Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain

Abstract

The relationship between persistent pain and self-directed, non-reactive awareness of present-moment experience (i.e., mindfulness) was explored in one of the dominant psychological theories of chronic pain - the fear-avoidance model[53]. A heterogeneous sample of 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed psychometrically sound self-report measures of major variables in this model: Pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability. Two measures of mindfulness were also used, the Mindful Attention Awareness Scale [4] and the Five-Factor Mindfulness Questionnaire [1]. Results showed that mindfulness significantly negatively predicts each of these variables, accounting for 17-41% of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing. This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear-avoidance model. Implications for the clinical use of mindfulness in screening and intervention are discussed.

A Multicenter Study of Physician Mindfulness and Health Care Quality

“…[16][17][18][19] The MAAS contains 14 items, such as, "I tend to walk quickly to where I am going without paying attention to what I experience along the way," "I find myself listening to someone with one ear, doing something else at the same time, " and "I forget a person's name almost as soon as I've been told it for the first time." 16 Possible responses are on a 6-point Likert scale anchored between almost always and almost never.…”

Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up

“…In fact, a central role in the development of chronic disabling pain seems to be played by catastrophic thinking [36,37]. According to the biopsychosocial model, catastrophizing is a central variable in the fear-avoidance cycle, leading to chronic pain-related disability [38]. Thus, addressing the cognitive distortions occurring in catastrophizing, for instance by an evidence-based cognitive behavioral approach, may interrupt the fear-avoidance cycle and help to reduce the pain chronicity and disability [39].The possible implications to health policy makers may involve considering the long-term cost-effectiveness of a more expensive and articulated multi-modal approach, including cognitive-behavioral therapy, dedicated to patients with chronic neck pain with baseline catastrophic thinking [8,40].…”

Present Moment Effects: Pain, Distress, and Cancer

“…Thus, mindfulness, being present-centered with non-judgmental acceptance of the present moment, is conceptually and theoret-ically incongruent with a non-now focus and conceptual processing with the negative bias toward pain such as is involved in anxiety and catastrophizing (Sullivan, Lynch, and Clark, 2005). Moreover, recent hierarchical multiple regression analyses were conducted on data from a heterogeneous sample of chronic pain patients in order to investigate the role of mindfulness in the fear-avoidance model of chronic pain (Schütze, Rees, Preece, and Schütze, 2010). The data revealed that mindfulness not only predicted pain catastrophizing when other variables were controlled, but also moderated the relationship between pain intensity and pain catastrophizing.…”