Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Design
2.2. Context and Setting
2.3. Research Team
2.4. Participants
2.5. Recruitment and Sampling
2.6. Data Collection Methods
2.7. Data Analysis
- (1)
- Thematic analysis: each transcript was read several times in a reflective process aimed at deepening the engagement with the participants’ stories [53]. This practice of dwelling helped to prevent superficial interpretations. Reflexive journaling and repeated readings of the transcripts supported the researcher in recognizing how their own perspective shaped the interpretation. Rather than attempting to set aside personal assumptions, the researcher engaged in a continuous process of self-reflection in line with Heidegger’s concept of the hermeneutic circle. Data were coded and general categories were identified as part of the final interpretive effort.
- (2)
- Specific episodes were analyzed by re-examining all aspects of the particular situations, including the quotations within each category.
- (3)
- Paradigmatic cases were sought, identifying the examples that captured the essence of a situation in a particularly illustrative way.
2.8. Credibility, Rigor, and Neutrality
3. Results
3.1. Self-Concept and the Experience of Pain
3.1.1. Beliefs About Themselves
“I get nervous about anything.”(Participant 5/1st interview).
“I’m very perfectionist, so I want everything to go very well.”(Participant 8/2nd interview).
“I’m not a conversation person either.”(Participant 4/1st interview).
“These things (worries) you can’t tell a lot of people… Yes, it is just that to find a friend today… Where are the ideal friends? … There are very few people.”(Participant 1/1st interview).
3.1.2. Personal Values
“To be able to stand on my own two feet … not having to depend on anyone.”(Participant 1/1st interview).
“First and foremost, my children, then my husband, then me (on a list of values).”(Participant 3/1st interview).
“At work I am committed, serious above all.”(Participant 7/1st interview).
“On a list of values, sexual ability I would put at the top of the list of what is fundamental.”(Participant 12/1st interview).
3.1.3. Personality Traits
“I’ve always had a bit of a complex about not achieving the level I should have had…”(Participant 11/1st interview).
“We don’t worry about ourselves…, we don’t put our needs first…—First the children, first the husband, first the grandchildren…—We feel unappreciated, we have felt poorly valued.”(Focus group with patients/Reyes Magos HC Center).
“Something happens to me, sometimes I don’t express what I feel, and when I don’t express myself, I feel bad…”(Participant 6/1st interview).
“A very important problem is that people come here for someone to listen to them. They don’t have anyone else to talk to.”(Focus group with healthcare professionals/Nuestra Sª del Pilar HC Center).
3.2. Obligations of Daily Life and the Perception of Pain
“While I am working, children make me feel agitated every day. Then I get home, and my mother is there, and I must take care of her. I’ve spent at least four years taking care of her, nonstop, and with all my energy.”(Participant 3/1st interview).
“Everything piles up for me, daily, I have a hard job, my mother is old, and I must take care of her, and I have a daughter with Asperger’s, and you do not stop, you are under stress all day long. I am in tension all day long.”(Focus group with patients/Juan de Austria HC Center).
“Maybe I’m doing something I should not be doing (at work), and it’s my fault, because there are things that I can refuse to do, but I don’t like to call and ask “hey, send me help…”, I can do it, but then I get angry with myself.”(Participant 7/1st interview).
“And I work, and I don’t stop, and I try to do my best so that everyone is taken care of and happy…”(Participant 9/1st interview).
3.3. Emotional Conflicts Related to CNP
3.3.1. Emotional Strain Resulting from Conflict
“Nevertheless, I have a feeling of uneasiness inside, honestly … I prefer to lose this rather than spoil my relationship with a family member—I’m very clear about that. I prefer to lose out than end up with a sister-in-law who won’t talk to me.”(Participant 2/1st interview).
“I always have to be supportive of him (husband) and take it easy, moving forward. Maybe I always put what’s important to me on the back burner.”(Participant 9/1st interview).
“I feel cheated… With that person I feel cheated …, I feel resentful …, and I restrain myself.”(Participant 11/1st interview).
“One of the things I see is a lot of worry, verbalization about their circumstances, a lot of self-examination… I see people who think too much, people who have obsessive thought, that’s what I find.”(Focus group with healthcare professionals/Reyes Magos HC Center).
3.3.2. Emotions During Conflict
“That afternoon I had a very bad afternoon because my husband said that nothing was wrong, so I felt like crushing him at that moment, I was very angry and worried, honestly, and the pain increased, I endured it and then pain increased even more.”(Participant 2/1st interview).
“And that fear I have … I always fear that something is going to happen at Christmas, like what happened in the past, and I get tense. Right now, I’m tense.”(Participant 8/1st interview).
“I’ve lost all hope and I’ve already lost … I do not care anymore. I have given up. I don’t like it this way, and there’s nothing else.”(Participant 4/1st interview).
3.3.3. Bodily Reactions to Emotional Strain
“Well, a lot of tension is in the back. In all these areas of the shoulder blades and neck (the patient points to the back of the neck, left side and left shoulder), my stomach also gets upset.”(Participant 2/2nd interview).
“Mostly tension in the arms … to be able to lift him up and… Same as a boxer, to lift him up and twist his neck.”(Participant 12/1st interview).
“I’m tense. It happens to me a lot, I have tension in my shoulders when I’m going to talk (about the conflict), and they tell me, don’t get tense, and I don’t realize it, when I talk, I become tense.”(Focus group with patients/Reyes Magos HC Center).
“In addition, in my patients these cervical pains usually appear at a specific point in time, the symptoms coincide when there has been something unpleasant, the children have left, the husband is not around…, something has happened.”(Focus group with healthcare professionals/Reyes Magos HC Center).
3.3.4. Individuals Involved in Conflict
“He’s my partner, he doesn’t believe in depression, he doesn’t believe in that, so he can’t help me. If something happens to me, well, yes, he suffers, but he doesn’t understand what’s happening to me.”(Participant 1/1st interview).
“They don’t understand this. My children say that I am to blame for the entire current situation, yes, the blame… Now they no longer understand me… My children! They told me things that had never been said to me before, besides addressing me with contempt and things like that.”(Participant 6/1st interview).
3.3.5. Conflict Resolution Strategies
“I felt like I put myself down, as if I wasn’t worth anything, as if people were attacking me because I was asking for it … but now, I’m really starting to see my life as it was before those problems. I have to overcome this, I have to appreciate myself, I have to value myself more than I did before… I feel capable, I can take on the world now … valuable, I value myself now more than ever.”(Participant 6/2nd interview).
“Now as a woman I feel very complete, very much valued, starting with myself, of course. And I see that there are many people who love me. I feel much better.”(Participant 8/2nd interview).
4. Discussion
4.1. Self-Concept and the Experience of Pain
4.2. Obligations of Daily Life and Pain Perception
4.3. Emotional Conflicts Related to CNP
4.4. Limitations of This Study
4.5. Implications for Practice and Future Research Directions
- Understand the relationship between physical pain and SP.
- Consider the potential influence of the patient’s interpersonal conflicts on pain perception, including present and past conflicts that the patient may mentally relive or project into the future, particularly if these conflicts are repeated and persist over time.
- Actively inquire about interpersonal conflicts, especially if the patient hints at them or if suspicions arise from her speech.
- Provide assistance to patients experiencing SP or refer them to an appropriate professional for further support.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CNP | Non-specific chronic neck pain |
CP | Chronic pain |
SP | Social pain |
HC | Primary Health Care Center |
Appendix A
1st Interview Stage | Target | Content |
---|---|---|
Start | Introductory question | Welcome and initial greeting. Brief explanation of what will be asked and its objective. Understand the individual’s current feelings and obtain a general overview of their experience with neck pain. |
Development | The perception of pain and its impact | Describe the characteristics, intensity, and impact of neck pain in an individual. |
Stressors related to pain | Explore the presence and sources of stress related to occupational and daily responsibilities, including feelings of being overwhelmed and the impact of interpersonal conflicts. | |
Self-perception | Explore self-identity, personality, and values in the context of chronic pain. | |
Emotional conflicts and pain perception | Explore the relationship between daily conflicts or stressful situations and exacerbation of neck pain. Identify specific triggers, emotional responses during such events, and conflict management strategies. | |
Bodily sensations related to conflicts | Investigate the bodily sensations associated with recalling interpersonal conflicts by guiding the participants to mentally relive these situations, with a focus on the location, quality, and intensity of the somatic experiences. | |
Closing | Final input and acknowledgments | Offer the interviewee the opportunity to add any further information. Thank them for their contribution. |
2nd Interview Stage | Target | Content |
---|---|---|
Start | Introductory question | Welcome and initial greeting. Understand the individual’s current feelings. Obtain a general overview of their experience with neck pain following a physiotherapy treatment. |
Development | Current pain status | Monitor the progression of neck pain over time by assessing the changes since the previous interview. |
Current impact of pain on daily life | Assess the impact of pain-related changes on daily activities and lifestyle. Explore which specific aspects have been affected. Investigate the emotional responses associated with these changes. | |
Current identification of pain sources and underlying causes | Explore significant life changes since the previous assessment that may influence the individual’s pain experience. Identify the individual’s current primary concerns that could be contributing to or exacerbating their pain. | |
Follow-up on emotional conflict and its impact on current pain perception | Evaluate whether the previously discussed conflict remains unresolved or has been resolved. Examine how either condition affects the individual’s pain. Explore the impact of conflict resolution, if applicable, on pain levels and the strategies employed to address the conflict. | |
Closing | Final input and acknowledgments | Offer the interviewee the opportunity to add any further information. Thank them for their contribution. |
Stage | Target | Content |
---|---|---|
Start | Introductory question | Welcome to the participants. Brief explanation of how the session will be conducted. |
Development | Symptoms and relevant aspects in the experience of pain | Identify multidimensional aspects of chronic pain, including its characteristics and quality, associated symptoms, and psychological factors such as fears and worries. Explore the pain’s impact on daily activities, behavioral and mobility changes, factors influencing pain, patient expectations, and their perceived role in treatment and pain progression. |
Pain-related stressors and their impact on pain perception | Examine the stressors that exacerbate pain, the influence of interpersonal relationships on pain perception, and the dynamic interaction between emotional and physical pain. | |
Closing | Final input and acknowledgments | Offer the participants the opportunity to add any further information. Thank them for their contribution. |
Stage | Target | Content |
---|---|---|
Start | Introductory question | Welcome to the participants. Brief explanation of how the session will be conducted. |
Development | Non-specific chronic neck pain | Explore the clinical and behavioral features of the patients with non-specific chronic neck pain, the diagnostic and management approaches in primary care, and the challenges encountered. Examine patient coping strategies and their effectiveness, as well as perceptions of the patients’ roles in their treatment and pain progression. |
Pain-related stressors and their impact on pain perception | Identify the stressors commonly linked to chronic neck pain and their clinical effects. Explore how the patients’ beliefs, emotions, and expectations shape their pain experience and treatment adherence. Discuss the interaction between emotional and physical pain. | |
Professional experience about chronic pain | Address their personal feelings, beliefs, and expectations related to pain. Explore the challenges in managing the psychological and emotional aspects of pain. Identify the communication strategies employed with the patients. Assess the perceived need for further learning in pain management. | |
Closing | Final input and acknowledgments | Offer the participants the opportunity to add any further information. Thank them for their contribution. |
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Participants | Sociodemographic and Clinical Data | ||
---|---|---|---|
Participants with non-specific chronic neck pain (N = 23) | Age | Years M (SD) | 53.9 (14.4) |
Sex | Women N (%) | 31 (75.6%) | |
Men N (%) | 10 (24.4%) | ||
Study level | No studies N (%) | 3 (7.3%) | |
Primary studies N (%) | 21 (51.2%) | ||
High school studies N (%) | 14 (34.2%) | ||
University studies N (%) | 3 (7.3%) | ||
Employment status | Active N (%) | 19 (46.3%) | |
Retired N (%) | 10 (24.4%) | ||
Housewife N (%) | 12 (29.3%) | ||
Goldberg Anxiety and Depression Scale | Likely anxiety N (%) | 29 (70.7%) | |
Likely depression N (%) | 30 (73.2%) | ||
Pain intensity | Visual Analogical Scale (mm) M (SD) | 48.1 (20.7) | |
Healthcare professionals (N = 46) | Profession | Physicians N (%) | 20 (43.5%) |
Nurses N (%) | 22 (47.8%) | ||
Physical therapists N (%) | 4 (8.7%) |
Primary Categories | Subcategories | Codes |
---|---|---|
Self-concept and pain experience | Beliefs about the self | Nervous |
Perfectionists | ||
Having communication issues | ||
Personal values | Family | |
Work | ||
Sexuality | ||
Personality traits | Self-devaluation | |
Need for expression | ||
Need for understanding | ||
Daily life obligations and pain perception | Caring for family members | Caring for family members |
Household chores | Household chores | |
Tending to the ill | Tending to the ill | |
Job | Job | |
Economic issues | Economic issues | |
Emotional conflicts related to CNP | Emotional Strain resulting from Conflict | Lack of self-respect |
Feelings of incomprehension | ||
Worry | ||
Rumination | ||
Lack of control | ||
Inability | ||
Emotions during Conflict | Anger | |
Fear | ||
Resignation | ||
Abandonment | ||
Guilt | ||
Humiliation | ||
Bodily Reactions to Emotional Strain | Neck | |
Shoulders | ||
Head | ||
Arms | ||
Stomach | ||
Individuals Involved in Conflict | Spouses | |
Children | ||
Co-workers | ||
Friends | ||
Conflict Resolution Strategies | Self-respect | |
Self-appreciation | ||
Improving communication |
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Pérez-Martín, Y.; Pérez-Muñoz, M.; Martín-Castro, B.; Nunez-Nagy, S.; Díaz-Pulido, B.; Rodríguez-Costa, I. Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study. J. Clin. Med. 2025, 14, 4748. https://doi.org/10.3390/jcm14134748
Pérez-Martín Y, Pérez-Muñoz M, Martín-Castro B, Nunez-Nagy S, Díaz-Pulido B, Rodríguez-Costa I. Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study. Journal of Clinical Medicine. 2025; 14(13):4748. https://doi.org/10.3390/jcm14134748
Chicago/Turabian StylePérez-Martín, Yolanda, Milagros Pérez-Muñoz, Beatriz Martín-Castro, Susana Nunez-Nagy, Belén Díaz-Pulido, and Isabel Rodríguez-Costa. 2025. "Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study" Journal of Clinical Medicine 14, no. 13: 4748. https://doi.org/10.3390/jcm14134748
APA StylePérez-Martín, Y., Pérez-Muñoz, M., Martín-Castro, B., Nunez-Nagy, S., Díaz-Pulido, B., & Rodríguez-Costa, I. (2025). Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study. Journal of Clinical Medicine, 14(13), 4748. https://doi.org/10.3390/jcm14134748