In search of the person in pain: A systematic review of conceptualization, assessment methods, and evidence for self and identity in chronic pain

• Psychological processes related to self are inconsistently examined in chronic pain.
• Self processes reviewed include evaluative self and self distinctive from evaluation.
• Negative evaluations of self are associated with problems in daily functioning.
• Distinctive self is associated with benefits in daily functioning.
• An integrated model of self is likely to better guide research.

One way to develop psychological approaches to chronic pain is to improve our understanding of psychological processes that both underlie the impacts of pain and can be addressed in treatment. A set of processes that deserves further attention in this regard is those related to self or personal identity. The aim of this systematic review was to examine the conceptualizations of processes related to the self in studies of people with chronic pain, approaches to assess these processes, and the evidence for their role in relation to key measures of daily functioning. Fifteen distinct self-related processes were identified from 54 studies. These processes include three categories: a sense of self that is based on self-evaluation, a sense of self that is based on attributes or self-description, and a sense of self that is detached from these. Different methods, including questionnaires, interviews and experimental approaches were adopted to assess these self-related processes. Relations between self-related processes with daily functioning were examined. The evidence suggests that negative evaluations of the self are particularly associated with problems in daily functioning in people with chronic pain while a sense of self that is distinct from these evaluations is associated with benefit in this functioning. Overall a lack of order or theoretical clarity in the studies included is also identified from the review. It appears, however, that greater order can be achieved by applying the distinction between the conceptualized versus the contextual self from the Psychological Flexibility model.