The \u201cself\u201d in pain: high levels of schema-enmeshment worsen fibromyalgia impact

Myrella Paschali,Asimina Lazaridou,Arvina Grahl,Marco Loggia,Robert R Edwards,Michael Berry,Vitaly Napadow,Eric S Vilsmark,Alessandra Anzolin,Jeungchan Lee

doi:10.1186/s12891-021-04740-5

Abstract

ObjectiveChronic pain can have detrimental effects on quality of life and a profound impact on one’s identity. The Pictorial Representation of Illness- and Self-Measure (PRISM), is a visual tool designed to measure the self-illness separation (SIS) that represents the degree of schema-enmeshment (i.e., the degree to which the self-schema and the illness-schema come to overlap). Our aim was to investigate the relationship between schema-enmeshment and pain-related outcomes in patients with fibromyalgia.MethodsIn this cross-sectional study, 114 patients with fibromyalgia completed self-report assessments of pain catastrophizing, pain severity and interference, impact of symptoms, anxiety, and depression. SIS was assessed using an iPad version of PRISM. Mediation analyses evaluated the mediating role of schema-enmeshment on the association between pain catastrophizing and fibromyalgia impact.ResultsA higher degree of schema-enmeshment was associated with greater pain catastrophizing, pain severity and interference, impact of symptoms, and depression. Moreover, a mediation analysis revealed that schema-enmeshment significantly mediated the association between pain catastrophizing and fibromyalgia impact (p < 0.001).ConclusionsOur results indicate that schema-enmeshment is associated with greater intrusiveness of chronic pain on everyday life, thereby posing significant limitations on the emotional and physical well-being of fibromyalgia patients. Schema-enmeshment also appears to partly account for the deleterious effect of pain catastrophizing on disease impact. The PRISM is a simple tool that may uniquely capture the extent to which chronic pain and illness infiltrates and affects one’s self-concept.

Highlights

Chronic pain can substantially interfere with quality of life and daily functioning [1, 2] and is strongly associated with depression, anxiety, fatigue, and suffering [3,4,5,6]
The present study uses a novel diagnostic instrument, a fairly large clinical sample, and formal mediation analysis to explore the role of schema-enmeshment among patients with fibromyalgia
Our results illustrate that the Pictorial Representation of Illness and Self-Measure (PRISM) can serve as a unique tool capturing the extent to which chronic pain and illness infiltrates and affects one’s self-concept

Summary

Introduction

Chronic pain can substantially interfere with quality of life and daily functioning [1, 2] and is strongly associated with depression, anxiety, fatigue, and suffering [3,4,5,6]. The degree of schema-enmeshment (i.e., the degree to which the self-schema and the illness-schema come to overlap, such that the one’s identity is defined by illness) is thought to partly determine the emotional adjustment to chronic pain [9]. Determining how to measure the impact of chronic pain on the self can be challenging, as the notion of “self ” is an abstract, subjective experience. Burden of suffering is defined as “a state of severe distress associated with events that threaten the intactness of the person” [12]. This term encompasses physical aspects of illness, and the illness’s psychological effects and the extent to which it impedes a patient’s daily life and relationships. The PRISM measures the self-illness-separation (SIS) [8, 11] which quantifies the schema-enmeshment between self and illness and is equivalent to the degree to which the illness defines, intrudes upon, or threatens the sense of self [9, 13]

Methods

Results

Discussion

Conclusion