Attachment, symptom severity, and depression in medically unexplained musculoskeletal pain and osteoarthritis: a cross-sectional study

PLoS One. 2015 Mar 25;10(3):e0119052. doi: 10.1371/journal.pone.0119052. eCollection 2015.

Abstract

Background: Attachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study.

Methods: 85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression.

Results: Patients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns.

Conclusions: Our results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arthralgia / etiology
  • Cross-Sectional Studies
  • Demography
  • Depression*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Pain / pathology*
  • Object Attachment
  • Odds Ratio
  • Osteoarthritis / complications
  • Osteoarthritis / pathology*
  • Psychometrics
  • Regression Analysis
  • Self Report
  • Severity of Illness Index
  • Young Adult

Grants and funding

This work was supported by the private foundation “Psychosomatik der Wirbelsäulenerkrankungen” (“Psychosomatics of spine disorders”), which is held in trust by the following attorneys: Dr. Klaus Kessler, Dr. Moritz Weber, Königsstraße 84, 70173, Stuttgart, Germany, E-mail: kessler@schelling.de; weber@schelling. This foundation does not run a URL. The funding was committed for this specific purpose to the University Hospital Heidelberg. The authors also would like to acknowledge financial support by the Deutsche Forschungsgemeinschaft (German Research Foundation) and Ruprecht-Karls-Universität Heidelberg within the funding program "Open Access Publishing." The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.