<p>As the number one cause of sick absenteeism and disability pension, musculoskeletal pain is considered a major health problem in Sweden and many other industrialized countries. Medical findings are often insufficient to explain the pain’s intensity or duration, and psychological factors are known to be important in understanding the aetiology and maintenance of pain. The current thesis examines the relationship between non-specific chronic musculoskeletal pain and cognitions, emotions and behaviours. In Study I, chronic pain patients were interviewed about pain experiences and the results indicated that some patients use psychological defences to deal with chronic pain. Study II was an experimental approach set up to study the association between chronic pain and selective memory. In a pictorial memory game, no differences were found between patients and controls in the neutral game. In the pain-related game patients decreased – and controls improved – their performance, a finding discussed in terms of cognitive avoidance. Study III used questionnaire and register data to examine the predictive value of psychosocial variables on sustained pain-related sick absenteeism and the results showed sense of mastery and recovery beliefs to be especially important. The studies are discussed in terms of emotional and defensive coping and it is suggested that defences can be related to excessive activity, which may increase the risk of future relapses. It was suggested that an increased acceptance of pain, at both an individual and a societal level – would favour rehabilitation and return-to-work for those suffering from persistent pain.</p>

As the number one cause of sick absenteeism and disability pension, musculoskeletal pain is considered a major health problem in Sweden and many other industrialized countries. Medical findings are often insufficient to explain the pain’s intensity or duration, and psychological factors are known to be important in understanding the aetiology and maintenance of pain. The current thesis examines the relationship between non-specific chronic musculoskeletal pain and cognitions, emotions and behaviours. In Study I, chronic pain patients were interviewed about pain experiences and the results indicated that some patients use psychological defences to deal with chronic pain. Study II was an experimental approach set up to study the association between chronic pain and selective memory. In a pictorial memory game, no differences were found between patients and controls in the neutral game. In the pain-related game patients decreased – and controls improved – their performance, a finding discussed in terms of cognitive avoidance. Study III used questionnaire and register data to examine the predictive value of psychosocial variables on sustained pain-related sick absenteeism and the results showed sense of mastery and recovery beliefs to be especially important. The studies are discussed in terms of emotional and defensive coping and it is suggested that defences can be related to excessive activity, which may increase the risk of future relapses. It was suggested that an increased acceptance of pain, at both an individual and a societal level – would favour rehabilitation and return-to-work for those suffering from persistent pain.

Långvarig smärta innebär ofta stora påfrestningar för individen med konsekvenser på många livsområden vilket utgör en utmaning för hälso- och sjukvården gällande bemötande utifrån ett helhetsperspektiv. En central aspekt av att leva med långvarig smärta är hur stress och påfrestningar hanteras exempelvis genom användning av psykologiska försvar. Syftet med denna studie var att bidra till ökad kunskap om psykologiska försvar hos personer med långvarig smärta utifrån frågeställningen:  vilka psykologiska försvar och psykologiska försvarsstrukturer framkommer när vuxna personer med långvarig smärta intervjuas om personligt relevanta områden. Datainsamlingen bestod av tio telefonintervjuer som transkriberades och analyserades med Defense Mechanism Rating Scales (DMRS). Resultaten visade på en varians av psykologiska försvar i deltagargruppen. Mest förekommande var högadaptiva försvar, särskilt humor och anknytning.  Utmärkande var även förekomsten av flertalet medeladaptiva försvar såsom annullering, samt det lågadaptiva försvaret nedvärdering av sig själv. Resultaten kan bidra till ökad förståelse om omedvetna hanteringsstrategier som kan påverka upplevelsen av smärta och även vara av vikt för hälso- och sjukvårdens bemötande av patienter med långvarig smärta. Vidare forskning inom området behövs för att undersöka samband mellan psykologiska försvar och andra relevanta faktorer såsom smärtdiagnos, smärtsymtom och behandlingsutfall. / Chronic pain is associated with extensive distress for the individual with consequences on several areas of life and constitutes a challenge for the healthcare system in approaching chronic pain from a holistic perspective. How individuals cope with distresses for example by using psychological defences is of significance for the chronic pain condition. The purpose of this study was to contribute to the body of knowledge regarding psychological defences that are used by individuals with chronic pain. The research question was: what psychological defences and structures of psychological defences appear when adults with chronic pain are being interviewed on personally relevant topics.  Ten telephone interviews were conducted, the material from interviews was transcripted and analysed using Defense Mechanism Rating Scales (DMRS). The results showed a variety of different psychological defences used by participants. High adaptive defences such as humour and affiliation were the most appearing. Furthermore, the occurrence of middle adaptive defences such as undoing was also detected in the material. Among the low adaptive defences devaluation of self stood out the most. The results contribute to the understanding of involuntary coping-strategies that may influence the experience of chronic pain. In addition, the results are important for the treatment of chronic pain patients within the healthcare. Further research in this field is needed to study links between defence mechanisms and other relevant aspects such as pain diagnosis, pain symptoms and treatment outcome.