Illness representations, coping and psychosocial outcome in chronic pain.
University of Southampton, School of Psychology,
Research has recognised the importance of understanding the chronic pain experience using a biopsychosocial model. This approach acknowledges the impact of cognitive factors on psychosocial adjustment to chronic pain. This literature review explores the difficulties encountered by individuals adapting to a life with pain. It evaluates the evidence pertaining to the idea that beliefs about illness and coping strategies affect psychosocial outcome in chronic pain. The review considers the role of cognitive factors in self-regulating illness using the Common-Sense Model of Illness Representations (CSM). An evaluation of this model as it applies to chronic conditions is provided. Reviewing the literature reveals that despite numerous studies examining the CSM in chronic illness, there is a paucity of research applying it specifically to chronic pain. This review highlights the potential usefulness of exploring the CSM in this population in order to consider both the empirical value of the CSM and gain further knowledge regarding useful psychotherapeutic interventions in chronic pain.
On this basis, the present study sought to investigate the CSM in a sample of adults with chronic pain. A significant relationship between a number of illness representations (beliefs about illness) and psychosocial outcomes was found. A subset of these met criteria for mediation. The findings imply that particular illness representations (identity, consequences and emotional representation) are associated with the coping strategy catastrophising, which in turn is associated with an increased tendency for depression, anxiety and reduced quality of life. Due to the cross-sectional design, causal inferences cannot be made. However, the findings imply partial support for the CSM in a chronic pain population. Directions for future research are highlighted, as well as implications for psychotherapeutic interventions which could help reduce unhelpful beliefs and maladaptive coping strategies.
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