Does relationships with others influence the perception of anxiety and pain in patients with chronic wounds?

Pain is a complex but common concern in patients with chronic wounds.     A burgeoning body of evidence suggests the intricate relationship between anxiety and pain.  In this study, the attachment framework was examined to determine how personal views of self (attachment anxiety) and others (attachment avoidance) may construct the pain experience during dressing change.  Attachment style differences have been found in systematic patterns of expectations, emotional reactivity, strategies for distress management and social behaviour based on an individual’s belief about the self and others.   The purpose of this study was to explore the relationship of attachment style and the experience of pain in terms of anticipatory pain, self reported pain and behavioural expression of pain in a population of older adults during wound dressing changes.  In this cross-sectional study, 96 older patients were asked to respond to a questionnaire that classified them into four different categories of attachment styles.   Patients were asked to rate their levels of anticipatory pain and actual pain levels at different times during wound care using a numerical rating scale. 

Repeated Measure Analysis of Variance (RM-ANOVA) was used to detect the differences in pain ratings before, during, and after dressing changes.  Post-hoc comparisons were done, using paired t-test to determine the time point at which pain scores differed.   ANOVA was used to detect differences in anticipatory pain, anxiety, and pain during dressing change among the four attachment groups.  Post Hoc analysis using Scheffe tests were used to identify which groups differed on these variables.  To test the mediating effect of anxiety between attachment and pain, multiple regression analyses were used.  Results indicated that patients experienced more pain during dressing change than at baseline ( t-tests, p<0.001).  Secure subjects reported less pain and anxiety than subjects with other attachment styles (ANOVA, p<0.001).  Results of regression analysis indicated that anxiety mediated the relationship between attachment and pain.
Results of this study also support the role that attachment plays in the experience of pain in older adults.  Clinicians must be cognizant of the impact of personality, anxiety, and anticipation of pain on actual pain experience.