Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain

Aims: A thinking process central to the etiology of emotional disorders, rumination is commonly observed in chronic pain. However, very little is understood about the characteristics of pain-related rumination and the mechanisms through which rumination impacts on pain perception and disability. This study began investigating this cognitive phenomenon by qualitatively examining chronic pain patients' experience of rumination. Methods: Semistructured interviews were conducted with 20 chronic pain patients. Themes were extracted from interview transcripts using thematic analysis.Results: Six themes were extracted from interviews with frequent ruminators. These elucidated the pattern of rumination and suggested a reciprocal relationship of rumination with not only pain, but also negative emotions and sleeplessness. Frequent ruminators appeared to hold positive beliefs about rumination and negative beliefs about self in overcoming pain. Two themes were extracted from interviews with infrequent ruminators: implicating negative beliefs about rumination and the flexible use of disengagement strategies in these individuals. Conclusion: Rumination occurs frequently and can be easily triggered by pain, negative emotions and sleeplessness in patients who lack alternative coping strategies and believe rumination is a way to problem-solve. A tentative model of pain-related rumination has been proposed, outlining interesting hypotheses for rigorous empirical investigations.