Action identification in chronic pain: how do people construct meaning in action?

Background: Action Identification Theory holds that every action has different 'levels' of meaning. High levels confer greater meaning and are preferentially sought but when the action is interrupted lower level identities with reduced meaning are elicited. The primary aim of this research was to develop a measure of action identification to investigate the hypothesis that interference to activity caused by chronic pain 'down regulates' levels of action identification thus effectively draining meaning from life. An additional aim was to investigate other factors which influence action identification in chronic pain. Methods: A measure of action identification for pain (AIP) was developed. The AIP was psychometrically evaluated in samples of students. It was administered to 47 chronic pain patients using a forced choice card-sort method. The chronic pain sample also completed the Meaningful Life Measure and measures of pain intensity, pain interference, depression, withdrawal from activity, acceptance and optimism. Results: The AIP demonstrated satisfactory internal consistency and test-retest reliability over 2 to 3 weeks. Data on the inter-correlations between variables are reported. Pain interference negatively correlated with meaning in life and action identification level positively correlated with meaning in life. Multiple regression analyses found that depression and negative mood, acceptance and optimism significantly contributed to variance in meaning in life. Interference and action identification did not. Possible explanations for the results are discussed. Conclusions: The AIP is a promising measure of action identification. Further work is necessary to overcome methodological limitations of the current research to reliably understand the process of action identification in chronic pain. Interventions aimed at increasing acceptance of pain and training optimism may help increase perceived meaning in life in chronic pain.