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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

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Volume 18, Issue 3

“When I feel the worst pain, I look like shit” – body image concerns in persistent pain

Oliver Sündermann
  • Corresponding author
  • Department of Psychology, National University of Singapore, 02-24, 9 Arts Link, 117570 Singapore, Singapore
  • Email
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/ Karin Rydberg
  • Department of Law, Psychology and Social Work, Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden
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/ Ludwig Linder
  • Department of Law, Psychology and Social Work, Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden
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/ Steven James Linton
  • Department of Law, Psychology and Social Work, Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden
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Published Online: 2018-04-17 | DOI: https://doi.org/10.1515/sjpain-2017-0163


Background and aims

Persistent pain is a pervasive condition that is often associated with a distorted body image. Most research into pain and body image investigated neural or physiological correlates (e.g. phantom limb pain), and much less is known about the psychological experience of body image changes in response to pain such as appearance concerns. The aim was to examine body image concerns in people with persistent pain, in particular appearance concerns and related coping behaviours and appearance-related emotions such as anger and shame.


Design was cross-sectional and data was collected through in-depth semi-structured interviews with people suffering from persistent musculoskeletal pain (n=7; six females; age=19–56), and analysed with inductive thematic analysis (TA).


Two main themes were identified: “Relationship to the painful body” and “Dissatisfaction with the body”, each containing three subthemes, along with the side-theme “Appearance concerns affected by pain and mood”. All participants reported appearance concerns, predominantly about their weight and related coping behaviours such as avoidance of mirrors, exercising or dieting and pain-induced mood changes that were associated with a negative body image.


People with persistent pain report appearance concerns, often related to pain-induced negative mood changes, and reduced functioning. It remains unclear to what extent attitudes towards the body change over time in accordance with pain. A wider concept of body image is required, including the perception of reduced functioning, related appraisals (e.g. “I look weak and old”) and appearance investment.

Keywords: body image; persistent pain; appearance concerns; qualitative research


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About the article

Received: 2017-11-14

Revised: 2018-03-11

Accepted: 2018-03-18

Published Online: 2018-04-17

Published in Print: 2018-07-26

Authors’ statements

Research funding: The study was supported by a grant from The Swedish Foundation for Humanities and Social Sciences.

Conflict of interest: None.

Informed consent: All participants provided written consent to their participation.

Ethical approval: The study was approved by the Regional Ethics Board, Uppsala (2015/480/1).

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 379–388, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2017-0163.

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