Role of rumination on daily adjustment in complex regional pain syndrome: a diary approach

Abstract

Background: Rumination is a repetitive thought process for unresolved issues. It has been known to be an important predictor of pain intensity and adjustment in patients with chronic pain including complex regional pain syndrome (CRPS). Rumination may magnify the threat value of pain sensations, and thus may facilitate maladjustment to pain. This study aimed to investigate the role of rumination in the relationship between daily pain intensity and daily adjustment (i.e., avoidance, disability, concentration) in patients with CRPS, using an end-of-day diary. Method: Twelve patients registered with the CRPS Association in Korea participated in this study. In the baseline phase, patients' demographic, pain-related variables, and rumination were measured by self-report questionnaires. During a subsequent diary phase, participants filled out an online-end-of-day diary over 15 consecutive days assessing daily pain intensity, daily avoidance, daily disability, and daily concentration. We used the hierarchical linear model for analyzing data. Results: Results showed that the level of rumination moderates the effect of daily pain intensity on daily avoidance, daily disability, and daily concentration. Specifically, the higher the level of rumination, the more the effect of daily pain intensity on daily adjustment, whereas the lower the rumination, the less the influence. Conclusions: This is the first study to examine the role of rumination on daily adjustment of patients with CRPS, suggesting that rumination may be an important factor in their daily adjustment. Thus, health professionals may consider helping patients effectively cope with their rumination.