Pain catastrophizing is related to temporal summation of pain but not temporal summation of the nociceptive flexion reflex

Abstract

Pain catastrophizing is associated with enhanced temporal summation of pain (TS-Pain). However, because prior studies have found that pain catastrophizing is not associated with a measure of spinal nociception (nociceptive flexion reflex [NFR] threshold), this association may not result from changes in spinal nociceptive processes. The goal of the present study in healthy participants was to examine the relationship between trait (traditional) and state (situation-specific) pain catastrophizing and temporal summation of NFR (TS-NFR) and TS-Pain. A secondary goal was to replicate prior findings concerning relationships between catastrophizing and NFR threshold, electrocutaneous pain threshold, and sensory and affective ratings of electrocutaneous stimuli. All analyses controlled for depression symptoms, pain-related anxiety, and participant sex. As expected, multiple regression analyses indicated that neither trait nor situation-specific catastrophizing was associated with NFR threshold, but that situation-specific catastrophizing was associated with pain ratings. Multilevel linear growth models of TS data indicated that situation-specific catastrophizing was associated with TS-Pain but not TS-NFR. Trait catastrophizing was not related to TS-Pain or TS-NFR. Together, these results confirm prior studies that indicate that catastrophizing enhances pain via supraspinal processes rather than spinal processes. Moreover, because catastrophizing was associated with TS-Pain but not TS-NFR, caution is warranted when using pain ratings to infer temporal summation of spinal nociceptive processes.

Pain Catastrophizing and Anxiety are Associated With Heat Pain Perception in a Community Sample of Adults With Chronic Pain

“…Preclinical studies suggest that pain catastrophizing may influence direct cortico-cortical interactions at the level of the spinal cord which can lead to alterations in nociceptive transmission. [29][30][31][32] The experience of pain and factors known to alter pain processing can also be mediated, in part, by supraspinal mechanisms. [29][30][31][32] Human functional imaging studies suggest an overlap exists in the areas of the brain (e.g., dorsolateral prefrontal cortex, inferior parietal areas, anterior cingulate cortex) activated by both pain stimuli and high levels of catastrophizing.…”

“…[29][30][31][32] The experience of pain and factors known to alter pain processing can also be mediated, in part, by supraspinal mechanisms. [29][30][31][32] Human functional imaging studies suggest an overlap exists in the areas of the brain (e.g., dorsolateral prefrontal cortex, inferior parietal areas, anterior cingulate cortex) activated by both pain stimuli and high levels of catastrophizing. 9,33 Thus, high levels of catastrophizing may tend to enhance cognitive activities that actually amplify nociceptive processing which, in turn, could lead to alterations in pain perception.…”

Altered processing of sensory stimuli in patients with migraine

“…111 The nociceptive flexion or withdrawal reflex (NWR) is a reliable measure of spinal nociception, as demon strated by the fact that it requires Aδ fibre activation, that the reflex threshold is related to the pain percep tion threshold, and that the reflex magnitude correlates positively with pain intensity ratings. 112,113 Temporal summation of pain develops in parallel with tem poral summation of the NWR of the lower limbs, reflected by a progressive increase in magnitude of the NWR after constant intensity electrical stimula tion (which activates both Aδ and C fibres, [113][114][115] and is inhibited by N methyl d aspartate receptor antago nists). 116 Interestingly, descending pain control systems modulate temporal summation of the NWR, 117 and might be dysfunctional in a number of chronic pain dis orders, including migraine.…”

Does pain catastrophizing contribute to threat-evoked amplification of pain and spinal nociception?

“…However, attempts to find a linkage between catastrophizing and NFR modulation have generally failed. 19,20,[46][47][48]59 The strongest evidence for determining relationships among variables comes from experimental manipulation. Given that cognitive-behavioral techniques have been shown to successfully reduce catastrophizing and improve pain-related outcomes, 7,29,30 the present study experimentally reduced pain catastrophizing using cognitive-behavioral techniques and examined the effect it had on threat-enhanced pain and NFR.…”