Chronic pain syndrome associated with health anxiety: A qualitative thematic comparison between pain patients with high and low health anxiety

Objectives. Based on the high prevalence of health anxiety among patients with chronic pain and the conceptual overlap between the diagnostic criteria for hypochondriasis and pain disorder, it has been suggested that the cognitive-behavioural theory of severe and persistent health anxiety can be applied to understand the problems presented by a subgroup of chronic pain patients. This study aimed to provide qualitative data to complement the progress of the existing experimental research and theory development. Design. A cross-sectional design with two groups was adopted. Method. In-depth semi-structured interviews were conducted with 60 chronic pain patients seeking medical treatment from a specialist clinic, and theoretical thematic analysis was performed on a subset of interview transcripts drawn from the five most health anxious and the five least health anxious of this sample. Results. Five themes emerged from the analysis, and they concerned (1) pain appraisal, (2) pain preoccupation, (3) coping strategies, (4) self-identity, and (5) suicidal ideation. Differences were observed between the health anxious and non-health anxious pain patients consistently across all these themes. Conclusions. The phenomenological information both informs and supports the idea that the cognitive-behavioural model of health anxiety can be adapted for the understanding of and development of treatments for pain patients with health anxiety. The findings also challenge the common practice of 'lumping' pain patients into a single group and underline the importance of matching treatments to the patients' psychological characteristics.