When pain remains Appraisals and adaptation

Cover picture: © Photographer Sebastian Kaulitzki. Agency: Dreamstime.com Printed in Sweden by US-AB, Stockholm 2007 Distributor: Stockholm University Library. For the ones who had a notion, a notion deep inside that it ain't no sin to be glad you're alive. I wanna find one face that ain't looking through me. I wanna find one place… Bruce Springsteen, 1978. Abstract As the number one cause of sick absenteeism and disability pension, musculoskeletal pain is considered a major health problem in Sweden and many other industrialized countries. Medical findings are often insufficient to explain the pain's intensity or duration, and psychological factors are known to be important in understanding the aetiology and maintenance of pain. The current thesis examines the relationship between non-specific chronic musculoskeletal pain and cognitions, emotions and behaviours. In Study I, chronic pain patients were interviewed about pain experiences and the results indicated that some patients use psychological defences to deal with chronic pain. Study II was an experimental approach set up to study the association between chronic pain and selective memory. In a pictorial memory game, no differences were found between patients and controls in the neutral game. In the pain-related game patients decreased -and controls improvedtheir performance, a finding discussed in terms of cognitive avoidance. Study III used questionnaire and register data to examine the predictive value of psychosocial variables on sustained pain-related sick absenteeism and the results showed sense of mastery and recovery beliefs to be especially important. The studies are discussed in terms of emotional and defensive coping and it is suggested that defences can be related to excessive activity, which may increase the risk of future relapses. It was suggested that an increased acceptance of pain, at both an individual and a societal level -would favour rehabilitation and return-to-work for those suffering from persistent pain. Key words: Chronic pain, musculoskeletal disorders, appraisals, coping, cognitive avoidance, identity, cognitive bias, psychological defences, acceptance, sick absenteeism. Svensk sammanfattnin