Cognitive appraisal and coping in chronic pain patients

Objectives: This study analyses the relationships between patients’ cognitive appraisals concerning their pain and the coping strategies they use. In addition, the way the coping strategy influences the intensity of perceived pain and impairment in these patients was studied. Methods: One hundred and twenty two patients with musculoskeletal chronic pain participated. The assessment tools were as follows: The Cognitive Appraisal Inventory for Chronic Pain Patients (CAI), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ) and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. Results: High levels of challenge appraisal were associated with low levels of passive coping and high levels of active coping strategies, whereas the harm, loss or threat appraisal predicted high use of passive coping strategies. Passive coping had three statistically significant path coefficients: high levels of passive coping were associated with low levels of functioning and high levels of pain intensity and impairment. However, high levels of active coping reported high levels of daily functioning. Discussion: By analysing the cognitive appraisals made by chronic pain patients, clinicians could make better predictions regarding the way they cope and adjust.     

Self-Efficacy and Chronic Pain Outcomes: A Meta-Analytic Review

A meta-analysis was performed to evaluate overall strengths of relation between self-efficacy (SE) and functioning (pain severity, functional impairment, affective distress) in chronic pain samples, as well as potential moderating effects of sociodemographic characteristics and methodologic factors on these associations. In sum, 86 samples (N = 15,616) fulfilled selection criteria for analysis. SE had negative overall correlations with impairment, affective distress, and pain severity although considerable heterogeneity was observed for all effect sizes. Age, pain duration, SE scale content (SE for functioning despite pain vs SE for pain control vs SE for managing other symptoms such as emotional distress) and type of impairment measure (self-report vs task performance) had significant moderating effects on SE–impairment associations. SE–affective distress relations were moderated by employment status and SE scale content. Finally, moderator analyses of studies having longitudinal designs indicated associations between baseline SE, and each outcome at follow-up remained significant in prospective studies that had statistically controlled for effects of baseline responses on that outcome. Hence, SE is a robust correlate of key outcomes related to chronic pain and a potentially important risk/protective factor that has implications for subsequent functioning in affected groups.PerspectiveMeta-analysis indicated that SE has significant overall associations with impairment, affective distress, and pain severity within chronic pain samples and identified several factors that contribute to variability in effect sizes. Findings highlighted SE as a robust correlate and potentially important risk/protective factor for subsequent adjustment in affected groups.     

Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain

Pain appraisals are closely tied to pain and functional outcomes. Pain-related injustice and pain catastrophizing appraisals have both been identified as important cognitive-emotional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes – as primary predictors and intermediary variables – little is known about whether they operate as independent or parallel mediators of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Exploratory analyses of specific quality of life domains indicated that injustice mediated the relationship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes.PerspectivePain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treatments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing.     

Exposure to Contact Sports Results in Maintained Performance During Experimental Pain

During pain, motor performance tends to decline. However, athletes who engage in contact sports are able to maintain performance despite the inherent pain that accompanies participation. This may be the result of being challenged rather than threatened by pain; adaptive coping strategies; habituation to pain; or finding pain less bothersome. This study aimed to measure performance of a novel motor task both in pain and not in pain within experienced contact athletes (n = 40), novice contact athletes (n = 40), and noncontact athletes (n = 40). Challenge and threat perceptions were manipulated during the pain condition and measures of pain tolerance, perception, coping styles, and bothersomeness were taken. Results indicated that contact athletes, regardless of experience, were able to maintain their performance during painful stimulation. Noncontact athletes, conversely, performed significantly worse during pain stimulation. In addition, contact athletes tended to be more challenged and the noncontact athletes more threatened within the pain condition. Experienced contact athletes demonstrated higher levels of pain tolerance and direct coping, and reported lower levels of pain bothersomeness and intensity than the other groups. The results suggest that even relatively brief exposure to contact sports may be enough to help maintain performance in pain. Being in a challenged state appears to be an important factor during performance in pain. Moreover, pain tolerance, intensity, and bothersomeness may differentiate novice and experienced athletes.PerspectiveExposure to voluntary pain and challenge states are associated with adaptive responses to pain. Motor task performance may be maintained in individuals with more experience of sports-related pain.     

Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: differential effects as a function of sex

Sex-related differences in the experience of clinical and experimental pain have been widely reported. Females are at elevated risk for developing several chronic pain conditions and women demonstrate greater sensitivity to noxious stimulation in the laboratory. However, relationships between responses to experimental noxious stimuli and the experience of clinical pain have not been well characterized. One previous study of healthy adults indicated that pain threshold and tolerance were associated with clinical pain among women but not men (i.e. females with lower pain threshold and tolerance reported more clinical pain). In the present investigation, relationships between pain tolerance and outcomes of treatment for chronic pain were evaluated in a sex-dependent manner. Ischemic pain tolerance was assessed prior to treatment in 171 chronic pain patients completing a pain management program. Outcomes were measured as changes in pain severity, affect, and pain-related disability. Over the course of treatment, women demonstrated greater improvement in pain-related disability while men showed more reduction in pain. Ischemic pain tolerance was related to outcome in a sex-specific fashion. Women with higher pain tolerances showed greater improvement in pain, more reduction in pain-related interference, and more increases in activity level than women with lower pain tolerances. In contrast, pain tolerance was not associated with positive treatment outcomes among men. These results indicate that experimental pain responses may be most clinically relevant for women, and that sex differences may exist in the determinants of pain-treatment outcomes.     

The Role of Mood States Underlying Sex Differences in the Perception and Tolerance of Pain

Abstract:   While sex differences in pain reporting are frequently observed, the reasons underlying these differences remain unclear. The present study examined sex differences in self-report and physiological measures of pain threshold and tolerance following the administration of two laboratory pain-induction tasks. The primary study aim centered on determining whether repeated exposure to such tasks would yield sex differences in terms of pain threshold and tolerance. In addition, it was hypothesized that if such differences did exist, negative mood states might account for changes in pain ratings, threshold, and/or tolerance in subsequent exposure to noxious stimuli. Recruited from a convenience sample, 66 participants (44 female and 22 male) were exposed to both thermal and cold noxious stimuli at three separate times, while psychophysiological and self-report data were collected. Because women outnumbered men 2:1, Fisher z transformations were performed to determine whether the observed associations between mood states and pain ratings differed. We found stronger associations between fatigue and thermal-heat pain ratings for men at their first and third exposure to the pain task compared to women ( z  = 2.11, P  < 0.05; z  = 3.14, P  < 0.001, respectively). Results indicated that women evidenced greater pain tolerance than men on both a behavioral and physiological level; however, they reported greater pain severity than men. Fatigue was also found to be particularly important to reports of pain severity in men and pain tolerance in response to noxious stimuli for women. Possible pathways in which mood states influenced these endpoints are discussed.     

Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain

Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N?=?137) —51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals.Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.     

Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain

Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, M_age=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain.PerspectiveAnger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.     

Injustice Appraisal,but not Pain Catastrophizing,Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain

Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies.PerspectiveMore frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.     

Pain Self‐Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain

The purpose of this study was to investigate cross‐sectional associations of pain self‐efficacy and fear of movement with pain intensity and disability in Italian patients with chronic low back pain (CLBP). One hundred and three adult outpatients with nonspecific CLBP were included in the study. Socio‐demographic and clinical characteristics were assessed, together with Italian versions of self‐reported questionnaires to measure the four constructs of interest. Multiple linear regression models were built with psychosocial constructs as main determinants, and pain intensity and disability as outcomes. Potential confounding of socio‐demographic and clinical characteristics was assessed. Pain self‐efficacy and fear of movement displayed moderate correlations with pain intensity (r = ?0.41 and 0.42, respectively) and disability (?0.55 and 0.54). Association models adjusted for pain intensity showed that both pain self‐efficacy (β = ?0.35, 95% CI = ?0.5; ?0.2, R² = 41%) and fear of movement (β = 0.65, 95% CI = 0.36; 0.93, R² = 40%) are significantly and strongly associated with disability. Pain self‐efficacy was no longer significantly associated with pain intensity when disability was added as a confounder to the model, whereas fear of movement retained its significant association (β = 0.06, 95% CI = 0.00;0.11, R² = 30%). No other variables acted as confounders in these associations. Pain self‐efficacy and fear of movement are very similarly associated with main outcomes in this sample of Italian patients with CLBP. The results of this study suggest that both psychosocial constructs should be considered in clinical management. Future studies should investigate whether these findings can be replicated in other samples, in longitudinal designs and if other variables not measured in this study confound the associations.     

Pain perception studies in tension-type headache

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders.     

Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain

OBJECTIVE: Pain-related coping strategies, especially catastrophizing, play an influential role in shaping pain responses. However, although numerous studies have examined the impact of catastrophizing on chronic pain outcomes, relatively few have evaluated relationships between individual differences in pain-related catastrophizing and pain perception, with most of those studies examining only pain threshold or pain tolerance. We assessed, for the first time, catastrophizing's association with the magnitude of temporal summation of pain, a primary marker for central nervous system sensitizability. METHODS: Thirty-eight healthy young women underwent standardized experimental pain testing, followed by administration of a brief questionnaire that assessed catastrophizing cognitions during the pain-testing session. RESULTS: Higher levels of pain-related catastrophizing were related to higher suprathreshold pain ratings and greater temporal summation of thermal pain, suggesting that catastrophizing may play a facilitatory role in the processing of pain-related information, though the specific pathways underlying this facilitation are not clear. CONCLUSIONS: These preliminary findings highlight the importance of coping in shaping individuals' responses to noxious stimuli, and suggest that interventions that decrease pain catastrophizing may reduce the burden of acute and chronic pain.     

Coping predictors of children's laboratory-induced pain tolerance, intensity, and unpleasantness.

This study examined coping predictors of laboratory-induced pain tolerance, intensity, and unpleasantness among 244 healthy children and adolescents (50.8% female; mean age, 12.73 +/- 2.98 years; range, 8-18 years). Participants were exposed to separate 4-trial blocks of pressure and thermal (heat) pain stimuli, as well as 1 trial of cold pain stimuli. Strategies for coping with pain were measured using the Pain Coping Questionnaire (PCQ). Linear regression analyses were conducted to examine the associations between the 8 PCQ subscales and pain responses (pain tolerance, intensity, and unpleasantness) to all 3 pain tasks, controlling for age and sex. We found that internalizing/catastrophizing predicted higher pain intensity across the 3 pain tasks and higher cold pain unpleasantness; seeking emotional support predicted lower pressure pain tolerance; positive self-statements predicted lower pressure pain intensity and lower cold pain intensity and unpleasantness; and behavioral distraction predicted higher pressure pain tolerance and lower heat pain unpleasantness. These results suggest that in healthy children, internalizing/catastrophizing, and seeking emotional support may be conceptualized as pain-prone coping strategies, and positive self-statements and behavioral distraction as pain-resistant coping strategies within the context of laboratory pain. PERSPECTIVE: These results support investigation of interventions with children that aim to reduce acute pain responses by modifying coping to reduce seeking of emotional support and catastrophizing and enhance the use of positive self statements and behavioral distraction.     

Trait Perceived Injustice Is Associated With Pain Intensity and Pain Behavior in Participants Undergoing an Experimental Pain Induction Procedure

Recent research has revealed robust cross-sectional and prospective associations among perceived injustice, pain, disability, and depressive symptoms in patients with chronic pain. To date, research has proceeded from the assumption that perceived injustice arises as a consequence of debilitating injury or illness. However, it is possible that perceived injustice might have trait-like characteristics, persisting even in the absence of an injustice-related eliciting event. The aim of the present study was to develop and test a measure of trait perceived injustice (Trait Injustice Experience Questionnaire [T-IEQ]). The item content of the T-IEQ was drawn from the original IEQ and adapted for relevance to a noninjury context. A sample of 118 healthy undergraduates completed the T-IEQ, measures of just world belief, and trait forgiveness prior to participating in an experimental pain procedure. Pain intensity, pain behavior, and emotional responses were recorded during the painful induction. The T-IEQ had good internal consistency and test−retest reliability. The validity of the T-IEQ was supported by significant associations with measures of just world belief and trait forgiveness. The T-IEQ was also associated with pain intensity, pain behavior, and ratings of sadness and anger. Anger mediated the relation between the T-IEQ and pain outcomes. The results of the present study suggest that individuals vary in their trait-like propensity to experience negative life events as unjust and that trait perceived injustice contributes to adverse pain outcomes.PerspectiveThe present findings suggest that perceived injustice might reflect an enduring tendency to experience negative life events as unjust. The findings also suggest that trait perceived injustice is associated with higher ratings of pain intensity and anger and more pronounced displays of pain behavior.     

Effects of threatening information on interpersonal responses to pain

Emerging evidence indicates that meanings attributed to pain contribute to tolerance and coping among affected individuals. However, links between pain appraisals and coping responses have received little attention within a broader interpersonal context. In this experiment, effects of appraisal on pain tolerance and coping were examined in adult dyads. Eighty‐six acquaintance/friend pairs were randomly assigned to the role of Participant in a cold pressor test (CPT) or observer–helper who assisted in coping. Before the task, pairs in the threat condition read about frostbite symptoms and consequences, while those in the reassurance condition read about the safety of the task. In a mixed condition, Participants and Observers read the reassurance and threat passage, respectively. Between‐groups analyses revealed threat group participants had lower pain tolerance and reported less cognitive coping than did participants in other appraisal conditions. Threat group observers reported less attention diversion, coping self‐statements and ignoring in helping their partner than did reassured observers. Pain language was also most prominent in transactions of threatened dyads. Finally, use of attention diversion by observers contributed to pain tolerance, independent of participant factors (reported pain, appraisal condition, reported coping) and pain language in conversations during immersions. The study highlights how appraisal contributes not only to pain tolerance and coping in the affected individual but also to care‐giving efforts of others in their social environment.     

Changes in Pain-Related Coping Strategies and Their Importance for Treatment Outcome Following Multimodal Inpatient Treatment: Does Sex Matter?

While sex differences in pain-related coping have been widely reported, little is known on sex differences in changes in coping following multimodal pain treatment and how these changes relate to treatment outcome. The present prospective study therefore aimed to investigate sex differences in coping strategies between boys and girls with chronic pain prior to multimodal inpatient treatment and at 3-month follow-up. Sixty-four boys and 103 girls with various pain disorders were evaluated. Core outcomes (pain intensity and pain-related disability) and coping were assessed via validated questionnaires. At admission, boys and girls used similar coping strategies. Three months following treatment, boys and girls decreased passive pain coping and seeking social support while they maintained the degree of positive self-instruction. Girls displayed higher seeking social support than boys and of importance, only for girls, a reduction in seeking social support was related to decreases in pain intensity. In both groups, the changes in coping were related to positive treatment outcome. Results suggest that both groups may benefit from reductions in passive pain coping and seeking social support. The causal quality of this relationship remains to be determined in future studies. Gender-role expectations and family interactions may account for the sex differences demonstrated for seeking social support.PerspectiveBoys and girls with chronic pain show profound similarities in pain-related coping strategies prior and after multimodal pain treatment. The changes in coping are related to positive treatment outcomes. Sex-specific treatment strategies for changing seeking social support may need to be developed and tested for their differential efficacy in boys and girls.     

Postoperative Pain in Children: Association Between Anxiety Sensitivity,Pain Catastrophizing,and Female Caregivers' Responses to Children's Pain

This study investigated the association between anxiety sensitivity and pain catastrophizing in children, caregivers' anxiety sensitivity and catastrophizing about children's pain and responses to children's pain, pain intensity reported by children, and pain intensity estimated by caregivers. The participants were 102 children scheduled for outpatient surgery and their female caregivers. Before the operation, caregivers' catastrophizing about children's pain, children's pain catastrophizing, and their anxiety sensitivity were assessed, as well as caregivers' responses to children's pain. Pain intensity reported by children and estimated by caregivers was evaluated after the operation and 24 hours afterward. Analyses were performed via path analysis. The results indicated that children and caregivers characterized by higher levels of anxiety sensitivity reported higher levels of pain catastrophizing and catastrophic thinking about children's pain, respectively. Caregivers with higher levels of catastrophic thinking about the children's pain reported higher levels of solicitousness and higher estimations of the children's pain intensity after the operation. Higher levels of children's pain catastrophizing were associated with more frequent responses of discouragement and higher pain intensity reported after the operation. These findings highlight the relevance of catastrophizing about children's pain and children's pain catastrophizing in the experience of postoperative pain in children.PerspectivePath analysis was used to test a hypothetical model of the associations between anxiety sensitivity, catastrophizing, parental responses, and postoperative pain in children. The results highlight the association between children's and parents' pain catastrophizing and discouragement and solicitous responses and the role of anxiety sensitivity as a traitlike factor associated with catastrophizing.     

Ethnic differences in responses to multiple experimental pain stimuli

A growing body of literature suggests that the experience of clinical pain differs across ethnocultural groups. Additionally, some evidence indicates greater sensitivity to experimentally induced pain among African Americans; however, most studies have included only one pain modality. This study examined ethnic differences in responses to multiple experimental pain stimuli, including heat pain, cold pressor pain, and ischemic pain. Heat pain threshold and tolerance, ratings of repetitive suprathreshold heat, and ischemic and cold pressor pain threshold and tolerance were assessed in 120 (62 African American, 58 white) healthy young adults. Also, several psychological instruments were administered. No ethnic group differences emerged for threshold measures, but African Americans had lower tolerances for heat pain, cold pressor pain and ischemic pain compared to whites. Ratings of intensity and unpleasantness for suprathreshold heat stimuli were significantly higher among African Americans. African Americans reported greater use of passive pain coping strategies and higher levels of hypervigilance. Controlling for passive pain coping did not account for group differences in pain responses, while controlling for hypervigilance rendered group differences in heat pain tolerance and ischemic pain tolerance non-significant. These findings demonstrate differences in laboratory pain responses between African Americans and whites across multiple stimulus modalities, and effect sizes for these differences in pain tolerance were moderate to large for suprathreshold measures. Hypervigilance partly accounted for group differences. Additional research to determine the mechanisms underlying these effects is warranted.     

Validation of the Pain Resilience Scale in a Chronic Pain Sample

Psychosocial factors that protect against negative outcomes for individuals with chronic pain have received increased attention in recent years. Pain resilience, or the ability to maintain behavioral engagement and regulate emotions as well as cognitions despite prolonged or intense pain, is one such factor. A measure of pain-specific resilience, the Pain Resilience Scale, was previously identified as a better predictor of acute pain tolerance than general resilience. The present study sought to validate this measure in a chronic pain sample, while also furthering understanding of the role of pain resilience compared with other protective factors. Participants with chronic pain completed online questionnaires to assess factors related to positive pain outcomes, pain vulnerability, pain intensity, and quality of life. A confirmatory factor analysis confirmed the 2-factor structure of the Pain Resilience Scale previously observed among respondents without chronic pain, although one item from each subscale was dropped in the final version. For this chronic pain sample, structural equation modeling showed that pain resilience contributes unique variance to a model including pain acceptance and pain self-efficacy in predicting quality of life and pain intensity. Further, pain resilience was a better fit in this model than general resilience, strengthening the argument for assessing pain resilience over general resilience.