Examining Emotional Pain Among Individuals With Chronic Physical Pain: Nomothetic and Idiographic Approaches

Objective: Emotional pain (i.e., pain affect in response to psychological experiences such as rejection or loss) may be a component of chronic pain syndromes given high co-occurrence with depression and neurobiological overlaps in pain affect resulting from physical and emotional experiences. In the current set of studies, we examined the relationship between emotional and physical pain using both nomothetic (i.e., group-level) and idiographic (i.e., individual-level) approaches. Methods: Individuals with chronic pain were recruited from the Washington University Pain Center. First, we assessed the relationship between emotional and physical pain at the group level. Then, three individuals from the group-level study completed ecological momentary assessment four times per day for at least four weeks. We assessed relationships between emotional and physical pain using correlations and Dynamic Structural Equation Modeling. Results: Emotional pain severity was significantly positively correlated with physical pain at the group level. However, results from idiographic analyses suggested that one individual did not display a significant correlation between physical and emotional pain, and two individuals displayed correlations larger than expected based on the group-level data. Competing models suggested that emotional and physical pain represented distinct constructs for the individuals studied. Conclusions: These results suggest that emotional pain may be an important component of chronic pain syndromes. However, idiographic models revealed heterogeneity that may have important implications for treatment. Further research is needed to understand whether idiographic relationships between emotional and physical pain can help identify effective treatment targets for individuals with co-occurring emotional and physical symptoms.