An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire.

Measurement and conceptual issues of pain catastrophizing have been raised in the literature. The issues of construct redundancy and measurement overlap have received particular attention, with suggestions that measures of pain catastrophizing are confounded with measures of negative mood, namely depression. The current study sought to investigate these issues in the coping strategies questionnaire-catastrophizing subscale (CSQ-CAT), a widely used measure of pain catastrophizing. Chronic pain patients (n=152) were recruited from the University of Florida pain clinics and completed a battery of psychological measures. Regression analyses indicated that measures of depression, anxiety, and anger accounted for 69% and 19% of the variance in measures of pain catastrophizing and pain, respectively. Trait anger and the cognitive and fearful dimensions of depression and anxiety were uniquely associated with pain catastrophizing. After controlling for measures of negative mood, pain catastrophizing contributed minimally to the prediction of pain. This study suggests that the CSQ-CAT is highly related to measures of negative mood and raises doubts about its measurement of the construct of pain catastrophizing. Results also provide support for theoretical accounts of the relationships between pain catastrophizing, negative mood, and pain. Clinical implications, future research directions, and alternative measures of pain catastrophizing are discussed.     

Sensory,psychological, and metabolic dysfunction in HIV-associated peripheral neuropathy: A cross-sectional deep profiling study

HIV-associated sensory neuropathy (HIV-SN) is a frequent complication of HIV infection and a major source of morbidity. A cross-sectional deep profiling study examining HIV-SN was conducted in people living with HIV in a high resource setting using a battery of measures which included the following: parameters of pain and sensory symptoms (7 day pain diary, Neuropathic Pain Symptom Inventory [NPSI] and Brief Pain Inventory [BPI]), sensory innervation (structured neurological examination, quantitative sensory testing [QST] and intraepidermal nerve fibre density [IENFD]), psychological state (Pain Anxiety Symptoms Scale-20 [PASS-20], Depression Anxiety and Positive Outlook Scale [DAPOS], and Pain Catastrophizing Scale [PCS], insomnia (Insomnia Severity Index [ISI]), and quality of life (Short Form (36) Health Survey [SF-36]). The diagnostic utility of the Brief Peripheral Neuropathy Screen (BPNS), Utah Early Neuropathy Scale (UENS), and Toronto Clinical Scoring System (TCSS) were evaluated. Thirty-six healthy volunteers and 66 HIV infected participants were recruited. A novel triumvirate case definition for HIV-SN was used that required 2 out of 3 of the following: 2 or more abnormal QST findings, reduced IENFD, and signs of a peripheral neuropathy on a structured neurological examination. Of those with HIV, 42% fulfilled the case definition for HIV-SN (n = 28), of whom 75% (n = 21) reported pain. The most frequent QST abnormalities in HIV-SN were loss of function in mechanical and vibration detection. Structured clinical examination was superior to QST or IENFD in HIV-SN diagnosis. HIV-SN participants had higher plasma triglyceride, concentrations depression, anxiety and catastrophizing scores, and prevalence of insomnia than HIV participants without HIV-SN.     

Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance

Sleep disturbance and pain catastrophizing are important mediators of the chronic pain experience. To date, these factors have not been considered concurrently despite compelling theoretical rationale to do so. In the present study, we examined whether pain catastrophizing not only has direct effects on clinical pain and pain-related interference, but also indirect effects through its association with sleep disturbance. We evaluated this hypothesis using a cohort (n=214) of myofascial temporomandibular disorder participants using a statistical bootstrapping technique recommended for tests of indirect effects. Results suggested that pain catastrophizing was associated with greater sleep disturbance, and that a significant portion of variance in clinical pain severity and pain-related interference attributable to pain catastrophizing was mediated by sleep disturbance. Supplementary analyses revealed that the rumination component of catastrophizing seemed to be indirectly related to clinical outcomes through sleep disturbance. No evidence for indirect effects was observed for helplessness and magnification components. These results suggest that rumination about pain may contribute to clinical pain indirectly through alterations in sleep. Prospective studies are needed to examine lagged associations between these constructs. These findings have important theoretical and clinical implications. Critically, interventions that reduce pain catastrophizing may concurrently improve sleep and clinical pain.     

The Relationship Between Cortical Excitability and Pain Catastrophizing in Myofascial Pain

Pain catastrophizing regularly occurs in chronic pain patients. It has been suggested that pain catastrophizing is a stable, person-based construct. These findings highlight the importance of investigating catastrophizing in conceptualizing specific approaches for pain management. One important area of investigation is the mechanism underlying pain catastrophizing. Therefore, this study explored the relationship between a neurophysiological marker of cortical excitability, as assessed by transcranial magnetic stimulation, and catastrophizing, as assessed by the Brazilian Portuguese Pain Catastrophizing Scale, in patients with chronic myofascial pain syndrome. The Pain Catastrophizing Scale is a robust questionnaire used to examine rumination, magnification and helplessness that are associated with the experience of pain. We include 24 women with myofascial pain syndrome. The Brazilian Portuguese Pain Catastrophizing Scale and cortical excitability were assessed. Functional and behavioral aspects of pain were evaluated with a version of the Profile of Chronic Pain scale and by multiple pain measurements (eg, pain intensity, pressure pain threshold, and other quantitative sensory measurements). Intracortical facilitation was found to be significantly associated with pain catastrophizing (β = .63, P = .001). Our results did not suggest that these findings were influenced by other factors, such as age or medication use. Furthermore, short intracortical inhibition showed a significant association with pressure pain threshold (β = .44, P = .04). This study elaborates on previous findings indicating a relationship between cortical excitability and catastrophizing. The present findings suggest that glutamatergic activity may be associated with mechanisms underlying pain catastrophizing; thus, the results highlight the need to further investigate the neurophysiological mechanisms associated with pain and catastrophizing.     

Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation

Numerous studies have found evidence for the role of catastrophizing about pain in adjustment to pain in both adults and children. However, the social context influencing pain and pain behaviour has been largely ignored. Especially in understanding the complexities of childhood pain, family processes may be of major importance. In line with the crucial role of pain catastrophizing in explaining adjustment and disability in adults and children, this study investigates the role of parental catastrophic thinking about their child's pain in explaining child disability and parental distress. To study parental catastrophizing, a parent version of the Pain Catastrophizing Scale (PCS-P) was developed. An oblique three-factor structure emerged to best fit the data in both a sample of parents of schoolchildren (N=205) and in a sample of parents of children with chronic pain (N=107). Moreover, this three-factor structure was found to be invariant across both parent samples. Further, in the clinical sample, parents' catastrophic thinking about their child's pain had a significant contribution in explaining (a) childhood illness-related parenting stress, parental depression and anxiety, and (b) the child's disability and school attendance, beyond the child's pain intensity.     

The influence of communication goals and physical demands on different dimensions of pain behavior

The purpose of the present research was to examine the influence of communication goals and physical demands on the expression of communicative (e.g., facial grimaces) and protective (e.g., guarding) pain behaviors. Participants with musculoskeletal conditions (N=50) were asked to lift a series of weights under two communication goal conditions. In one condition, participants were asked to estimate the weight of the object they lifted. In a second condition, participants were asked to rate their pain while lifting the same objects. The display of communicative pain behaviors varied as a function of the communication goal manipulation; participants displayed more communicative pain behavior when asked to rate their pain while lifting objects than when they estimated the weight of the object. Protective pain behaviors varied with the physical demands of the task, but not as a function of the communication goals manipulation. Pain ratings and self-reported disability were significantly correlated with protective pain behaviors but not with communicative pain behaviors. The results of this study support the functional distinctiveness of different forms of pain behavior. Findings are discussed in terms of evolutionary and learning theory models of pain behavior. Clinical implications of the findings are addressed.     

The effect of catastrophizing and depression on chronic pain--a prospective cohort study of temporomandibular muscle and joint pain disorders

Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and self-limiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and disability. It has been suggested that depression and catastrophizing contributes to TMJD chronicity. This article assesses the effects of catastrophizing and depression on clinically significant TMJD pain (Graded Chronic Pain Scale [GCPS] II-IV). Four hundred eighty participants, recruited from the Minneapolis/St. Paul area through media advertisements and local dentists, received examinations and completed the GCPS at baseline and at 18-month follow-up. In a multivariable analysis including gender, age, and worst pain intensity, baseline catastrophizing (β 3.79, P < 0.0001) and pain intensity at baseline (β 0.39, P < 0.0001) were positively associated with characteristic of pain intensity at the 18th month. Disability at the 18-month follow-up was positively related to catastrophizing (β 0.38, P < 0.0001) and depression (β 0.17, P = 0.02). In addition, in the multivariable analysis adjusted by the same covariates previously described, the onset of clinically significant pain (GCPS II-IV) at the 18-month follow-up was associated with catastrophizing (odds ratio [OR] 1.72, P = 0.02). Progression of clinically significant pain was related to catastrophizing (OR 2.16, P < 0.0001) and widespread pain at baseline (OR 1.78, P = 0.048). Results indicate that catastrophizing and depression contribute to the progression of chronic TMJD pain and disability, and therefore should be considered as important factors when evaluating and developing treatment plans for patients with TMJD.     

Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain

We examined the relationship between catastrophizing and a 3-stage model of pain processing, consisting of pain sensation intensity (stage 1), pain unpleasantness (stage 2), and suffering (stage 3). We studied 310 patients with chronic and severe osteoarthritic knee pain (68.7% female) using 4 competing structural equation models. A strong relationship was found between the suffering construct and its indicators. Of the 4 theoretically plausible models, we found a model with 3 specific pathways of pain sensation leading to the final stage of pain-related suffering. A unique contribution of this study is the integration of catastrophizing into the 3 pain stages. In this model, catastrophizing mediates the relationship between pain-related unpleasantness and suffering, as well as the relationship between sensation and suffering through unpleasantness. Psychological intervention targeting catastrophizing could provide reduction of pain-related suffering that adds to the benefits of therapies directed toward the primary sensory and immediate unpleasant dimensions of pain. These results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain.     

The Role of Perceived Injustice in the Experience of Chronic Pain and Disability: Scale Development and Validation

INTRODUCTION: The primary objective of this research was to evaluate the psychometric properties of a questionnaire designed to assess perceive injustice associated with injury. METHODS: In Study 1, the 12-item Injustice Experience Questionnaire (IEQ) was administered to 226 individuals with musculoskeletal conditions. A subsample of 85 individuals were interviewed 1-year later about their ongoing symptoms and return to work status. In Study 2, the IEQ and other pain-related measures were administered on two separate occasions to 70 pain patients participating in a functional restoration rehabilitation program. RESULTS: -Study 1 Principal components analysis yielded a two-component solution with eigenvalues greater 1. Item content of the two components reflected elements of blame and irreparability of loss. In cross sectional analyses, the IEQ was significantly correlated with measures of catastrophic thinking, r = .75, P < .01, fear of movement/re-injury, r = .58, P < .01, depression, r = .66, P < .01, and pain severity, r = .54, P < .01. Cross-sectional regression analyses revealed that the IEQ, beta = .44, P < .01, and the PCS, beta = .18, P < .05, each contributed significant unique variance to the prediction of pain severity. The IEQ prospectively predicted return to work status, OR = .75, 95% CI = .58-.99, but not pain severity. RESULTS: -Study 2 Analyses supported the test re-test reliability of the IEQ, r = .90, P < .01. Treatment-related changes in the IEQ were significantly correlated with an objective index of improved physical function, r = .51, P < .01. CONCLUSIONS: The findings of these two studies support the construct validity of the IEQ and suggest that this measure might be a useful complement to psychosocial assessment of individuals with persistent pain conditions. Discussion addresses the processes through which perceived injustice might impact on disability and rehabilitation outcomes.     

Responses to pain in school‐aged children with experience in a neonatal intensive care unit: Cognitive aspects and maternal influences

Previously, it was shown that school‐aged (9–14yr) preterm and fullterm children with neonatal pain exposure exhibit elevated heat pain thresholds and heightened perceptual sensitization to tonic painful heat when tested under standard conditions [Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Long‐term alteration of pain sensitivity in school‐aged children with early pain experiences. Pain 2006;125:278–85]. Here, changes in the psychosocial context of pain responses in these children, who had been hospitalized ≥7 days after birth including ≥3 days of treatment in a neonatal intensive care unit (NICU), are reported. Nineteen preterm (≤31 weeks gestational age) and 20 fullterm children (≥37 weeks gestational age) with NICU experience, recruited retrospectively and selected based on strict exclusion criteria, and 20 fullterm control children participated. Preterm NICU children endorsed more pain catastrophizing as compared to controls. Mothers of preterm children, who had been more severely ill and had been hospitalized longer than fullterm NICU children, were more likely to engage in solicitous pain‐related behavior. Maternal influence was also assessed by comparing heat pain thresholds and perceptual sensitization to tonic painful heat obtained in the presence versus absence (i.e. standard testing conditions) of the mother. In all three groups, maternal presence was associated with increased heat pain thresholds. Control children habituated significantly more to tonic heat when their mother was present. The NICU children showed overall significantly less habituation than the controls; there was no modulating effect of maternal presence. Especially in highly vulnerable children such as preterms, neonatal pain exposure and prolonged hospitalization may, aside from neuronal plasticity, promote maladaptive pain‐related cognitions and foster parental behavior that reinforces the child's pain response.