Pain and Personality

Because psychological factors are so clearly implicated in the experience of pain and because at least some pain serves clear functions for the chronic pain sufferer, researchers have examined whether there is a pain-prone personality: a constellation of personality traits that predispose a person to experience chronic pain. Research suggests that this hypothesis is too simplistic.

First, pain itself can produce alternations in personality that are consequences, not causes, of the pain experience. Second, individual experiences of pain are far too varied and complex to be explained by a single personality profile. Nonetheless, a certain personality correlates are reliably associated with chronic pain, including neuroticism, introversion, and the use of passive coping strategies. Because findings like these provide clues to the treatment of pain, researchers have continued to refine their understanding of profiles of pain patients.

Developing psychological profiles of different groups of pain patients has proven to be helpful for treatment, and so, although these profiles are not thought of as pain-prone personalities, they are useful in specifying problems that patients with particular types of pain have or may develop.

To examine these issues, researcher have drawn on a variety of personality instruments, especially the Minnesota Multiphase Personality Inventory (MMPI). Chronic pain patients typically show elevated scores on three MMPI subscales: hypochondriasis, hysteria, and depression. This constellation of these factors is commonly referred to as the "neurotic triad" because it frequently shows up in the personality profiles of patients with neurotic disorders as well.

Depression reflects the feelings of despair or hopelessness that can often accompany long-term experience with unsuccessfully treated pain. Pain does not appear to be a sufficient condition for the development of depression, but rather, leads to a reduction in activity level and in perceptions of personal control or mastery, which in turn, can lead to depression. Depression can, then, feed back into the total pain experience, both aggravating the pain itself and increasing the likelihood of debilitating pain behaviors, such as leaving work. This profile has implications for the treatment if pain because interventions with depressed pain patients must address chronic depression and the thought disorders that result, in addition to the pain itself.

Chronic pain is also associated with psychopathology including depression and anxiety disorders, substance use disorders, and other psychiatric problems. The reason chronic pain and psychopathology are so frequently associated is not fully known. One possibility is that chronic pain activates and exacerbates a latent psychological vulnerability that was not previously recognized, leading to diagnosable psychopathology.