Social anxiety and pain-related fear impact each other and aggravate the burden of chronic pain patients: More individually tailored rehabilitation need

Silje Endresen Reme; Harald Breivik

doi:10.1016/j.sjpain.2016.05.033

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Social anxiety and pain-related fear impact each other and aggravate the burden of chronic pain patients: More individually tailored rehabilitation need

Silje Endresen Reme und Harald Breivik

Veröffentlicht/Copyright: 1. Juli 2016

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Aus der Zeitschrift Scandinavian Journal of Pain Band 12 Heft 1

In this issue of the Scandinavian Journal of Pain Matilda Wurm and her co-workers publish a study on the consequences of cooccurrence of social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation [1]. This is the second study from the strong pain research group in Örebro concerning social anxiety, and how social anxiety complicates the situation and increases the burden of suffering in patients with chronic pain [2]. Social anxiety, particularly when severe and disabling, is a significant barrier to the efforts of health care providers trying to relieve pain and reduce pain-interference of psychosocial and physical functions.

The aim of this recent study was to study different patterns of social anxiety and how they influence pain-related fear. Among 180 patients undergoing multimodal pain rehabilitation for musculoskeletal pain conditions they found a subgroup of 30 patients with high scores on the Social Phobia Screening Questionnaire and high pain-related fear of painful movements on the Tampa Scale of Kinesiophobia. This group of patients had higher levels of anxiety vulnerability, negative affect, and higher general emotional symptomatology.

1 Individually tailored treatment for chronic pain patients with high social anxiety

Clearly, patients with chronic pain who in addition struggle with social anxiety and pain-related fear need better individually tailored efforts by the helpers, as they do not appear to benefit from group therapies in a multimodal pain rehabilitation programme [1,2,3]. Despite a modest reduction in symptoms and disability at post-treatment follow-ups, all subgroups except the social anxiety and pain-related fear group showed statistically significant improvements. Although the study design to some extent limits interpretation of results, the study findings still generates important hypotheses that should be followed up in future studies.

2 Social anxiety in pain patients also impedes return-to-work efforts

In the recently published study on social anxiety in pain patients interested in returning to work [2] similar results implicate fears of pain-related social situations at work as important hindrances in the efforts of returning chronic pain patients to their work environment [2,3].

3 Addressing the social anxiety directly in future studies

Although we do not know exactly how long treatment the patients did receive in this particular study [1], we know that a multimodal pain treatment in groups of patients does not appear to be effective at all for them. Whereas the Wurm and co-worker study needs to be replicated in larger studies, such studies should include known effective treatments for specific anxiety disorders such as social anxiety [4]. Addressing the problem of social anxiety directly through a well-documented approach, should be a promising avenue for future treatment studies.

4 Social anxiety in chronic pain patients should be studied with qualitative methodology

The authors also suggest another path for future research following from their study [1], namely qualitative studies to entangle the individuals’ experiences, and from that perspective try to understand better what is going on in this subgroup of patients; what are their experiences and why do they not respond to treatment that other pain patients benefit from. Qualitative studies have more than once provided researchers with answers that they could not have imagined or come up with themselves. This particular suggestion for a future follow-up study thus appears to be a wise path to follow.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.03.006.

Oslo University Hospital, Department of Pain Management and Research, Pbox 4950 Nydalen, 0424 Oslo, Norway. Tel.: +47 23073691

Conflict of interest: None declared.

References

[1] Wurm M, Edlund S, Tillfors M, Boersma K. Characteristics and consequences of the co-occurrence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment. Scand J Pain 2016;12:45-52.Suche in Google Scholar

[2] Thomtèn J, Boersma K, Flink IK, Tillfors M. Social anxiety, pain catastrophizing and return-to-work self-efficacy in chronic pain: a cross-sectional study. Scand J Pain 2016;11:98-103.Suche in Google Scholar

[3] Børsting Jacobsen H, Endresen Reme S. The role of social anxiety in chronic pain and the return-to-work process. ScandJ Pain 2016;11:153-4.Suche in Google Scholar

[4] NICE Guidelines. Social anxiety disorder: recognition, assessment and treatment. London: National Institute for Health and Care Excellence, Clinical Guideline; 2013. nice.org.uk/guidance/cg159Suche in Google Scholar

Published Online: 2016-07-01

Published in Print: 2016-07-01

Artikel in diesem Heft

https://doi.org/10.1016/j.sjpain.2016.05.033