Sense of self, social functioning and response to multidisciplinary treatment for chronic pain

Abstract

The quality of relationships with others is important to how people adjust to and live with chronic pain. Often persistent pain can interfere with interpersonal relationships, which can lead to distress in chronic pain populations. Evidence has suggested that a sense of social disconnection and perceived burden are important to overall distress in people with chronic pain. Other factors may be related to a sense of disconnection and burden, including attachment and partners' responses to pain. However, how these constructs relate to each other and the potential effect of all these factors on the response to multidisciplinary treatment has received little attention. Existing research on interpersonal factors in chronic pain often focuses on one or two of the aforementioned factors in isolation. This thesis includes a narrative literature review which aimed to evaluate current understandings of interpersonal processes in chronic pain (Chapter 2) followed by three empirical studies. These were a qualitative study using thematic analysis to examine feelings of social disconnection and burden on others (Chapter 4), a longitudinal quantitative study to examine whether feelings of social disconnection and burden predicted response to treatment (Chapter 5), and a longitudinal quantitative study to explore whether perceived partner responses and attachment interacted to predict depressive symptomology at the end of multidisciplinary treatment. The literature review brought together existing accounts and identified avenues for future research which consider both the person with chronic pain and their partners' perspectives and also shifting the focus to broader social relationships. In the qualitative study, semi-structured interviews were conducted with people with chronic pain. Thematic analysis identified factors which contributed to feelings of social disconnection and burden and suggested possible connecting pathways. This study also highlighted the potential buffering role of autonomy support. The first quantitative study showed that a higher sense of burden was related to pain catastrophising at the end of treatment, and that a lack of social support was related to poorer pain self-efficacy and pain acceptance. The final quantitative study found that high levels of attachment anxiety in people with chronic pain and partner solicitousness was associated with higher levels of depression post-treatment. This thesis makes an original contribution to the chronic pain literature by integrating and testing aspects of existing interpersonal accounts and producing several novel findings. Future research using dyadic (person with chronic pain and their partner) analyses and examining different interpersonal processes longitudinally is indicated, along with work which includes other members of the social network. To improve outcomes for people with difficult interpersonal relationships, modification of treatments to include interpersonal elements may be necessary.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Brown (Supervisor)