Pain Catastrophizing and Fear of Pain predict the Experience of Pain in Body Parts not targeted by a Delayed-Onset Muscle Soreness procedure (original) (raw)
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Pain-related fear and avoidance of physical exertion following delayed-onset muscle soreness
PAIN, 2011
The current study examined the relationship between pain-related fear, physical performance, and painrelated interference in the context of experimentally induced pain to the lower back. Thirty healthy participants completed a test of maximal trunk strength before and after induction of delayed-onset muscle soreness (DOMS) to the trunk extensors. Pain-related fear (Tampa Scale of Kinesiophobia and Pain Anxiety Symptom Scale) was assessed prior to DOMS induction, and measures of current pain and pain-related interference with life activities were obtained 1 day after DOMS induction. As predicted, pain-related fear was not related to strength production prior to DOMS induction. However, following DOMS induction, pain-related fear predicted reduced maximal strength production, individual decrement in maximal strength performance, and increased pain-related interference in life activities. Current pain intensity and anthropometric factors did not contribute significantly to these outcome measures. To our knowledge, this is the first study to identify the impact of pain-related fear on physical performance among a healthy group of individuals following experimental acute low back injury. The findings extend previous research on psychological variables and simulated injury, and suggest that pain-related fear may be an important vulnerability factor in development of disability following acute pain experience.
The Journal of Pain, 2008
Pain-related fear and catastrophizing are important variables of consideration in an individual's pain experience. Methodological limitations of previous studies limit strong conclusions regarding these relationships. In this follow-up study, we examined the relationships between fear of pain, pain catastrophizing, and experimental pain perception. One hundred healthy volunteers completed the Fear of Pain Questionnaire (FPQ-III), Pain Catastrophizing Scale (PCS), and Coping Strategies Questionnaire-Catastrophizing scale (CSQ-CAT) before undergoing the cold pressor test (CPT). The CSQ-CAT and PCS were completed again following the CPT, with participants instructed to complete these measures based on their experience during the procedure. Measures of pain threshold, tolerance, and intensity were collected and served as dependent variables in separate regression models. Sex, pain catastrophizing, and pain-related fear were included as predictor variables. Results of regression analyses indicated that after controlling for sex, pain-related fear was a consistently stronger predictor of pain in comparison to catastrophizing. These results were consistent when separate measures (CSQ-CAT vs. PCS) and time points (pre-task vs. "in-vivo") of catastrophizing were used. These findings largely corroborate those from our previous study and are suggestive of the absolute and relative importance of pain-related fear in the experimental pain experience. Perspective-Although pain-related fear has received less attention in the experimental literature than pain catastrophizing, results of the current study are consistent with clinical reports highlighting this variable as an important aspect of the experience of pain.
The Journal of Pain, 2003
This investigation assessed the relationships among recalled, expected, and actual muscle pain intensity and unpleasantness during a period of 48 hours. We hypothesized that (1) specific expectations of pain after 24 hours would account for a significant amount of variance in actual pain, (2) recalled pain from the most recent episode of naturally occurring muscle pain would be significantly associated with expected pain, and (3) the accuracy of expectations (ie, the difference between expected and actual pain) would increase across time as the onset of muscle pain occurred. Ninetyfive students completed 3 sessions. In Session 1, recalled muscle pain and expected muscle pain in the next 24 hours were collected before exercise. In Sessions 2 and 3, muscle pain during movement and expected pain in the next 24 hours were collected. Recalled muscle pain was associated with expectations at baseline, r values ؍ .26 to .47, P < .05. The accuracy of expected intensity increased during the study, t ؍ 3.20, P < .01, and the accuracy of expected unpleasantness was associated with change in expected unpleasantness, r values ؍ ؊.28, P < .01. The amount of variance in actual intensity and unpleasantness accounted for by expectations increased up to 55% and 52%, respectively, during the study. Expected unpleasantness did not account for variance in actual intensity. Expected intensity accounted for 3% of the variance in actual unpleasantness, but only in the second 24-hour period. Thus, our hypotheses were generally supported, but unanticipated findings regarding changes across time in the relationships among recalled, expected, and actual muscle pain were also detected.
BMC Musculoskeletal Disorders, 2011
Background: Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). Methods: Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. Results: NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion: These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.
Development of the Fear of Pain Questionnaire-III
Journal of Behavioral Medicine, 1998
Fear and/or anxiety about pain is a useful construct, in both theoretical and clinical terms. This article describes the development and refinement of the Fear of Pain Questionnaire (FPQ), which exists in its most current form as the FPQ-III. Factor analytic refinement resulted in a 30-item FPQ-III which consists of Severe Pain, Minor Pain, and Medical Pain subscales. Internal consistency and test-retest reliability of the FPQ-III were found to be good. Four studies are presented, including normative data for samples of inpatient chronic pain patients, general medical outpatients, and unselected undergraduates. High fear of pain individuals had greater avoidance/escape from a pain-relevant Behavioral Avoidance Test with Video, relative to their low fear counterparts, suggesting predictive validity. Chronic pain patients reported the greatest fear of severe pain. Directions for future research with the FPQ-III are discussed, along with general comments about the relation of fear and anxiety to pain.
Pain, 2006
Pain-related fear and pain catastrophizing are associated with disability and actual performance in chronic pain patients. In acute low back pain (LBP), little is known about the prediction of actual performance or perceived disability by pain-related fear and pain catastrophizing. This experimental, cross-sectional study aimed at examining whether pain-related fear and pain catastrophizing were associated with actual performance and perceived disability. Ninety six individuals with an episode of acute LBP performed a dynamic lifting task to measure actual performance. Total lifting time was used as outcome measure. The results show that pain-related fear, as measured with the Tampa Scale for Kinesiophobia, was the strongest predictor of this physical task. Using the Roland Disability Questionnaire as a measure of perceived disability, both pain-related fear and pain catastrophizing, as measured with the Pain Catastrophizing Scale, were significantly predictive of perceived disability and more strongly than pain intensity was. The results of the current study suggest that pain-related fear is an important factor influencing daily activities in individuals suffering an episode of acute LBP. The study results have important clinical implications, especially in the development of preventive strategies for chronic LBP. q
PAIN, 2013
Recent evidence indicates that pain-related fear can be acquired through associative learning. In the clinic, however, spreading of fear and avoidance is observed beyond movements/activities that were associated with pain during the original pain episode. One mechanism accounting for this spreading of fear is stimulus generalization. In a voluntary movement-conditioning paradigm, healthy participants received predictable pain (ie, one movement predicts pain, another does not) in one context, and unpredictable pain in another context. The former procedure is known to induce cued pain-related fear to the painful movement, whereas the latter procedure generates contextual pain-related fear. In both experimental pain contexts, we subsequently tested fear generalization to novel movements (having either proprioceptive features in common with the original painful movement or nonpainful movement). Results indicated that in the predictable pain context, pain-related fear spreads selectively to novel movements proprioceptively related to the original painful movement, and not to those resembling the original nonpainful movement. In the unpredictable context, nondifferential fear generalization was observed, suggesting persistent contextual pain-related fear and poor safety learning. These data illustrate that spreading of pain-related fear is fostered by previously acquired movement-pain contingencies. Based on recent advances in anxiety research, we proposed an innovative approach conceptualizing predictable pain as a laboratory model for fear of movement in regional musculoskeletal pain, and unpredictable pain generating contextual pain-related fear as a prototype of widespread musculoskeletal pain. Consequently, fear generalization might play an important role in spreading of pain-related fear and avoidance behavior in regional and widespread musculoskeletal pain.
European Journal of Pain, 2006
Three fundamental fears -anxiety sensitivity (AS), injury/illness sensitivity (IS) and fear of negative evaluation (FNE) -have been proposed to underlie common fears and psychopathological conditions. In pain research, the relation between AS and (chronic) pain processes was the subject of several studies, whereas the possible role of IS has been ignored. The current research examines the role of IS with respect to various pain-related variables in two studies. In the first study, 192 healthy college students completed the Sensitivity Index (SI; a composite measure assessing the three fundamental fears) and various pain-related questionnaires. In a second study, 60 students out of the original sample took part in a pain induction procedure and completed the SI as well. We first examined the properties of the SI. Factor analysis on the SI replicated the proposed factor structure [Taylor S. The structure of fundamental fears, J Behav Ther Exp Psychiat 1993;24:289-99]. However, some items of the ASI did show problematic loadings and were therefore excluded in subsequent analyses. The main hypothesis of the current study states that IS is a stronger predictor than AS of pain catastrophizing and fear of pain as assessed by self-report measures, and of pain tolerance and anticipatory fear of pain as assessed in a pain induction study. This hypothesis could be confirmed for all variables, except for pain tolerance, which was not predicted by any of the three fundamental fears. The current study can be considered as an impetus for devoting attention to IS in future pain research.
Manipulation of pain catastrophizing: An experimental study of healthy participants
Journal of Pain Research, 2008
Pain catastrophizing is associated with the pain experience; however, causation has not been established. Studies which specifi cally manipulate catastrophizing are necessary to establish causation. The present study enrolled 100 healthy individuals. Participants were randomly assigned to repeat a positive, neutral, or one of three catastrophizing statements during a cold pressor task (CPT). Outcome measures of pain tolerance and pain intensity were recorded. No change was noted in catastrophizing immediately following the CPT (F (1,84) = 0.10, p = 0.75, partial η 2 Ͻ 0.01) independent of group assignment (F (4,84) = 0.78, p = 0.54, partial η 2 = 0.04). Pain tolerance (F (4) = 0.67, p = 0.62, partial η 2 = 0.03) and pain intensity (F (4) = 0.73, p = 0.58, partial η 2 = 0.03) did not differ by group. This study suggests catastrophizing may be diffi cult to manipulate through experimental pain procedures and repetition of specifi c catastrophizing statements was not suffi cient to change levels of catastrophizing. Additionally, pain tolerance and pain intensity did not differ by group assignment. This study has implications for future studies attempting to experimentally manipulate pain catastrophizing.
Pain, 1999
This experiment was set up to test the hypothesis that confrontation with feared movements would lead to symptom-speci®c muscular reactivity in chronic low back pain patients who report high fear of movement/(re)injury. Thirty-one chronic low back pain patients were asked to watch a neutral nature documentary, followed by a fear-eliciting video-presentation, while surface electromyography (EMG) recordings were made from the lower paraspinal and the tibialis anterior muscles. It was further hypothesized that negative affectivity (NA) would moderate the effects of fear on symptom-speci®c muscular reactivity, as well as the effects of muscular reactivity on pain report. The results were partly as predicted. Unexpectedly, paraspinal EMG-readings decreased during video-exposure but this decrement tended to be less in fearful patients than in the non-fearful patients. Negative affectivity did not moderate this effect, but moderated the effect of painrelated fear on muscular reactivity of lower leg muscles. In addition, NA directly predicted muscular reactivity in the right tibialis anterior muscle. As predicted, there was a signi®cant covariation between left paralumbar muscular activity and pain report. This association was moderated by NA, but in the opposite direction. The ®ndings extend the symptom-speci®city model of psychophysiological reactivity, and support the idea that pain-related fear perpetuates pain and pain disability through muscular reactivity.