Pain catastrophizing and mental health phenotypes in adults with refractory chronic pain: A latent class analysis

Slawek, Deepika; Syed, Madiha; Cunningham, Chinazo O.; Zhang, Chenshu; Ross, Jonathan; Herman, Merrill; Sohler, Nancy; Minami, Haruka; Levin, Frances R.; Arnsten, Julia H.; Starrels, Joanna L.

doi:10.1016/j.jpsychires.2021.12.001

Cited by 24 publications

(21 citation statements)

References 69 publications

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“…Among the psychological factors related to pain, anxiety and fear (emotional aspects of pain) in particular may play important roles in establishing chronic pain [ 2 ]. In addition, pain catastrophizing is common in chronic pain patients, where anxiety and fear of pain are further reinforced by negative affectivity and threatening illness information [ 3 ]. Consequently, when the attention of patients is restricted solely to their pain, they avoid any behaviors that predict induction of pain, leading to a dramatic reduction in physical activity (establishment of inactivity).…”

Section: Introductionmentioning

confidence: 99%

Brain Mechanisms of Exercise-Induced Hypoalgesia: To Find a Way Out from “Fear-Avoidance Belief”

Kami

Tajima

Senba

2022

IJMS

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It is well known that exercise produces analgesic effects (exercise-induced hypoalgesia (EIH)) in animal models and chronic pain patients, but the brain mechanisms underlying these EIH effects, especially concerning the emotional aspects of pain, are not yet fully understood. In this review, we describe drastic changes in the mesocorticolimbic system of the brain which permit the induction of EIH effects. The amygdala (Amyg) is a critical node for the regulation of emotions, such as fear and anxiety, which are closely associated with chronic pain. In our recent studies using neuropathic pain (NPP) model mice, we extensively examined the association between the Amyg and EIH effects. We found that voluntary exercise (VE) activated glutamate (Glu) neurons in the medial basal Amyg projecting to the nucleus accumbens (NAc) lateral shell, while it almost completely suppressed NPP-induced activation of GABA neurons in the central nucleus of the Amyg (CeA). Furthermore, VE significantly inhibited activation of pyramidal neurons in the ventral hippocampus-CA1 region, which play important roles in contextual fear conditioning and the retrieval of fear memory. This review describes novel information concerning the brain mechanisms underlying EIH effects as a result of overcoming the fear-avoidance belief of chronic pain.

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Section: Introductionmentioning

confidence: 99%

Brain Mechanisms of Exercise-Induced Hypoalgesia: To Find a Way Out from “Fear-Avoidance Belief”

Kami

Tajima

Senba

2022

IJMS

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“…Chronic pain patients with high pain catastrophizing and mental health conditions (depression, anxiety, posttraumatic stress disorder [PTSD], attention deficit/hyperactivity disorder [ADHD]) have also been shown to have more severe pain, poorer outcomes, and lower quality of life than those without mental health conditions. 25 Another study of patients with chronic neck pain found high pain intensity, clinical insomnia, and a high level of depression/anxiety to be strongly associated with high pain catastrophizing. 54 In acute pain management, similar to chronic pain management, it may be warranted that clinicians begin identifying patients most likely to benefit from being assessed for pain catastrophizing (eg, patients with chronic pain; and/or psychiatric diagnoses and/ or insomnia; 25,54,55 and/or opioid use disorder 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…20 Pain catastrophizing is described as a cascade of negative thoughts and emotions (helplessness, rumination, and magnification) in response to actual or anticipated pain, [21][22][23] occurring in up to 30% of chronic pain patients. 22,24,25 In chronic pain patients, pain catastrophizing has been associated with opioid misuse 26 and opioid craving, 27 as well as increased pain intensity, especially in women. 21 Furthermore, it can be predictive of delayed opioid cessation after surgery, 28 acute postoperative pain, and chronic postsurgical pain.…”

Section: Introductionmentioning

confidence: 99%

“…21 Furthermore, it can be predictive of delayed opioid cessation after surgery, 28 acute postoperative pain, and chronic postsurgical pain. [29][30][31][32][33] Opioid use disorder and mental illness often co-occur, 34 and opioid misuse 26 and mental illness 25 are often associated with pain catastrophizing. Dependence, depression, and worsening of underling mental illnesses are all known potential opioid side effects.…”

Section: Introductionmentioning

confidence: 99%

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Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care

et al. 2023

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Background: Limited studies are available on patients' perspectives regarding opioid-related awareness, beliefs, and pain management in primary care settings in the US. Pain catastrophizing (PC) is a cascade of negative thoughts and emotions in response to actual or anticipated pain. High PC is 1 of the strongest predictors of negative pain outcomes.Method: A cross-sectional survey was administered at Family Medicine clinics in the Pacific Northwest, November 2018-January 2019. Logistic regression was used to model the adjusted odds of participants' awareness and beliefs on opioid epidemic issues, side effects/risks, and general beliefs by opioid prescription expectations and PC.Results: 108 participants completed the survey. Compared with participants with low PC, high PC participants were 74% less likely to be aware of opioid epidemic issues (OR = 0.26, P = .005, 95% CI:0.10-0.67), 62% less likely to be aware of opioid side effects/risks (OR = 0.38 P = .040, 95% CI: 0.15-0.96) and had 2.4 times increased odds of holding more positive beliefs about opioids and/or stronger beliefs regarding pain control, yet the latter did not reach statistical significance (OR = 2.40 P = .083, 95% CI: 0.89-6.47).Conclusion: Significant gaps existed among our participants with high PC in their awareness of opioid epidemic issues and side effects/risks compared with their low PC counterparts. They may also carry positive beliefs regarding opioids and pain-control in general. In any pain care, it seems important to identify patients with high pain catastrophizing. Doing so may facilitates exploration of their beliefs and expectations regarding pain management and aids in tailoring individualized treatment and prevent adverse side effects.

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“…Despite associations between PTSS and PC in varied populations with chronic pain (Benedict et al, 2020; Gilliam et al, 2019; Linnemørken et al, 2020; Slawek et al, 2022) and severe injury requiring hospitalization (Giummarra et al, 2017), their role in the acute aftermath of mild-moderate injury is unclear. Both PC (Schütze et al, 2018) and PTSS (Giummarra et al, 2018) are responsive to cognitive-behavioral therapy (CBT), highlighting the importance of collecting data regarding PTSS and PC around the time of injury to inform the content and timing of acute interventions to prevent chronic pain (Shalev et al, 2019).…”

mentioning

confidence: 99%

A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.

Pacella¹,

Plaitano²,

Suffoletto³

et al. 2023

Rehabilitation Psychology

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Purpose/Objective: Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). Research Method/Design: This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. Results: Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. Conclusions/Implications: These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention.

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Pain catastrophizing and mental health phenotypes in adults with refractory chronic pain: A latent class analysis

Cited by 24 publications

References 69 publications

Brain Mechanisms of Exercise-Induced Hypoalgesia: To Find a Way Out from “Fear-Avoidance Belief”

Brain Mechanisms of Exercise-Induced Hypoalgesia: To Find a Way Out from “Fear-Avoidance Belief”

Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care

A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.

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