‘I call it stinkin’ thinkin’’: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing

Abstract

While most participants described pain rumination as uncontrollable and harmful, dwelling on pain could be helpful when focused on tangible and solvable problems, thereby translating into adaptive coping behaviours that eventually interrupt rumination. Future treatments may be more effective if they are based on individualized formulations of pain catastrophizing that focus on its perseverative nature and implicit function. Statement of contribution What is already known on this subject? Chronic pain affects one in five people, and psychological coping responses are key targets within gold standard biopsychosocial interventions. People who have elevated pain catastrophizing tend to have worse pain outcomes, including increased pain, disability, and emotional distress. What people believe about their own thinking (i.e., their metacognitions) influences how much they worry or ruminate. What does this study add? This is the first qualitative study exploring metacognitions in people with chronic pain and the first to target a purposive sample of people with elevated pain catastrophizing. People with elevated pain catastrophizing often see rumination as uncontrollable and harmful but may simultaneously believe it helps them to solve problems or feel prepared for future threats. Pain catastrophizing is not a stable and enduring trait but fluctuates both within and across individuals in response to pain, context, metacognitive beliefs about rumination, and coping behaviours.

Attentional Patterns Toward Pain-Related Information: Comparison Between Chronic Pain Patients and Non-pain Control Group

“…Future studies need to compare attentional and interpretational biases between chronic pain patients with different types of chronic pain conditions (e.g., musculoskeletal disorders vs. autoimmune diseases) and compare attentional biases toward different types of stimuli including ambiguous sensorimotor stimuli, pictures of body part relevant to the pain location as well as symbolic pain stimuli. The third possibility for non-significant results of the present study (i.e., non-significant effect of pain catastrophizing on attentional patterns to pain stimuli among chronic pain individuals) is the complex and multifaceted nature of pain catastrophizing construct (Schütze et al, 2017(Schütze et al, , 2020. This concept includes the emotional construct (i.e., helplessness), the cognitive process construct (i.e., rumination), and the cognitive content construct (i.e., magnification).…”

“…This concept includes the emotional construct (i.e., helplessness), the cognitive process construct (i.e., rumination), and the cognitive content construct (i.e., magnification). Schütze et al (2017) also argued that pain catastrophizing is a more "state-like, " not "trait-like" construct that can change depending on internal and external triggers, pain levels, metacognition about rumination (rumination can help to solve problems vs. rumination is uncontrollable and harmful to manage pain), and coping activities. Future studies need to utilize multiple assessments of pain catastrophizing in order to investigate the effects of pain catastrophizing on attentional bias to pain stimuli among chronic pain patients.…”

Metacognition, perseverative thinking, and pain catastrophizing: A moderated‐mediation analysis

“…That is, the more harmful people believe perseverative thinking is for their mood or pain, the more they worry about this, thereby fuelling the cycle of perseverative thinking, even if the content of these thoughts shifts towards worry about worry (meta‐worry). This ego–dystonic thinking has been found to often be confusing and upsetting in people with generalized anxiety (Wells, ) as well as those with elevated pain catastrophizing (Schütze et al, ), which highlights the negative affective dimension of holding unhelpful meta‐beliefs.…”

“…Just as disorder‐specific MCT protocols exist for treating different psychological disorders (Wells, ), MCT for chronic pain should be tailored to the pain‐specific metacognitions found in this cohort (Schütze et al, , ). Similarly, the attention‐training techniques that are integral to MCT may require adaptation given the unique attentional demands found in people with chronic pain (Crombez, Van Ryckeghem, Eccleston, & van Damme, ; Sharpe et al, ).…”

“…MCT is yet to be tested in pain populations and only a handful of studies have started exploring metacognition in people with pain (Kollmann, Gollwitzer, Spada, & Fernie, ; Schütze, Rees, Slater, Smith, & O’Sullivan, ; Schütze et al, ; Spada, Gay, Nikčevic, Fernie, & Caselli, ; Yoshida et al, ; Ziadni, Sturgeon, & Darnall, ). This study therefore attempted to test a model of how perseverative thinking and metacognition are related to PC.…”