Mental defeat in chronic pain: initial exploration of the concept

Objectives: "Mental defeat" has been found to be an important psychologic reaction to painful trauma. Chronic pain patients also report mental defeat in relation to their experience of pain episodes. A measure of mental defeat was devised and evaluated in terms of (1) psychometric properties and (2) specificity of scores in relation to disabling chronic pain.
Methods: A total of 304 participants completed the Pain Self Perception Scale, a questionnaire designed to measure mental defeat as a reaction to pain. Participants also completed the Short-Form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. Chronic pain patients from a tertiary hospital clinic (n = 94) were compared with patients experiencing acute pain (n = 38), pain-free controls (n = 79), community volunteers suffering from chronic pain (n = 32) or acute pain (n = 30), and patients diagnosed with anxiety disorders (n = 31). Test-retest reliability was assessed in subsamples of chronic pain patients and community volunteers.
Results: The mental defeat measure was both internally consistent and reliable. Chronic pain patients showed elevated levels of mental defeat relative to all other groups, including people with chronic pain of the same intensity of pain who were not seeking treatment. Pain-specific mental defeat may be linked to disability and the seeking of specialist treatment.
Conclusions: Research on mental defeat may allow the development of new treatment strategies for chronic pain syndromes and a better understanding of the link between chronic pain, depression, and posttraumatic stress disorder.