Abstract
Background: The relationship between Obsessive-Compulsive Disorder (OCD) and Chronic Pain is a presently under-researched area. This study aimed to explore the prevalence and impact of OCD, investigated through both OCD 'caseness' and obsessive-compulsive symptoms (OC-S), among individuals with Chronic Pain attending community-based Pain Management Services in New Zealand.
Methods: This study was conducted through a mixed-method approach using a convergent parallel framework, with information gathered and analysed in two strands. The study's quantitative strand employed survey methods to analyse the interactions between OC-S, as measured by the Obsessive Compulsive Inventory-Revised, and a range of pain-associated psychosocial and clinical outcomes for 103 participants at the time of their starting a Pain Management Service programme. Seventy-seven participants then went on to complete follow-up measures at the end of their individual Pain Management Service programmes to analyse relationships between OC-S and clinical outcomes related to pain severity and interference. The qualitative strand employed in-depth, one-on-one, semi-structured interviews, guided by an Interpretative Phenomenological Analysis (IPA) approach. This explored the lived experiences of eight interviewees with co-existing Chronic Pain and OCD/OCD 'caseness' who had recently completed a Pain Management Programme.
Results: A significant variability was found between the participant-reported diagnosis of OCD (2%) and OCD 'caseness' based on symptom screening (36%). This is suggestive of OCD/OC-S being a more prevalent concern in the Chronic Pain population within New Zealand, than is presently recognised. Quantitative analysis also revealed that elevated OC-S were associated with increased pain severity, significant pain catastrophisation, and a distinct pattern of healthcare utilisation. The relationship with pain-associated life interference and self-efficacy was more complex. The impact of OC-S on clinical outcomes at the completion of Pain Management Service programmes was unclear, although findings were tentatively suggestive of higher OC-S possibly being associated with a greater potential for improvement through pain-rehabilitation programmes.
Qualitative findings identified three superordinate themes: 'A Horrible Road', 'I Have Limits Now', and 'A Hidden Issue'. The indication through these themes was of an interaction and battle between the physical and functional limitations arising from pain, with that of long-established OC-S, contributing to challenges related to uncertainty and loss of control. Compulsive behaviours, in this context were often paradoxically used to enable coping. OC-S was highlighted as a consistently under-recognised factor within the interviewees' pain contexts, contributing to challenges in pain-directed interventions.
Conclusion: This research provides intriguing evidence that OCD and its associated symptoms represent a potentially significant, yet largely unrecognised, factor in the experience of Chronic Pain. The findings highlight the importance of routine screening for OC-S in pain management settings and suggest that addressing these symptoms may be crucial for supporting effective pain rehabilitation. Further research is warranted to clarify and expand upon these exploratory findings.