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Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

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Abstract

Catastrophizing about pain is related to elevated pain severity and poor adjustment among chronic pain patients, but few physiological mechanisms by which pain catastrophizing maintains and exacerbates pain have been explored. We hypothesized that resting levels of lower paraspinal muscle tension and/or lower paraspinal and cardiovascular reactivity to emotional arousal may: (a) mediate links between pain catastrophizing and chronic pain intensity; (b) moderate these links such that only patients described by certain combinations of pain catastrophizing and physiological indexes would report pronounced chronic pain. Chronic low back pain patients (N = 97) participated in anger recall and sadness recall interviews while lower paraspinal and trapezius EMG and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded. Mediation models were not supported. However, pain catastrophizing significantly interacted with resting lower paraspinal muscle tension to predict pain severity such that high catastrophizers with high resting lower paraspinal tension reported the greatest pain. Pain catastrophizing also interacted with SBP, DBP and HR reactivity to affect pain such that high catastrophizers who showed low cardiovascular reactivity to the interviews reported the greatest pain. Results support a multi-variable profile approach to identifying pain catastrophizers at greatest risk for pain severity by virtue of resting muscle tension and cardiovascular stress function.

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References

  • Arena, J. G., Sherman, R. A., Bruno, G. M., & Young, T. R. (1991). Electromyographic recordings of low back pain subjects and non-pain control is six different positions: Effects of pain levels. Pain, 45, 23–28.

    Article  PubMed  CAS  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    PubMed  CAS  Google Scholar 

  • Bragdon, E. E., Light, K. C., Costello, N. L., Sigurdsson, A., Bunting, S., Bhalang, K., & Maixner, W. (2002). Group differences in pain modulation: Pain-free women compared to pain-free men and to women with TMD. Pain, 96, 227–237.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Carlson, C. R., & McCubbin, J. A. (1992). The relationship between pain sensitivity and blood pressure in normotensives. Pain, 48, 463–467.

    Article  PubMed  CAS  Google Scholar 

  • Bruehl, S., & Chung, O. Y. (2004). Interactions between the cardiovascular and pain regulatory systems: An updated review of mechanisms and possible alterations in chronic pain. Neuroscience and Biobehavioral Reviews, 28, 395–414.

    Article  PubMed  Google Scholar 

  • Bruehl, S., Chung, O. Y., Ward, P., Johnson, B., & McCubbin, J. A. (2002). The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: The effects of opioid blockade. Pain, 100, 191–201.

    Article  PubMed  CAS  Google Scholar 

  • Bruehl, S., McCubbin, J. A., & Wilson, J. F. (1994). Coping styles, opioid blockade, and cardiovascular response to stress. Journal of Behavioral Medicine, 17, 25–40.

    Article  PubMed  CAS  Google Scholar 

  • Burns, J. W. (1995). Interactive effects of traits, states, and gender on cardiovascular reactivity during different situations. Journal of Behavioral Medicine, 18, 279–303.

    Article  PubMed  CAS  Google Scholar 

  • Burns, J. W. (2006a). The role of attentional strategies in moderating links between acute pain induction and subsequent emotional stress: Evidence for symptom specific reactivity among chronic pain patients versus healthy nonpatients. Emotion, 6, 180–192.

    Article  PubMed  Google Scholar 

  • Burns, J. W. (2006b). Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients. Emotion, 6, 309–319.

    Article  PubMed  Google Scholar 

  • Burns, J. W., Bruehl, S., & Quartana, P. J. (2006). Anger management style and hostility among patients with chronic pain: Effects on symptom-specific physiological reactivity during anger- and sadness-recall interviews. Psychosomatic Medicine, 68, 786–793.

    Article  PubMed  Google Scholar 

  • Burns, J. W., Kubilus, A., & Bruehl, S. (2003). Emotion induction moderates effects of anger. Management style on acute pain sensitivity. Pain, 106, 109–118.

    Article  PubMed  Google Scholar 

  • Burns, J. W., Wiegner, S., & Derleth, M. (1997). Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models. Health Psychology, 16, 319–326.

    Article  PubMed  CAS  Google Scholar 

  • Dimsdale, J. E., Stern, M. J., & Dillon, E. (1988). The stress interview as a tool for examining physiological reactivity. Psychosomatic Medicine, 50, 64–71.

    PubMed  CAS  Google Scholar 

  • Edwards, L., McIntyre, D., Carroll, D., Ring, C., France, C. R., & Martin, U. (2003). Effects of artificial and natural baroreceptor stimulation on nociceptive responding and pain. Psychophysiolgy, 40, 762–769.

    Article  Google Scholar 

  • Edwards, L., Ring, C., McIntyre, D., & Carroll, D. (2001). Modulation of the human nociceptive flexion reflex across the cardiac cycle. Psychophysiology, 38, 712–718.

    Article  PubMed  CAS  Google Scholar 

  • Edwards, R. R., & Fillingim, R. B. (2005). Styles of pain coping predict cardiovascular functioning following a cold pressor test. Pain Research and Management, 10, 219–222.

    PubMed  Google Scholar 

  • Feldman, P. J., Cohen, S., Lepore, S. J., Matthews, K. A., Kamarck, T. W., Marsland, A. L. (1999). Negative emotions and acute physiological responses to stress. Annals of Behavioral Medicine, 21, 216–222.

    Article  PubMed  CAS  Google Scholar 

  • Fields, H. L. (1987). Pain. New York: Raven.

    Google Scholar 

  • Flor, H., Birbaumer, N., Schugens, M. M., & Lutzenberger, W. (1992). Symptom- specific psychophysiological responses in chronic pain patients. Psychophysiology, 29, 452–460.

    Article  PubMed  CAS  Google Scholar 

  • Flor, H., Birbaumer, N., Schulte, W., & Roos, R. (1991). Stress-related electromyographic responses in patients with chronic temporomandibular pain. Pain, 46, 145–152.

    Article  PubMed  CAS  Google Scholar 

  • Flor, H., Turk, D. C., & Birbaumer, N. (1985). Assessment of stress-related psychophysiological reactions in chronic back pain patients. Journal of Consulting and Clinical Psychology, 53, 354–364.

    Article  PubMed  CAS  Google Scholar 

  • Fridlund, A. J., & Cacioppo, J. T. (1986). Guidelines for human electromyographic research. Psychophysiology, 23, 567–589.

    Article  PubMed  CAS  Google Scholar 

  • George, S. Z., Wallace, M. R., Wright, T. W., Moser, M. W., Greenfield, W. H. 3rd, Sack, B. K., Herbstman, D. M., & Fillingim, R. B. (in press) Evidence for a biopsychosocial influence on shoulder pain: Pain catastrophizing and catechol-O-methyltransferase (COMT) diplotype predict clinical pain ratings.

  • Ghione, S. (1996). Hypertension-associated hypalgesia: Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences. Hypertension, 28, 494–504.

    PubMed  CAS  Google Scholar 

  • Hirsh, A. T., George, S. Z., & Riley, J. L. (2007). An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire. European Journal of Pain, 11, 75–81.

    Article  PubMed  Google Scholar 

  • Kamarck, T. W., Shiffman, S. M., Smithline, L., Goodie, J. L., Paty, J. A., Gnys, M., & Jong, J. Y. (1998). Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: Daily life consequences of recurring stress in a multiethnic adult sample. Health Psychology, 17, 17–29.

    Article  PubMed  CAS  Google Scholar 

  • Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The west Haven-Yale multidimensional pain inventory (WHYMPI). Pain, 23, 345–356.

    Article  PubMed  CAS  Google Scholar 

  • Lundberg, U., Dohns, I. E., Melin, B., Sandsjo, L., Palmeund, G., Kadefors, R., Ekstron, M., & Parr, D. (1999). Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. Journal of Occupational Health Psychology, 4, 245–255.

    Article  PubMed  CAS  Google Scholar 

  • Lundberg, U., Kadefors, R., Melin, B., Palmeund, G., Hassmen, P., Engstrom, M., & Dohns, I. E. (1994). Psychophysiological stress and EMG activity of the trapezius muscle. International Journal of Behavioral Medicine, 1, 354–370.

    Article  PubMed  CAS  Google Scholar 

  • Mense, S. (1993). Nociception from skeletal muscle in relation to clinical muscle pain. Pain, 54, 241–289.

    Article  PubMed  CAS  Google Scholar 

  • Michael, E. S., & Burns, J. W. (2004). Catastrophizing and pain sensitivity among chronic pain patients: Moderating effects of sensory and affect focus. Annals of Behavioral Medicine, 27, 185–194.

    Article  PubMed  Google Scholar 

  • Neumann, S. A., & Waldstein, S. R. (2001). Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender. Journal of Psychosomatic Research, 50, 245–253.

    Article  PubMed  CAS  Google Scholar 

  • Prkachin, K. M., Williams-Avery, R. M., Zwaal, C., & Mills, D. E. (1999). Cardiovascular changes during induced emotion: An application of Lang’s theory of emotional imagery. Journal of Psychosomatic Research, 47, 255–267.

    Article  PubMed  CAS  Google Scholar 

  • Rau, H., & Elbert, T. (2001). Psychophysiology of arterial baroreceptors and the etiology of hypertension. Biological Psychiatry, 57, 179–201.

    Article  CAS  Google Scholar 

  • Seminowicz, D. A., & Davis, K. D. (2006). Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain, 120, 297–306.

    Article  PubMed  Google Scholar 

  • Sjegaard, G., Lundberg, U., & Kudefors, R. (2000). The role of muscle activity and mental load in the development of pain and degenerative processes of the muscle cell level during computer work. European Journal of Applied Physiology, 83, 99–105.

    Article  Google Scholar 

  • Spanos, N. P., Radtke-Bodorik, L., Ferguson, J. D., & Jones, B. (1979). The effects of hypnotic susceptibility suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain. Journal of Abnormal Psychology, 3, 282–292.

    Article  Google Scholar 

  • Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524–532.

    Article  Google Scholar 

  • Sullivan, M. J. L., & D’Eon, J. L. (1990). Relation between catastrophizing and depression in chronic pain patients. Journal of Abnormal Psychology, 99, 260–264.

    Article  PubMed  CAS  Google Scholar 

  • Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17, 52–64.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This research was supported in part by Grants NS37164 from the National Institute of Neurological Disorders and Stroke and MH071260 from the National Institute of Mental Health (John W. Burns, Ph.D.), and NS046694 and NS050578 from the National Institute of Neurological Disorders and Stroke (Stephen Bruehl, Ph.D. and Ok Y. Chung, M.D., M.B.A.).

The authors gratefully acknowledge the generosity, help and cooperation of the staff at the Pain & Rehabilitation Clinic of Chicago, without which this study would not have been possible.

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Wolff, B., Burns, J.W., Quartana, P.J. et al. Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models. J Behav Med 31, 105–114 (2008). https://doi.org/10.1007/s10865-007-9138-z

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  • DOI: https://doi.org/10.1007/s10865-007-9138-z

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