Abstract/Summary

Pain is a complex multifaceted experience. Pathology does not always correlate to symptomatology, with many individual differences being involved in the genesis of chronic pain. Identifying some of the factors associated with pain will help to build a model for vulnerability and inform on targeted interventions. Study one compared a large chronic pain population to a healthy population for differences in psychosocial factors in the workplace. The results indicated that, compared to healthy individuals, people in pain reported significantly poorer relationships with their managers and colleagues, felt they were discriminated against, felt subjected to more threats and abuse, and were not as appreciated for their efforts. Interestingly, they felt more competent in their job role and reported greater job security. Study two assessed whether attending to a painful stimulus (intrinsic attention to pain) was associated with a ‘pro-nociceptive’ phenotype (characterised by enhanced temporal summation and less efficient conditioned pain modulation). The results showed that endogenous pain modulatory mechanisms were responsible for 39% of the variation in intrinsic attention to pain. Study three correlated Five-Factor Mindfulness Questionnaire (FFMQ) scores with rates of sensitisation to a repetitive/consistent pain stimulus over a brief paradigm. The findings revealed that people who scored low on the FFMQ were at higher risk of sensitisation to pain. Study four examined the construct validity of the Central Sensitisation Inventory (CSI) by meta-analysing correlations of the CSI with measures of nociceptive responsivity (Quantitative Sensory Testing) and psychological constructs (anxiety, depression, stress etc). The CSI was strongly correlated with psychological constructs and showed weak/no association to nociception. Overall, this thesis suggests that a wide range of biopsychosocial factors contribute towards pain. Workplace environment, endogenous modulatory mechanisms, trait mindfulness and psychopathology should be considered when building a model to help predict vulnerability and inform on targeted intervention, to improve resilience to pain.