Have you ever noticed how some people give in to their back pain while others push through and do whatever they want regardless of the pain? What makes the difference in these two groups of patients? What makes the persistent group keep on keepin' on? Why does the avoidance group give up?
One way to better understand the difference in behavior among chronic low back pain sufferers is to look at self-discrepancies. These are the differences between how the patient sees him or herself versus how he or she would like to be. Other measurable self-discrepancies include who you would like to be versus who you think other people want you to be. There is also the difference between who you are and who you are afraid to be.
Differences between these conflicting viewpoints can create anxiety, fear, depression, distress, and more pain. Understanding that these conflicts exist, measuring them, and reducing them may help improve function and eliminate disability among chronic back pain sufferers.
Researchers in The Netherlands have been working on creating a model to identify and measure self-discrepancies based on behavior. Now they are using this tool to evaluate level of perceived disability and quality of life. They hope to be able to uncover the thought process behind avoidance versus persistence actions. Finding better ways to treat chronic low back pain may depend upon recognizing these behavioral variables.
Over 100 people participated in the study. They all had similar chronic low back pain. Everyone completed a variety of questionnaires about pain, depression, activity level, and quality of life.
Everyone was interviewed about their health-related quality of life. Each of these measures was taken twice: at the beginning of the study and again six months later. Everyone also carried a special device called an accelerometer for two weeks. This tool measured level of activity by calculating how much time each person was up and moving.
They found a curious mix of results. First, men were more likely to demonstrate persistent behavior (push through the pain). Patients who were most like who they wanted to be were also more likely to be persistent in their behavior.
But patients who were far away from being their ideal-self were also more likely to engage in persistence behaviors. In both groups (avoiders and persisters), the stronger these behaviors, the more disabled the patients perceived themselves. Overall, higher pain levels translated into poorer perceived quality of life and mental health.
You might think that people who are up and going despite the pain would be close in who they want to be and who they are (called the ideal self). But in fact, in this study the authors said it was more likely that there is a subgroup of persistence patients.
This subgroup (called endurance copers) overdo in order to "get everything done." They end up pushing too hard and suffering more pain, which then puts them farther from where they want to be.
What are the implications of this study? In other words, how is this information going to help chronic low back pain sufferers? The authors say it's not clear yet just what can be determined from the results of this study. They are just in the first phase of making hypotheses (theories) about the relationship between chronic pain and behavior and testing them out.
In the end, the hope is to find better ways to help and treat patients with chronic low back pain. If it turns out that self-discrepancy behaviors are part of the problem, then treatment strategies directed toward regulating these thoughts and actions may be helpful.
Reference: Ivan P. J. Huijen, et al. Effects of Self-Discrepancies on Activity-Related Behavior: Explaining Disability and Quality of Life in Patients with Chronic Low Back Pain. In PAIN. September 2011. Vol. 152. No. 9. Pp. 2165-2172.