Browsing by Author "Stamp, Gabriella Elisabeth"

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    The association between adult attachment style and pain perception in a South African cohort
    (University of the Witwatersrand, Johannesburg, 2024) Stamp, Gabriella Elisabeth
    Our response to threats, including pain, is believed to be learnt during our early interpersonal connections and experiences. Interpersonal relationships can be measured through four adult attachment style classifications: Secure, Dismissing, Preoccupied and Fearful, with the latter three being collectively classified as Insecure attachment styles. Preliminary epidemiological evidence suggests that Insecure attachment styles are more prevalent in those with chronic pain, while experimental studies investigating the association between adult attachment and pain are inconclusive. In two separate investigations, the aims of my research were (i) to determine the association between adult attachment style and chronic pain prevalence and burden in a South African population, and (ii) to determine the association between the different adult attachment styles and measures of experimental pain as a way of assessing a potential mechanism for possible differences in pain perception between the attachment styles. In the first study, a nationwide online survey of a general South African population assessed adult attachment style (using The Experience in Close Relationships - Relationship Structures (ECR-RS) Questionnaire), prevalence of chronic pain and psychological factors that are typically associated with pain, including depression, anxiety and pain catastrophising. In participants who reported experiencing chronic pain, the association with attachment style and pain burden (pain sites, severity and interference, using the Brief Pain Inventory) was further investigated. A total of 2371 participants completed the survey, with the cohort being generally young in age (median age 23 years; IQR 20-28), well-educated and primarily female (74%), with predominantly a middle-to-high socioeconomic status. In this cohort, I found a higher-than-expected prevalence of chronic pain (27%); previously reported prevalence data in a South African population found the prevalence to be 18%. All three Insecure attachment styles were associated with increased chronic pain prevalence when compared to the Secure attachment style (Dismissing: 31%, Odds ratio [95%CI] = 1.38 [1.02-1.85], p=0.037; Preoccupied: 42%, Odds ratio [95%CI] = 2.26 [1.62-3.13], p<0.001; Fearful: 49%, Odds ratio [95%CI] = 2.95 [2.03-4.29], p<0.001). In participants with chronic pain, adult attachment style was not directly associated with the overall burden of chronic pain. Rather, my study found that pain catastrophising was the mediating factor between Insecure adult attachment styles and an increased burden of chronic pain. Female volunteers who had completed the survey were invited to participate in the second study, which involved in-person experimental procedures to evaluate the experience of thermal pain and mechanisms of pain analgesia using the Conditioned Pain Modulation (CPM) paradigm. In the 103 young (median age 21 years; IQR 20- 23) and well-educated (all completed at least secondary education) sample, no significant relationship was found between attachment style and heat pain threshold (t(54) = -0.45, p = 0.654), heat pain tolerance (t(47) = -1.16, p = 0.250), and intensity of heat pain (Estimate [95%CI] = -0.11 [-0.34-0.11], p-value = 0.330). Similarly, descending pain inhibition (assessed using CPM) was not associated with adult attachment style (t(59) = -0.97, p = 0.338). In these South African cohorts, adult attachment style directly associated with chronic pain prevalence, with remarkably more than double the chronic pain prevalence in Fearfully, compared to Securely, attached individuals. A possible mechanism underlying the association between insecure attachment style and high chronic pain prevalence may be differences in pain modulatory pathways, which was investigated through the CPM test paradigm in Part 2 of my research. Pain catastrophising mediated the relationships between attachment style and burden of pain, highlighting the role and impact of cognitive factors and the perception of threat on both attachment style and pain. Adult attachment style did not associate with perception of experimental pain, nor did it associate with mechanisms of pain inhibition. The data of the two research components of my thesis highlight the differences between chronic clinical pain and the once-off experience of experimental pain in a controlled and safe environment. The negative data in the experimental study may be explained by three main limitations: (i) The experimental protocol was not threatening enough and was unlikely to consistently activate the adult attachment system; (ii) individuals with high attachment anxiety and attachment avoidance dimension scores did not participate in the experimental study, which means the sample was biased and may not have shown any differences even if the protocol was threatening enough to activate the attachment system; (iii) the experimental pain protocol likely does not capture the threatening nature of chronic pain due to complex interactions of psychosocial factors that accompany chronic pain. These limitations are informative for future experimental pain studies, and I believe that CPM cannot, at this point, be ruled out as a mechanism for the increased chronic pain prevalence in insecurely compared to securely attached individuals. Moreover, pain catastrophising as a potential mechanism underlying the association between adult attachment style and the prevalence of chronic pain may also be a potential avenue for future studies to pursue.