org/10.1007/s10926–015-9596-z.Suche in Google Scholar
[6] Vlaeyen JWS, Morley SJ, Linton SJ, Boersma K, de Jong J. Pain-related fear: exposure based treatment for chronic pain. Seattle, WA: IASP Press; 2012.Suche in Google Scholar
[7] Bonanno GA, Burton CL. Regulatory flexibility: an individual differences perspective on coping and emotion regulation. Perspect Psychol Sci 2013;8:591–612.Suche in Google Scholar
[8] Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull 2008;134:163.Suche in Google Scholar
[9] Flink I, Boersma K, Linton SJ. Pain catastrophizing as repetitive negative thinking: a development of the conceptualization. Cogn Behav Ther 2013;42: 215–23.Suche in Google Scholar
[10] Linton SJ. A transdiagnostic approach to pain and emotion. J Appl Biobehav Res 2013;18:82–103.Suche in Google Scholar
[11] McCracken LM, Morley S. The psychological inflexibility model: a basis for integration and progress in psychological approaches in pain management. J Pain 2014;15:221–34.Suche in Google Scholar
[12] Van Damme S, Kindermans H. A self-regulation perspective on avoidance and persistence behavior in chronic pain: new theories, new challenges? Clin J Pain 2015;31:115–22.Suche in Google Scholar
© 2015 Scandinavian Association for the Study of Pain
Artikel in diesem Heft
- Editorial comment
- Editorial comment on Helen Richardson’s and Stephen Morley’s study on “Action identification and meaning in life in chronic pain”
- Original experimental
- Action identification and meaning in life in chronic pain
- Editorial comment
- Editorial comment on Karlsson et al. “Cognitive behavior therapy in women with fibromyalgia. A randomized clinical trial”
- Clinical pain research
- Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial
- Editorial comment
- Assessing insomnia in pain – Can short be good?
- Observational study
- The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients
- Editorial comment
- Reliability of pressure pain threshold testing (PPT) in healthy pain free young adults
- Observational study
- Reliability of pressure pain threshold testing in healthy pain free young adults
- Editorial comment
- Qualitative research in complex regional pain syndrome (CRPS)
- Topical review
- Building the evidence for CRPS research from a lived experience perspective
- Editorial comment
- Complex role of peroxisome proliferator activator receptors (PPARs) in nociception
- Original experimental
- Systemic administration of WY-14643, a selective synthetic agonist of peroxisome proliferator activator receptor-alpha, alters spinal neuronal firing in a rodent model of neuropathic pain
- Editorial comment
- Evaluation of pain in children with communication difficulties: r-FLACC translated and validated in Nordic languages
- Clinical pain research
- Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score
- Clinical pain research
- The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy
- Editorial comment
- Coping with painful sex – A neglected female problem
- Clinical pain research
- Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale
- Original experimental
- Spatial summation of thermal stimuli assessed by a standardized, randomized, single-blinded technique
Artikel in diesem Heft
- Editorial comment
- Editorial comment on Helen Richardson’s and Stephen Morley’s study on “Action identification and meaning in life in chronic pain”
- Original experimental
- Action identification and meaning in life in chronic pain
- Editorial comment
- Editorial comment on Karlsson et al. “Cognitive behavior therapy in women with fibromyalgia. A randomized clinical trial”
- Clinical pain research
- Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial
- Editorial comment
- Assessing insomnia in pain – Can short be good?
- Observational study
- The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients
- Editorial comment
- Reliability of pressure pain threshold testing (PPT) in healthy pain free young adults
- Observational study
- Reliability of pressure pain threshold testing in healthy pain free young adults
- Editorial comment
- Qualitative research in complex regional pain syndrome (CRPS)
- Topical review
- Building the evidence for CRPS research from a lived experience perspective
- Editorial comment
- Complex role of peroxisome proliferator activator receptors (PPARs) in nociception
- Original experimental
- Systemic administration of WY-14643, a selective synthetic agonist of peroxisome proliferator activator receptor-alpha, alters spinal neuronal firing in a rodent model of neuropathic pain
- Editorial comment
- Evaluation of pain in children with communication difficulties: r-FLACC translated and validated in Nordic languages
- Clinical pain research
- Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score
- Clinical pain research
- The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy
- Editorial comment
- Coping with painful sex – A neglected female problem
- Clinical pain research
- Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale
- Original experimental
- Spatial summation of thermal stimuli assessed by a standardized, randomized, single-blinded technique
