Abstract
BackgroundAttachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study.Methods85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression.ResultsPatients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns.ConclusionsOur results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.
Highlights
Psychosocial factors in chronic painThe experience of chronic pain is multifactorial, and neither merely biologically determined nor a purely psychogenic phenomenon
Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the unexplained musculoskeletal pain (UMP) group
Our results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis
Summary
Psychosocial factors in chronic painThe experience of chronic pain is multifactorial, and neither merely biologically determined nor a purely psychogenic phenomenon. Current models conceptualize chronic pain as resulting from complex interactions between biological and psychosocial factors [1]. Personal characteristics such as beliefs about the meaning of bodily sensations or about self-efficacy affect the way patients perceive or cope with pain, and thereby influence the course of pain-related disease. Attachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. Few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study
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