People who struggle to identify and describe their emotions may experience greater disruption from chronic pain over time, according to new research.
A large two-year study led by Johns Hopkins Medicine found that adults with higher levels of alexithymia, a trait marked by difficulty recognising and expressing emotions, went on to develop greater psychological distress.
That distress was then linked to increased pain interference, meaning pain had a greater impact on daily activities and quality of life.
The findings were published in Health Psychology.
Researchers followed 1,453 adults living with chronic pain across the US over a two-year period.
Chronic pain is usually defined as pain lasting longer than three months.
According to the US Centers for Disease Control and Prevention, 24.3 per cent of adults experience chronic pain, while 8.3 per cent have chronic pain severe enough to limit their daily physical activity.
Previous studies have linked alexithymia with worse pain outcomes, including greater pain severity, physical interference, depression and anxiety.
However, the Johns Hopkins team said this study is among the first to explore how the relationship develops over time.
Senior author Dr Rachel Aaron, associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, said: “Prior studies have shown that alexithymia tends to be higher in people who have chronic pain.
“However, we did not know whether alexithymia leads to worse pain, or whether worse pain leads to alexithymia.
“We also have not had a good understanding of why these two distinct processes were related.”
Participants were assessed for alexithymia using the Toronto Alexithymia Scale, a 20-item questionnaire that measures difficulty identifying feelings, difficulty describing feelings and externally oriented thinking.
Researchers also measured pain severity and pain interference using subscales of the Brief Pain Inventory.
Anxiety and depression were assessed using the Patient-Reported Outcomes Measurement Information System to evaluate psychological distress.
Using advanced statistical modelling, the researchers examined whether emotional processing difficulties predicted later pain outcomes and whether psychological distress played a mediating role.
They found that patients with higher alexithymia at the start of the study developed greater psychological distress one year later.
Increased distress then predicted greater pain interference at two years.
However, alexithymia and distress did not significantly increase the intensity of pain reported by participants.
Pain interference also did not predict later alexithymia, suggesting that emotional processing difficulties may be a risk factor for worsening pain-related disruption rather than a consequence of it.
Aaron said: “Greater difficulties identifying one’s own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety.
“This in turn can lead to greater difficulties managing chronic pain.
“These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress, to improve pain outcomes.”
The researchers said the findings point to psychological distress, particularly anxiety and depression, as an important treatment target for people with chronic pain.
They added that helping patients recognise and process emotions could play a role in improving long-term pain outcomes.
The study was funded by the Johns Hopkins Clinician Scientist Award and the National Institutes of Health.