Background & Aims

People often report pain as stubbornly ‘stuck’ in their lives, with their pain and escaping pain becoming the focus of thoughts and behaviour. This focus is initially intuitive but can result in a pattern of inflexibility. Such ‘stickiness’ occurs in other clinical areas (e.g., depression, anxiety disorders, eating disorders), but has not been explored in the context of pain. There is limited understanding of how stickiness presents in a pain context and contributes to pain chronicity. We aim to precisely define the concept of stickiness in a pain context and produce a theoretical framework that encompasses the cognitive and behavioural facets that play a role in pain becoming stuck.
This work is a core part of our work in CRIISP (Consortium for Researching the Individual, interpersonal, and social aspects of pain) funded by the UK APDP (Advanced Pain Discovery Platform).

Methods

A rapid review of existing literature was conducted to draw out what is known about stickiness within the context of pain, as well as other relevant clinical conditions. We explored broadly, characterising around the themes of (in)flexibility, repetition, and fixation. Our focus on stickiness differs from existing ideas of flexibility, such as cognitive flexibility, to include a broader definition of ‘flexibility of thought’ and behaviour. This aims to move beyond flexibility within an exclusively executive function domain, which has focussed on set-shifting and task switching. We sought to draw on concepts such as ability to change expectations, single-minded or dogmatic thinking styles, perspective taking, and identifying alternative viewpoints and solutions. These concepts have been developed and explored in domains outside of pain, including depression, communication, and political authoritarianism.

Results

Our rapid review of core constructs was synthesised through discussion into a new working framework of stickiness. Core components were: 1. flexibility of thought, such as expectation change, 2. open-mindedness, recognising alternatives and perspective taking, and 3. flexibility of behaviour, extent to which it is repetitive, cyclical, and robust/resistant to change. Our review also highlighted potentially relevant constructs, such as perseverative thinking and rumination, attentional biases, and tendency to fixate or lack of disengagement from specific stimuli. From this it is suggested that pain-related stickiness could manifest as increased attention to pain stimuli, difficulty changing expectations about pain, and/or modifying behaviours associated with the experience of pain.

Conclusions

This new framework is the first attempt to articulate what we mean by stickiness within a pain context. It builds upon understanding from existing literature from different disciplines to present a novel approach to understand the challenges experienced by people with chronic pain. The next step is to test elements of this framework and refine it accordingly. Immediate next steps will be to explore: a) how stickiness relates to self-report and observable behavioural pain outcomes b) whether stickiness is a predisposing or maintaining factor in chronic pain and c) if stickiness is general and trait like or state/context specific. There is also a need to develop new methodologies to understand stickiness, including self-report questionnaires, using new experimental paradigms, and explore relevance to people living with pain. We envisage our framework to be potentially applied transdiagnostically and have relevance for different health conditions.

References

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Presenting Author

Edmund Keogh

Poster Authors

Laura Carter

PhD

University of Bath

Lead Author

Emma Fisher

PhD

University of Bath

Lead Author

Amanda Lillywhite

PhD

University of Bath

Lead Author

Edmund Keogh

PhD

University of Bath

Lead Author

Chris Eccleston

PhD

University of Bath

Lead Author

Topics

  • Mechanisms: Psychosocial and Biopsychosocial