Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models.

Burns, John W.; Wiegner, Sandra; Derleth, Martha; Kiselica, Kathleen; Pawl, Ronald P.

doi:10.1037/0278-6133.16.4.319

Cited by 34 publications

(29 citation statements)

References 24 publications

(49 reference statements)

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“…Results support this kind of multi-variable approach. Burns et al (1997) found that the significant but modest main effect between depressed mood and chronic pain severity was moderated by stress-induced lower paraspinal reactivity, such that the highest chronic pain was reported by chronic low back pain patients with high levels of depressed mood and who showed high levels of lower paraspinal reactivity. Patients with high depressed mood but who were not strong lower paraspinal muscle reactors reported pain comparable to patients with low depressed mood.…”

Section: Introductionmentioning

confidence: 96%

“…The procedure was adapted from Dimsdale et al (1988). The anger and sadness recall procedures elicit significant muscle tension, SBP, DBP and HR reactivity (Burns et al 1997;Burns 2006b). Moreover, findings tell that both anger and sadness recall interviews elicit self-reported valence and arousal in expected directions (Burns et al 2003;Neumann and Waldstein 2001).…”

Section: Emotion-induction Interviewsmentioning

confidence: 99%

“…Burns and colleagues (Burns 2006a;Burns et al 1997) found that lower paraspinal reactivity to psychological stress was related to reports of day-to-day chronic pain severity among chronic low back pain patients, whereas trapezius tension (muscles distal from the source of pain) was not. Lundberg (1994Lundberg ( , 1999 found that people with trapezius myalgia and substantial neck/shoulder pain evinced higher levels of trapezius muscle tension during work than people without.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, chronic low back pain patients can be expected to show aberrant stressinduced muscular responses specific to the disorder; that is, exaggerated contraction of muscles in the low back (i.e., lower paraspinals). Findings support symptom-specificity models among low back pain patients (Arena et al 1991;Burns 2006a;Flor et al 1991Flor et al , 1992 and those with neck and shoulder pain (Lundberg et al 1994(Lundberg et al , 1999, and suggest that frequent or sustained stress-induced tension of muscles specific to a disorder may maintain and aggravate existing chronic pain.Burns and colleagues (Burns 2006a;Burns et al 1997) found that lower paraspinal reactivity to psychological stress was related to reports of day-to-day chronic pain severity among chronic low back pain patients, whereas trapezius tension (muscles distal from the source of pain) was not. Lundberg (1994Lundberg ( , 1999 found that people with trapezius myalgia and substantial neck/shoulder pain evinced higher levels of trapezius muscle tension during work than people without.…”

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Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

et al. 2007

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Catastrophizing about pain is related to elevated pain severity and poor adjustment among chronic pain patients, but few physiological mechanisms by which pain catastrophizing maintains and exacerbates pain have been explored. We hypothesized that resting levels of lower paraspinal muscle tension and/or lower paraspinal and cardiovascular reactivity to emotional arousal may: (a) mediate links between pain catastrophizing and chronic pain intensity; (b) moderate these links such that only patients described by certain combinations of pain catastrophizing and physiological indexes would report pronounced chronic pain. Chronic low back pain patients (N = 97) participated in anger recall and sadness recall interviews while lower paraspinal and trapezius EMG and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded. Mediation models were not supported. However, pain catastrophizing significantly interacted with resting lower paraspinal muscle tension to predict pain severity such that high catastrophizers with high resting lower paraspinal tension reported the greatest pain. Pain catastrophizing also interacted with SBP, DBP and HR reactivity to affect pain such that high catastrophizers who showed low cardiovascular reactivity to the interviews reported the greatest pain. Results support a multi-variable profile approach to identifying pain catastrophizers at © Springer Science+Business Media, LLC 2007 john.burns@rosalindfranklin.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript greatest risk for pain severity by virtue of resting muscle tension and cardiovascular stress function. KeywordsPain catastrophizing; Chronic pain severity; Lower paraspinal muscle tension; Cardiovascular reactivity; Profile approachCatastrophizing about pain is linked to elevated pain severity and poor adjustment among chronic pain patients (Sullivan et al. 1995). It is defined as a tendency to rumi-nate, magnify and feel helpless about pain (Sullivan et al. 1995), and as a negative automatic appraisal of painful stimuli rooted in activation of maladaptive beliefs or pain schemas (Michael and Burns 2004;Spanos et al. 1979;Sullivan et al. 2001). Irrespective of theoretical conceptualization, only a few physiological mechanisms by which pain catastrophizing maintains and exacerbates chronic pain intensity have been explored (e.g., Edwards and Fillingim 2005).Physical and psychological stress may lead to frequent and intense, or low level but sustained muscular contractions (Sjegaard et al. 2000). This muscle activity can increase pain through ischemia and hypoxia (Fields 1987), and through changes in mechanoreceptor sensitivity (Mense 1993). Flor and colleagues (Flor et al. 1985(Flor et al. , 1991(Flor et al. , 1992 proposed a "symptom-specificity" model of chronic pain, which proposes that patients with certain kinds of musculoskeletal disorders can be distinguished from patients with other kinds of musculoskeletal disorders by substantial stres...

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Section: Introductionmentioning

confidence: 96%

Section: Emotion-induction Interviewsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

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“…One reasonable possibility is that anger exacerbates pain by increasing physiological arousal (Burns, 1997;Cacioppo, Bernston, Klein, & Poehlmann, 1997). For example, Burns, Wiegner, Derleth, Kiselica and Pawl (1996) reported the results of a study that demonstrated anger-induced stress produced increased muscle tension, which in turn predicted a greater level of pain severity in chronic back pain patients. It was found that this effect was specific to anger; a measure of depression that was significantly correlated with pain was not associated with increased muscle reactivity.…”

Section: Anxietymentioning

confidence: 99%

The biopsychosocial approach to chronic pain: Scientific advances and future directions.

Gatchel¹,

Peng²,

Peters³

et al. 2007

Psychological Bulletin

2,518

1,903

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The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness, to the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.KEY WORDS: biopsychosocial; chronic pain; neuroscience of pain; pain and cognition; pain and emotion Biopsychosocial Approach to Chronic Pain 3The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions During the past decade, there has been an explosion of research on chronic pain, with significant advances in understanding its etiology, assessment and treatment (Gatchel, 2004; Turk & Monarch, 2002). This research has important health care implications Epidemiological research has shown that chronic pain (loosely defined as prolonged and persistant pain of at least 3-months duration) and chronic recurrent pain (recurrent episodes of pain interspersed with pain free periods extending over months or years) affects 10% -20% of adults in the general population (Blyth et al., 2001; Gureje, Von Korff, Simon & Gater, 1998; Vehaak, Kerssens, Dekker, Sorbi & Bensing, 1998). For example, in a large-scale epidemiological study, Von Korff, Crane, Lane et al. (2005) estimated a 19% prevalence for chronic spinal pain (neck and back) in the U.S. in the previous year, and a 29% lifetime rate. The American Academy of Pain Management (2003) asserted that approximately 57% of all adult Americans reported experiencing recurrent or chronic pain in the past year. About 62% of those individuals reporting being in pain for more than 1 year, and 40% noted that they were constantly in pain. Indeed, as Gatchel (2004) has summarized that pain is a pervasive medical problem: it affects over 50 million Americans and costs more than $70 billion annually in health care costs and lost productivity; it accounts for more than 80% of all physician visits. Moreover, chronic pain is often associated with major comorbid psychiatric disorders and emotional suffering.As the above factors attest, the prevalence and cost of chronic pain is a major physical and mental health care problem in the United States. Moreover, individuals 50 years of age and older are twice as likely to have been diagnosed with chronic pain (Gatchel, 2004;. Currently, there are approximately 35 million Americans aged 65 years or older, accounting for 12.4% of t...

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Chronic Pain

Turk

Wilson

2012

Handbook of Psychology, Second Edition

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Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models.

Cited by 34 publications

References 24 publications

Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

The biopsychosocial approach to chronic pain: Scientific advances and future directions.

Chronic Pain

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