Theory of mind in chronic pain: the relationship between mentalising abilities, pain perception and emotional awareness

Abstract

Introduction: Chronic pain is one of the most prevalent and disabling chronic health conditions affecting people. Based on biopsychosocial model, chronic pain has significant biological, psychological, and social causes and consequences, such as loss of productivity, depressive symptoms, cognitive impairments and social interaction disturbances [1]. The highly increasing evidence shows that this may be due to structural, functional and neurochemical changes. Especially functional connectivity reorganisation in several brain regions and increased activation in certain brain regions such as insula, anterior cingulate cortex (ACC), thalamus, amygdala, prefrontal cortex (PFC) which overlaps with emotion regulation pathways [2]. Aim: Recently, researchers started exploring the association between chronic pain and emotional awareness through alexithymia, which refers to an ineffective identification and expression of one's emotions [3]. Yet very little studies analyse pain impact on Theory of Mind (ToM), or mentalizing – the ability to infer on mental states, such as intentions, beliefs, or emotions in others [4]. Analyzing relationship between pain and mentalising abilities could help to understand pain impact to cognitive-emotional functioning and explain the difficulties in social interactions. The aim of our study was to explore the link between pain characteristics, mentalising and emotional awareness in persons with chronic pain. [...].