Worry and chronic pain: a misdirected problem solving model.

An important human faculty is our ability to verbally ruminate on possible negative outcomes and plot methods of avoidance or escape. In his novel ‘Saturday’ Ian McEwan succinctly captures the features of worry that make it psychologically relevant to our consideration of chronic pain. First, worry is related to the perceived threat of danger; second, we worry not about what was but about what might be (it is future orientated); third, it functions to promote avoidance; fourth, it is exacerbated when external competition for attention is low (e.g., at night) and finally, it can be hard to control, going unchecked by reason, logic, or self-persuasion. In this topical review we argue that worry is a valuable construct for investigation of the cognitive reality of chronic pain. We begin by defining the construct of worry and map its boundaries within the larger field of fear and anxiety. Next, we apply worry to chronic pain describing how it operates within the context of pain and dis-