Chronic pain patients' perceptions of their future: a verbal fluency task

Depression is a common feature of chronic pain, but the content of depressed cognitions in groups with chronic pain may be qualitatively different from other depressed groups. Future thinking has been extensively studied in depressed population; however, to our knowledge, this is the first study to investigate future thinking, using a verbal fluency task, in chronic pain. This study investigated the content of cognitions about the future, which are postulated to be a key mechanism in the development of clinical depression, but have not been studied in groups with chronic pain. This study used the future thinking task to investigate general future thinking and health-related future thinking in 4 groups of participants: those with pain and concurrent depression, those with pain without depression, those with depression without pain, and healthy control participants. One hundred seventy-two participants generated positive and negative future events, and rated the valence and likelihood of these events. Responses were coded for health-related content by 2 independent raters. Participants with depression (with and without pain) produced more negative and less positive future events than control participants. Participants with pain (depressed and nondepressed) produced more positive health-related future events than control participants. Participants with depression and pain produced more negative health-related future events than the nondepressed pain group. The findings suggest that participants with pain and depression exhibit a cognitive bias specific to negative aspects of health-related future thinking. This focus facilitates understanding of the relationship between depression and pain processing. The implications for therapeutic interventions are discussed.