Self-warmth, self-coldness and self-esteem as predictors of quality of life and disability in chronic pain. A systematic review of the impact of fibromyalgia on quality of life using the Short Form-36 and an empirical study of the relationship between self-warmth, self-coldness and self-esteem on quality of life and disability in a chronic pain population
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Background: Chronic pain conditions particularly fibromyalgia (FM) are an important issue considering the demand that they place on health services and the negative impact on an individual’s well-being. Research regarding what impact FM may have on the various domains of health related quality of life is sparse. In addition, research identifying predictors relating to a person’s self-concept on pain outcomes such as quality of life and disability is scarce in a chronic pain population. Self-esteem has been linked to psychological adjustment in various chronic diseases (Chong et al, 2009) and is suspected to be a vulnerability factor in FM (Johnson et al., 1997; Michielsen et al., 2006). Research on self-compassion found that it is a significant predictor of increased psychological adjustment in people with chronic medical conditions (Wren, Somers, & Wright, 2011). The majority of research on self-compassion has been conducted in non-clinical samples. Identifying the predictive values of self-esteem and the self-compassion subscales (self-warmth and self-coldness) in relation to pain outcomes are useful provided they can be enhanced and utilised to inform intervention. Aims: This research portfolio had two aims, to systematically review and carry out a meta-analysis with the literature investigating the impact of FM on health related quality of life using the Short Form-36 version one and to investigate whether self-warmth, self-coldness and self-esteem act as predictors of quality of life and disability for individuals with chronic pain. Method: A systematic review and meta-analysis of studies which assessed the impact of FM on health related quality of life was undertaken. Sensitivity and subgroup analyses were conducted to address the level of heterogeneity in the studies. The empirical study comprised of a cross-sectional design in which 60 individuals with chronic pain were recruited from three NHS sites based in Fife and Lothian and a pain self-management group in Fife to complete six validated psychometric questionnaires: Self Compassion Scale (Neff, 2003), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Brief Pain Inventory- Short Form (Cleeland, 1991), Pain Disability Questionnaire (Anagnostis, Gatchel, & Mayer, 2004), Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983) and Quality of Life Scale (Burckhardt, Woods, Schultz, & Ziebarth, 2003). Systematic Review Results: In total, 18 studies met the inclusion criteria of the systematic review and demonstrated that the health related quality of life of individuals with FM was lower compared to healthy controls on all eight subdomains of the SF-36 particularly Physical Role. It was found that Social Functioning was the subdomain least affected when comparing participants with FM to healthy controls. Empirical Project Results: Quality of life was lower than previous research with females reporting a higher level of quality of life than males. It was found that after controlling for demographic and clinical variables, self-warmth was the only significant predictor for quality of life but not on levels of disability. Neither self-coldness nor self-esteem were significant predictors on scores of quality of life or disability. Conclusion: The above studies expand literature on the nature of chronic pain and its outcomes such as health related quality of life. The meta-analysis evidenced that HRQoL was lower in individuals with FM than in healthy controls. The association between symptom severity and quality of life requires further investigation in FM. Psychological interventions targeting the development of self-warmth attributes and skills may have a beneficial effect in improving quality of life for people with chronic pain. While the systematic review highlighted that FM has a more significant impact physically rather than mentally in relation to quality of life, both studies highlighted the need for interventions to target the psychological adjustment of people with chronic pain conditions.