A questionnaire by researcher C.R. Cloninger and colleagues is useful in clinical practice to detect personality disorders (PDs) among patients who are experiencing chronic pain. The questionnaire, called the Temperamental and Character Inventory, identifies traits such as harm avoidance, novelty seeking reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence.
It has long been thought that certain personality traits could affect how patients react to pain and pain treatment. The authors of this study wanted to compare the personality profiles of patients with chronic pain (CPP) with patients who do not have chronic pain; they also wanted to see whether the TCI questionnaire could predict the personality disorders and the different subtypes within. To do this, researchers recruited 207 patients who attended a local pain clinic. The majority of patients complained of back and leg pain (72 percent), followed by neck and arm pain (13 percent), abdominal pain (3 percent) and other sites (12 percent). One hundred seven pain-free controls also participated.
Pain in the CPP group was assessed through a variety of tools, including the German version of the Brief Pain Inventory, the Temperament and Character Inventory, the German version of the Beck Depression Inventory, the German version of the State-Trait-Anxiety Inventory, the Mini-International Plus, and the Standard Clinical Interview for DSM-IV Personality Disorders.
When analyzing all the data, the researchers found that a high Harm Avoidance in CPPs was an important part of forming the emotional core of personality. Earlier studies have shown that the fear of pain and the associated behavior can be more disturbing and disabling than pain itself. The researchers also note the important finding among CPPs is the low scores on self-directedness and cooperativeness, which represent the cognitive core. This gives people a feeling that they can control or positively influence unpleasant situations or that they can solve a problem. In fact, along with the other issues found by the questionnaires and tests, the study findings showed that 41 percent of CPPs had at least one personality disorder, which is relevant to issue of chronic pain as this can negatively affect the outcome of pain management.
Broken down, the findings were as follows: “TCI predicted an average of 23 percent in PD symptom counts, the Self-directedness and cooperative personality traits appeared to be significant predictors in determining the presence or absence of a PD by correctly classifying 75.8 percent of CPPs.”
The authors conclude that knowing about these issues can help identify that there is a relationship between the neurobiological basis of the relationship between specific personality traits and treating chronic pain. By knowing this, future studies could look at the usefulness of discovering such traits in planning pain treatment plans.