A PLURALIST CHARACTERIZATION OF PAIN MEANING AFTER WHIPLASH

Abstract

The experience of pain is multidimensional. Biological, psychological and social factors combine to inform the experience of pain. This bio-psychosocial view has become popular given shortcomings of the pervasive medical model in accounting for pain persistence in conditions such as whiplash associated disorder (WAD). However, the majority of research has examined components of this model separately. Furthermore, important pain beliefs have not been explored in the context of WAD. In order to better understand the experience of WAD, the objective of this thesis was to examine the experience of WAD-related pain beliefs with a pluralist and integrated approach. Biological and social factors are investigated in relation to WAD-related pain beliefs using multiple methods reflecting the multidimensional experience of pain. Three chapters principally addressed the objective of the thesis. In chapter two, a narrative review of nocebo hyperalgesia is presented illustrating the biological effects of belief. Neurochemical and neuroanatomical changes were shown to coincide with altered or manipulated expectations of pain. In chapter three, WAD-related pain beliefs were examined in a longitudinal mixed-method study. Initially, beliefs are explored quantitatively then more deeply with a qualitative methodology. This qualitative piece illuminated a shared inter-subjective meaning of WAD-related pain beliefs reflecting a desire to be cured or fixed. This over-arching theme underscores an adaptive perspective of pain early after WAD, but becomes maladaptive as pain persists. In chapter four, the prognostic value of, and inter-relationships among, beliefs was examined. WAD-related pain beliefs were found to be related to catastrophizing, which is consistent with theoretical assertions relating pain and catastrophizing. In addition, early WAD-related beliefs pertaining to negative expectations, catastrophizing and mystery were associated with future pain and disability. Finally, considering data collection challenges in longitudinal observation studies, chapter five was devoted to exploring these issues and proposing recommendations for future studies. This thesis builds on growing literature highlighting the importance of cognitive factors shaping the experience of WAD. More importantly, by examining WAD-related pain beliefs from divergent perspectives the multi-dimensional nature of pain is highlighted. This pluralist approach supports the use of multiple approaches to examining pain within a study or research program.