The term attachment is used in psychology to characterize a person’s ability to maintain closeness with another person. Based on personal history and life experience, attachment can become secure or insecure. Studies have shown that a secure attachment style can positively impact the ability to tolerate and manage pain. Studies have also shown that the reverse is true of an insecure attachment style.

Psychological Component

With burn wounds among the most painful injuries a person can experience, and the pain occurring not only during the initial infliction, but potentially increasing during the treatment process, Jennifer E. Nyland, PhD, and colleagues developed a study to explore the impact of a person’s attachment style on their experience of
burn wound pain. In the Journal of Burn Care & Research, they wrote, “The study builds upon… past work to investigate specifically how attachment style affects the experience of acute burn pain.”

The study enrolled 141 acute burn survivors whose electronic medical records were accessed from the time of burn unit admission. Pain severity was assessed using the Pain Intensity Rating Scale (PIRS). Daily analgesic medication level was also considered an indirect measure of pain. To streamline this calculation, opioids were
converted to IV morphine equivalent daily dose (MEDD).

Attachment Styles

The Relationship Questionnaire (RQ) was used to determine one of four attachment style of each participant:
Dr. Nyland and colleagues examined each attachment style individually as well as via two groups: secure and insecure.

Using the RQ to measure attachment style, 46.8% of participants were classified as secure and 53.2% as insecure, with a further breakdown of 19.1% as fearful, 8.5% as preoccupied, and 25.5% as dismissing.

Analysis of variance (ANOVA) was conducted using the four attachment styles as categorical variables and the two continuous pain variables (ie,reported pain score based on PIRS and MEDD administration).

Significantly Lower MEDDs With Secure Attachment

ANOVA results were statistically significant when average MEDD administration was analyzed as the dependent variable and RQ-based attachment style was analyzed as the independent variable (P=0.02). The Fisher’s method least significant difference analyses indicated statistically significant differences in MEDD administration between participants with secure and fearful attachment styles (P=0.005) and between the those with secure and preoccupied attachment styles (P=0.04; Figure). Participants with a secure attachment style required significantly lower MEDD administration than participants with an insecure attachment style (ie, fearful, preoccupied, and dismission combined; P=0.005). An average daily administration of 33.18±21.74 MEDD was reported for participants with a secure attachment style, compared with 44.66±25.35 MEDD for
those with an insecure attachment style.

There was no significant effect produced when comparing verbal pain scores (VPS) using PIRS across the four attachment styles as the independent variable. When the dichotomous variable of participants with secure attachment style was compared with participants with insecure attachment style, VPS were significantly lower in participants with secure attachment style (P=0.04). Burn-related characteristics were found to have no bearing on the results as determined by a series of t-tests, the study authors noted.

A Patient-Centered Approach

“For burn patients specifically, good pain management should include the use of pharmacological and nonpharmacological treatment modalities to be able to meet the multifaceted needs of this patient population,” wrote Dr. Nyland and colleagues, adding that “a patient-centered approach—with a goal of learning to self-manage pain rather than focus on being pain free—may best meet the needs of burn patients.”