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The present study examined the prospective value of pain catastrophizing, fear of pain, and depression in the prediction of multisite musculoskeletal pain following experimentally induced delayed onset muscle soreness (DOMS). The study sample consisted of 119 (63 females, 56 males) healthy university students. Measures of pain catastrophizing, fear of pain and depression were completed prior to the DOMS induction procedure. Analyses revealed that pain catastrophizing, and fear of pain prospectively predicted the experience of multisite pain following DOMSinduction. Analyses also revealed that women were more likely to experience multisite pain than men. There was no significant relation between depressive symptoms and the experience of multisite pain. The discussion addresses the mechanisms by which pain catastrophizing and fear of pain might contribute to the spreading of pain. Clinical implications of the findings are also addressed.Key words: multisite pain, fibromyalgia, catastrophizing, fear of pain, depression, sex differences.Highlight points: Pain catastrophizing, and fear of pain prospectively predict the experience of multisite pain following DOMS-induction.Women are more likely to experience multisite pain than men.Depressive symptoms have no influence on the experience of multisite pain.Fear of pain may underlie the experience of multisite pain through generalization. Psychology of multisite pain 3Recent research indicates that musculoskeletal pain frequently occurs at more than one anatomical site 6, 9, 47 . A survey of patients attending general practice clinics revealed that three quarters of chronic pain patients reported pain in more than one site 6 . Multisite pain has been associated with poorer prognosis as indicated by heightened susceptibility to chronicity, increased health and mental health problems and greater disability 11, 32, 33, 38 . In light of the high prevalence and increased costs associated with multisite pain, clinical researchers have called for more research on risk factors and determinants of multisite pain 33, 38 .Psychological factors such as pain catastrophizing, fear of pain and depression have been discussed as possible risk factors the development of multisite pain 4, 9 .Although it has been suggested that psychological variables might play a role in the onset or maintenance of multisite pain, the correlational nature of clinical studies precludes strong statements about causality. On the basis of research conducted to date, it cannot be ruled out that psychological variables such as pain catastrophizing, fear of pain and depression might be consequences rather than antecedents of multisite pain.The present study used an experimental approach to address the possible antecedent status of psychological variables in the experience of multisite pain. One advantage of using an experimental approach is that putative psychosocial risk factors can be assessed prior to pain induction, thereby permitting examination of the antecedent status of the variables. In addi...

Objectives Previous research has shown that sensitivity to movement-evoked pain is associated with higher scores on self-report measures of disability in individuals who have sustained whiplash injuries. However, it remains unclear whether sensitivity to movement-evoked pain is associated with work-disability. The aim of the present study was to examine the relation between sensitivity to movement-evoked pain and occupational status in individuals receiving treatment for whiplash injury. Methods A sample of 105 individuals with whiplash injuries participated in a testing session where different measures of pain (i.e. spontaneous pain, multi-site pain, sensitivity to movement-evoked pain) were collected during the performance of a simulated occupational lifting task. Results Hierarchical logistic regression analysis revealed that the measures of multisite pain and sensitivity to movement-evoked pain made significant independent contributions to the prediction of work-disability. Discussion The findings suggest that including measures of multisite pain and sensitivity to movement evoked pain in assessment protocols has the potential to increase the value of pain assessments for the prediction of occupational disability associated with whiplash injury. Clinical and theoretical implications of the findings are addressed.

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The present study examined whether 1) placebo hypoalgesia can be generated through implicit associative learning (ie, conditioning in the absence of conscious awareness) and 2) the magnitude of placebo hypoalgesia changes when expectations about pain are made explicit. The temperature of heat pain stimuli was surreptitiously lowered during conditioning trials for the placebo cream and the magnitude of the placebo effect was assessed during a subsequent set of trials when the temperature was the same for both placebo and control conditions. To assess whether placebo hypoalgesia could be generated from an implicit tactile stimulus, a 2 × 2 design was used with direction of cream application as one factor and verbal information about which cream was being applied as the second factor. A significant placebo effect was observed when participants received verbal information about which cream was being applied but not following implicit conditioning alone. However, 87.5% of those who showed a placebo response as the result of implicit conditioning were able to accurately guess the order of cream application during the final trial, despite a lack of awareness about the sensory manipulation and low confidence in their ratings, suggesting implicit learning in some participants. In summary, implicit associative learning was evident in some participants but it was not sufficient to produce a placebo effect suggesting some level of explicit expectation or cognitive mediation may be necessary. Notably, the placebo response was abolished when expectations were made explicit, suggesting a delicate interplay between attention and expectation.

Objective To investigate the: (1) role of basic muscle pain sensitivity and psychological factors in the prediction of movement-evoked pain (MEP) following delayed onset muscle soreness (DOMS), and (2) association of MEP with changes in systemic muscle pain sensitivity following DOMS induction. Methods Fifty-one participants were assigned to either eccentric resistance exercise or control groups. They completed questionnaires evaluating psychological distress and underwent muscle pain sensitivity evaluation by the pressure pain threshold (PPT) test at the exercised and remote muscles, before and 24 hours following the intervention. MEP intensity was determined in response to lifting a 3kg canister using a visual analogue scale (VAS). Results The exercise group demonstrated MEP intensity of 5/10 on VAS and reduced PPTs at the main exercised muscle (p<0.001). A regression tree analyses revealed that the level of anxiety trait predicted a higher MEP intensity. A secondary analysis showed that 53% participants who were DOMS responders (MEP > mild intensity; ≥ 3/10 VAS) exhibited decreased PPTs in the exercised (p<0.001) and remote (p = 0.027) muscles following eccentric exercise. Characterization of DOMS responders revealed that, at baseline, they had lower PPTs in the exercised (p = 0.004) and remote (p = 0.001) muscles and reported higher psychological distress i.e., anxiety trait and depression symptoms (p<0.05), compared to non-responders. A regression analysis revealed that lower PPT or high levels of anxiety trait increased the probability to become a responder (p = 0.001). Conclusions Susceptibility to MEP following DOMS is determined by muscle pain hypersensitivity and high levels of anxiety trait. MEP at the early stage of DOMS is linked with an increase in systemic muscle pain sensitivity suggestive of central mechanisms. This knowledge is valuable in translating science into clinical musculoskeletal pain management.

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