The role of personality type and cognitive biases in chronic back pain

Esselaar, Maaike Wilhelmina Helena Hubertus (2023) The role of personality type and cognitive biases in chronic back pain. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Chronic back pain is the single biggest cause of disability among adults in the world with a significant social, economic, and personal impact. The lack of an underlying pathology in some cases of chronic back pain means that psychology may play an important role. Previous investigations considered the chronic back pain population to be a homogenous group with the same coping mechanisms and pain related behaviours. However, recent studies have suggested that there might be sub-groups with different behaviours and coping mechanisms within the chronic pain population. This thesis used a mixed method approach to investigate the effect of personality traits on chronic back pain. Using a well-established cohort study the effects of the big five personality types on chronic back pain assessed three outcomes over an 8-year period: consistent chronic pain, recovered from chronic pain and acquired chronic pain.. Neuroticism was found to be the biggest risk factor for chronic pain in all three outcomes and physical activity and, in some cases, Extraversion and Conscientiousness were protective. The next study investigated cognitive biases within Weinberger’s personality types: defensive high anxious, high anxious, low anxious, and repressors. Results indicated that the repressors had a goal oriented gaze behaviour that is similar to that of a control group whereas in contrast the high anxious and defensive high anxious individuals appeared to have an attentional bias towards the back and face. The final study in this thesis investigated the motor imagery profile of a chronic back pain population as well as the motor imagery profile of each of the Weinberger personality types. Overall, individuals with chronic back pain had lower imagery scores than the pain free control group. When split according to personality type the results seem to suggest that the high anxious had the lowest imagery scores, whereas the repressors’ imagery scores were similar to those of the control group. Taken together, the results from this thesis provide further support for the heterogeneity of individuals with chronic back pain and investigated a new type of imagery intervention that could address limitations in current chronic pain management.