Repression in chronic pain: An idea worth recovering

Repression, defined as a process by which threatening information is kept o ut of conscious awareness, has long been a topic in the chronic pain litera ture. Emerging in psychodynamic theories, chronic pain is thought to arise from repressed emotions that are converted into physical symptoms; this not ion seems to account for much anecdotal evidence and has received empirical support from work with Minnesota Multiphasic Personality Inventory (Hathaw ay & McKinley, 1943) profiles-particularly the conversion-V. However, the c onstruct validity of this profile among pain patients has been called into question. The emergence of the cognitive-behavioral model of chronic pain i gnited a proliferation of research, but because it rejected psychodynamic p ain theory, investigation of repression was largely suspended. This lapse l eaves unexplained-almost unrecognized-findings that a plurality of chronic pain patients are characterized by constrained emotion, and that repressed, inhibited, and denied negative emotions or traumatic memories have a profo und impact on chronic pain. To address these important phenomena and to rei nvigorate research, three methods are proposed: (a) expand current empirica l clustering procedures, which rely on the Multidimensional Pain Inventory (Kerns, Turk, Rudy, 1985), with measures of defensiveness to isolate patien ts who report high pain/disability and deny negative affect; (b) employ Wei nberger and colleagues' (1979, 1990) "repressive style" to examine the resp onses of repressor pain patients; (c) pursue Pennebaker and colleagues' (19 86, 1988) theory about disclosure of traumatic events to examine effects of inhibition and disinhibition on persistent pain. Although an integrated mo del may be premature, it is argued that repression should receive renewed a ppreciation; it was never really absent, just forgotten.