An Experimental Approach to Examining Psychological Contributions to Multisite Musculoskeletal Pain

Abstract

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...

Knee Pain and Structural Damage as Risk Factors for Incident Widespread Pain: Data From the Multicenter Osteoarthritis Study

“…In an experimental study using delayed onset muscle soreness in a young, healthy population, Niederstrasser 28 reported that the initial pain intensity experienced with the fatiguing eccentric exercise was not predictive of WSP 24 hours later. However, the healthy sample, the acute, temporary nature of the initial pain stimulus, and the short time frame to evaluate for onset of WSP, are not necessarily relevant to the population or the chronic pain stimulus associated with OA.…”

Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain

“…On the contrary, patients suffering from medical comorbidities seem to be more prone to poor mental health, emotional distress, and insomnia. [36] Also, Niederstrasser et al [37] demonstrated that pain catastrophizing and fear of pain increased the risk of multisite pain following experimentally induced musculoskeletal injury. Therefore, patients with medical comorbidities or multisite musculoskeletal pain may be closely linked to a high level of pain catastrophizing.…”

Comparison of operant escape and reflex tests of nociceptive sensitivity

“…Inescapable nociceptive stimulation such as this is stressful, and it produces freezing behavior. Freezing occurs under conditions of fear (Rau and Fanselow, 2009), which increases pain sensitivity (Niederstrasser et al, 2014) and generates phenomena consistent with post-traumatic stress disorder (PTSD; Yamamoto et al, 2009). Thus, freezing occurs when pain sensitivity is increased, and yet hyporeflexia is observed, because of interference with the motor component of flexion/withdrawal (Finn et al, 2006).…”

“…A fast-developing literature has established that anxiety states such as catastrophizing are potent determinants of the presence of human pain and its intensity (Jovanovic and Norrholm, 2011;Parr et al, 2012;Niederstrasser et al, 2014;Schreiber et al, 2014). Thus, chronic stress can generate certain chronic pain conditions (e.g., fibromyalgia and post-traumatic stress disorder), without obvious participation by other mechanisms (Gupta, 2013;Moeller-Bertram et al, 2014;Vierck, 2006b).…”