Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study 2023 Lopez-Ruiz et al

Abstract:
Background: Personality traits are relevant for pain perception in persistent pain disorders, although they have not been studied in depth in sensitized and nonsensitized patients with knee osteoarthritis (OA).

Objective: To explain and compare the personality profile of patients with OA, with and without central sensitization (CS), and fibromyalgia (FM).

Setting: Participants were selected at the Rheumatology Department in two major hospitals in Spain.

Participants: Case-control study where the sample consists of 15 patients with OA and CS (OA-CS), 31 OA without CS (OA-noCS), 47 FM, and 22 controls. We used a rigorous and systematic process that ensured the sample strictly fulfilled all the inclusion/exclusion criteria, so the sample is very well delimited.

Primary outcome measures: Personality was assessed by the Temperament and Character Inventory of Cloninger.

Results: The percentile in harm-avoidance dimension for the FM group is higher compared to OA groups and controls. The most frequent temperamental profiles in patients are cautious, methodical, and explosive. Patients with FM are more likely to report larger scores in harm-avoidance, with an increase in logistic regression adjusted odds ratio (ORadj) between 4.2% and 70.2%.

Conclusions: Harm-avoidance seems to be the most important dimension in personality patients with chronic pain, as previously found. We found no differences between OA groups and between sensitized groups, but there are differences between FM and OA-noCS, so harm-avoidance might be the key to describe personality in patients with CS rather than the presence of prolonged pain, as found in the literature before.

https://www.mdpi.com/1660-4601/20/4/2935/htm

 

I'm not sure the authors are clear on what is meant by personality traits. In particular, if someone is in pain, and he tries to avoid doing things that exacerbate the pain, that avoidance does not qualify as a personality trait. It qualifies as a subset of common sense.

 

I think here's how this whole thing actually works:

In chronic illness, the body is already burdened by the illness and has little capacity to tolerate further stress. So the patients become more risk averse, avoidant, less confident, and less interested in taking on difficult tasks. It's a survival strategy, not a personality trait that somehow causes illness.

And when the patients happen to be subject to unavoidable stress they're more likely to react intensely because they can't handle it well.

They're in survival mode, not in growth & productivity mode.

Whenever a patient switches from survival mode into growth & producitivty mode, this can be interpreted by an observer as evidence that a change in mental attitude leads to health. But in reality the patient switched mode because they reached a level of sufficient health.

 

I have FM and at Christmas had a huge flare-up. I can contrast that period with last Sunday during which I experienced no pain all day which is a once a year phenomenon.

Around Christmas, the effect on my brain (and behavior) of a severe, body-wide, explosion of pain signals that increased over days was huge.

The slightest movement was painful, Sound, light, and inputs from the outside world, such as receiving a text message, or having to respond to a relative's email were beyond my capabilities and perceived as threats due to my brain impairment.

I'd like to see my brain imaged during a huge flare-up. That could be more telling than "personality traits."


Contrast those "holidays" with a very rare no pain day:

-- I was able to do taxes; I didn't confuse numbers; I didn't have any confusion at all. Completing household tasks was easy. Moving my body didn't hurt.


Perhaps these Spanish researchers find their focus fascinating and useful; I certainly don't.

 

How can anyone argue that "harm avoidance" is a personality trait and not just crumble down in deep, deep shame? Of course people in pain avoid more pain. DUH. Poor people have expense avoidance. DUH. Do they literally not understand the meaning of pain and really I guess not because there's simply no other reasonable explanation for giving up entirely on basic common sense with Meyers-Briggs medicine.

And of course there's a tell about how they use works when they call harm avoidance a personality trait. If you define normal reactions as personality traits, you're going to "see" personality traits everywhere. Especially when there aren't because the entire premise is silly. You don't even need a personality to avoid pain, it's a basic animal mechanism for survival.

And as if any of "cautious, methodical, and explosive" means a damn thing. What is wrong with these people that they can genuinely clown around with nonsense and feel proud of it? Oh, right, they get constant praise and applaud by the rest of the profession. Right. Ugh.

 

People who burn their hand avoid putting it back in the fire .

Perhaps the sheer lack of consequence for poor science is seeping into everything ...

 

The (pseudo-) superiority stance of the psych (mostly psych) researchers pointing their fingers at the majority, female, FM sufferers (sometimes obese, like many many Westerners) for being "difficult."

Maybe they are "difficult" because they are not believed by anyone, not their families, not their medical providers, not the general public and not their employers, not really.

Not only does that raise the "tone" for anger but the illness itself, when in full flare mode, screws up emotions into a frenzy that does not present as calm and submissive in the exam room. Or does present as mentally vacant. Or whatever result.

And lord knows, a female contesting the knowledge of FM in a male primary care doc does not go over well. Female assertiveness is, well, seen as not pleasing, not operating procedure.

Over and over I have had to laugh (inside, silently, to myself) over what my primary care doc and what the psych researchers say or write when they expound about FM. The most ridiculous and (clinically) useless.

These psychs (or radiologist in this case, or what have you specialists) lack famialiarilty with FM patients in general. They are not specialty clinicians involved in research who have experience with thousands of patients (this is what it takes to know and appreciate our "presentation" and our challenges).

No, they are looking at surfaces. Not too bright, that. Enough of these amateurs!