Type D Personality, and Stigma in Myofascial Pain Syndrome

Gulseren Demir Karakilic

Status: Completed

Conditions: Chronic Neck Pain; Quality of Life; Stigma; Type D Personality; Cervical Myofascial Pain Syndrome; Anxiety and Depression; Psychological Distress

Study type: Observational

Funder types: Other

Identifiers

NCT07292155

2025-GOKAEK-2513_2025.07.02505

Details and patient eligibility

About

Cervical myofascial pain syndrome is a chronic musculoskeletal condition characterized by the presence of sensitive trigger points and taut muscle bands, resulting in localized or referred pain, muscle stiffness, and limited range of motion. The disorder frequently leads to functional limitations and a reduction in quality of life. Although the physical features of cervical myofascial pain syndrome have been well documented, its psychological and social dimensions have not been adequately explored. Personality traits and social factors may influence pain perception, coping mechanisms, and treatment adherence. Type D personality, also known as distressed personality, is defined by the coexistence of negative emotions and social inhibition and has been associated with worse outcomes in various chronic diseases. Stigma represents another psychosocial factor that may contribute to disability and emotional distress in chronic pain conditions.

This case-control study aims to investigate the prevalence of Type D personality traits and anticipated stigma among patients with cervical myofascial pain syndrome compared with healthy individuals. The study further explores the relationships between personality type, stigma, and clinical and psychological parameters, including anxiety, depression, disability, and health-related quality of life. Findings are expected to support a more comprehensive, biopsychosocial understanding of cervical myofascial pain syndrome and emphasize the importance of psychological screening and social support in clinical management.

Full description

Cervical myofascial pain syndrome is a non-inflammatory pain disorder associated with painful trigger points in skeletal muscles of the neck and shoulder region. It is characterized by regional pain, restricted neck mobility, muscle tightness, fatigue, and autonomic symptoms such as increased sweating or dizziness. The condition is common among adults, particularly women, and often coexists with other chronic pain syndromes such as tension-type headache or fibromyalgia. Because there are no specific laboratory or imaging tests, diagnosis is based on detailed clinical examination and symptom evaluation. The persistence of pain can lead to emotional distress, sleep disturbance, and significant impairment in daily activities.

Personality and psychosocial factors are known to play important roles in chronic pain perception and coping. Type D personality, defined by the presence of both negative affectivity and social inhibition, has been shown to negatively influence health behaviors and quality of life in several chronic disorders. Individuals with this personality type tend to experience anxiety, irritability, and social withdrawal, which may exacerbate pain-related disability and emotional burden. Another relevant factor is stigma, which refers to social devaluation or exclusion based on illness. Patients with chronic pain may internalize stigma, leading to shame, reduced help-seeking behavior, and decreased treatment adherence. Despite its relevance, stigma has not been investigated in patients with cervical myofascial pain syndrome. This study seeks to fill that gap by assessing both Type D personality and anticipated stigma in this patient population.

Materials and Methods

This case-control study was conducted between July 2025 and October 2025 at the Departments of Neurology and Physical Medicine and Rehabilitation, Bozok University Faculty of Medicine, Yozgat, Turkey. Ethical approval was obtained from the Bozok University Clinical Research Ethics Committee (Approval No: 2025-GOKAEK-2513_2025.07.02_505). All participants provided written informed consent before inclusion.

Participants

The study included outpatients aged 18 to 65 years who were clinically diagnosed with cervical myofascial pain syndrome for at least six months. Diagnosis was made according to established clinical criteria, including localized pain at rest, referred pain from a palpable taut band, a hypersensitive tender spot within the affected muscle, and restricted range of motion. The control group consisted of healthy volunteers matched by age, sex, and education level. Exclusion criteria included systemic diseases, rheumatologic or neurologic disorders, psychiatric conditions such as schizophrenia or bipolar disorder, cervical disc herniation, radiculopathy, myelopathy, and use of psychotropic medication.

Data Collection and Instruments

Demographic and clinical data were recorded using a structured questionnaire that included information on age, sex, marital status, educational level, occupation, and disease duration. Participants completed a set of standardized, validated instruments administered face-to-face by trained healthcare professionals:

Headache Impact Test (HIT-6): Assesses the degree to which headaches affect daily activities, including pain intensity, social and cognitive functioning, and emotional well-being. Higher scores indicate greater impact.

Neck Disability Index (NDI): Measures the extent to which neck pain interferes with everyday activities such as reading, working, sleeping, and recreation.

Hospital Anxiety and Depression Scale (HADS): Evaluates symptoms of anxiety and depression over the previous week through two subscales.

Type D Personality Scale (TDPS): A 14-item instrument assessing negative affectivity and social inhibition. Scores equal to or higher than ten on both subscales indicate the presence of Type D personality traits.

Chronic Illness Anticipated Stigma Scale (CIASS): A 12-item scale assessing expected stigma from family and friends, the workplace, and healthcare providers. Each item is rated on a five-point Likert scale, with higher scores representing greater perceived stigma.

Short Form-36 Health Survey (SF-36): Evaluates health-related quality of life across eight domains, including physical functioning, vitality, social functioning, and mental health. Higher scores denote better perceived health status.

Enrollment: 54 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

Adults aged 18 to 65 years.

Patients diagnosed with cervical myofascial pain syndrome according to Travell and Simons criteria:

1. localized pain at rest,
2. referred pain or altered sensation in the typical referral zone of a trigger point,
3. a palpable taut band containing a hypersensitive tender spot, and
4. restricted range of motion of the affected muscle.

Duration of symptoms for at least six months.

Outpatients followed in the Department of Physical Medicine and Rehabilitation.

Voluntary participation and provision of written informed consent.

Healthy control participants matched by age, sex, and education, without musculoskeletal or systemic diseases.

Exclusion criteria

History of cervical disc herniation, radiculopathy, or myelopathy.

Presence of systemic or rheumatologic diseases.

Current psychiatric or neurological disorders such as schizophrenia, bipolar disorder, dementia, epilepsy, autism, or intellectual disability.

Use of psychotropic medication or ongoing psychiatric treatment.

History of major surgery or trauma involving the cervical region.

Pregnancy or lactation.

Inability to complete questionnaires due to cognitive or language barriers.

Refusal or withdrawal of informed consent.

Trial design

54 participants in 2 patient groups

Cervical Myofascial Pain Syndrome Group

Description:

This group includes adults between 18 and 65 years of age who were clinically diagnosed with cervical myofascial pain syndrome for at least six months. Participants were evaluated at the Departments of Neurology and Physical Medicine and Rehabilitation at Bozok University. Each participant completed a detailed clinical and psychosocial assessment using standardized questionnaires, including the Headache Impact Test, the Neck Disability Index, the Hospital Anxiety and Depression Scale, the Type D Personality Scale, the Chronic Illness Anticipated Stigma Scale, and the Short Form 36 Health Survey. These assessments were used to evaluate pain severity, neck-related disability, emotional status, personality traits, perceived stigma, and quality of life.

Healthy Control Group

Description:

This group includes healthy volunteers who were matched to the patient group by age, sex, and education level. Individuals in this group did not have any musculoskeletal, rheumatologic, neurological, or psychiatric disorders. They completed the same assessment battery as the patient group, including the Headache Impact Test, the Neck Disability Index, the Hospital Anxiety and Depression Scale, the Type D Personality Scale, the Chronic Illness Anticipated Stigma Scale, and the Short Form 36 Health Survey, in order to allow direct comparison of psychological and functional characteristics between groups.