The role of personality type in the management of chronic musculoskeletal pain

Chronic pain is a complex condition with a significant social and economic impact and a better understanding of the factors affecting improvement is required to inform best practice in the management process. Few studies have considered the effect of Weinberger et al.’s personality types in the management of pain. The four personality types are suggested to respond differently to threatening information such as pain, because of their attentional and interpretive biases. Using a variety of research methods, the global aim of this programme of research was to determine whether the management of chronic pain would be enhanced through the use of treatment stratified on the basis of personality type. This thesis highlights important differences in the response to pain and pain management between the personality types, which are masked if the population is analysed homogenously. Defensive high-anxious individuals were more prevalent in the patient population compared to the asymptomatic control group and attended to pain related information more than the other groups. Defensive high-anxious individuals reported greater improvement for both pain and disability and showed stronger links between improvements in pain and disability and baseline psychological factors than the non-extreme individuals. The findings suggest that current treatments are more effective for defensive high-anxious patients. Furthermore, the high proportion of defensive high-anxious individuals highlights the need for psychologically based interventions to be delivered earlier. Stratifying the population may allow for more targeted interventions, which could be more cost effective and reduce the number of patients remaining in the care system.