Acute and chronic pain are two different entities. The intensity of acute pain is closely associated with tissue damage. Chronic pain, i.e. pain lasting three months or more, is associated with early adversities, emotional distress, depressiveness, catastrophizing and helplessness beliefs, social exclusion and job dissatisfaction. There is a ‘chicken-and-egg’ type of question: Is the depressive symptomatology present before or after the onset of pain. The traditional biomedical model of pain has not managed to offer a method to cure chronic pain. In recent decades the biopsychosocial model of pain has guided us from pain as sensation produced by injury toward the concept of pain as a multidimensional experience. The aim of the present dissertation was to study the connection between early, mainly emotional adversities, chronic pain, depressiveness and pain disability.
The dissertation is part of a larger study entitled ‘the survey of the psychic profile of pain patients’. The data was collected from January 2004 to March 2005. The pain patients (N=271) in the study were chronic, first-visit pain patients in six pain clinics in central and northern Finland and the control participants (N=331) were municipal employees of Raahe town administration. The study method used was a cross-sectional questionnaire and also interviews. The existence of early adversities was estimated with the Young Schema Questionnaire-short form-Finnish version (YSQ-S2-extended), which was developed to measure 18 early maladaptive schemas (EMS).
The internal consistency of the YSQ-S2-extended was adequate to high in both samples and the groups showed equal goodness-of-fit statistics in CFA. For the first time the hypothesized 18 EMS structure of YSQ was confirmed in the total sample. The results supported the use of the Finnish version of YSQ among chronic pain patients. Of the chronic pain patients, 58.3% scored EMSs as meaningful, reflecting that the schema was active. Those pain patients with meaningful EMSs had significantly higher pain intensity, duration of pain and pain disability. The two most commonly occurring EMSs were Unrelenting Standards/Hypercriticalness (US) and Self-Sacrifice (SS) EMSs. The behaviour induced by them exacerbated the pain situation according to the interview study. Emotional Deprivation EMS predicted pain disability as much as did pain intensity and the number of pain sites in chronic pain patients. When the two samples were compared, pain patients showed higher scoring in EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. From the pain variables, pain disability showed the widest variation in EMS activity, but only in pain patients. The most severely disabled chronic pain patients showed an increase in Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. This supports the idea that severely disabled chronic pain patients suffer from early emotional maltreatment. To uncover the possible psychic patterns of chronic pain patients, the EMS data was subjected to exploratory factor analysis (EFA). The chronic pain patient group showed two schema factors (SF), whereas a three-factor structure was found in the control sample. In pain patients, the first and larger SF1 (‘Loser’) showed a shameful, defective, socially isolated, failure, emotionally inhibited, deprived, submissive and resigned pattern, which had a strong association (r=.72) with their depressiveness. The SF2 (‘Encumbered’) showed a demanding, approval seeking, self-sacrificing and punitive pattern. The SF2 and the active SS and US schemas reflected cognitive-emotional structures of the same kind which propelled them to a behaviour which exacerbated their pain disease. The data of both the chronic pain patients and painful control participants (N=271) supported a biopsychosocial pain model where SFs predicted depressiveness and both depressiveness and pain intensity predicted pain disability, which was the ‘end state’. However, the models differed in the direction of the path between pain intensity and depressiveness – depressiveness predicted pain intensity and vice versa, in the pain patient and control samples respectively. The effect size of depressiveness was approximately 11 times the effect size of pain intensity on pain disability in the pain patients. Among the controls, the effect size of pain intensity was 5.6 times the effect size of depressiveness on pain disability. When the duration of pain was more than two years, depressiveness became the sole predictor of pain disability among the chronic pain patients.
Childhood adversities have a lifelong effect on wellbeing and illness. This study highlights the consequences of early maladaptive schemas in chronic pain and its associate; depression. They both markedly impair the quality of life. Schema-focused therapy may offer a special tool to help chronic pain patients.
