Psychological predictors of pain expression and activity intolerance in chronic pain patients

Abstract

Recent research suggests that communicative and protective pain behaviors represent functionally distinct subsystems of behavior associated with pain. The present research examined whether components of pain experience such as pain severity, catastrophizing and fear of pain were differentially associated with communicative and protective pain behaviors. It was predicted that pain severity would be associated with decreased physical tolerance and heightened expression of pain behavior. It was also predicted that pain catastrophizing would be preferentially associated with communicative pain behaviors, and fear of pain would be preferentially associated with protective pain behaviors and decreased physical tolerance. To test these predictions, work-disabled patients with musculoskeletal pain conditions (N=72) were filmed as they participated in a simulated occupational lifting task. Multiple regressions revealed that pain severity was uniquely associated with decreased physical tolerance and increased expression of protective pain behaviors. Pain catastrophizing was uniquely associated with the expression of both communicative and protective pain behaviors. Fear of pain was associated with physical tolerance and protective pain behaviors but not when controlling for pain severity. This study provides additional evidence for the functional distinctiveness of different types of pain expression and provides preliminary evidence for the functional distinctiveness of pain expression and activity intolerance. Discussion addresses the processes by which psychological factors might influence the display of different types of pain behaviors. Discussion also addresses how different types of interventions might be required to specifically target the sensory and behavioral dimensions of the pain system.

The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1

“…32,66 Numerous factors within the biopsychosocial model likely contribute to the difficulty of current treatment approaches to prevent the poor recovery and growing disability rates that affect a substantial subset of people with LBP. 23,32,46,[64][65][66] One of the primary barriers to developing more effective interventions is a lack of knowledge regarding the physiologic mechanisms by which LBP is propagated and sustained. 6,12,14,20,40,53 Specifically, there is a paucity of research that T T STUDY DESIGN: Single-group, prospective, repeated-measures design with responder analysis.…”

Changes in Pain Catastrophizing Following Physical Therapy for Musculoskeletal Injury: The Influence of Depressive and Post-traumatic Stress Symptoms

“…For instance, emotional disclosure interventions allow patients to communicate their perception of pain and its emotional impact. Several studies suggest that this may be an important intervention for patients with elevated levels of catastrophizing [8,17,42,43]. Reassurance and activity encouragement is another brief intervention [42,44], which has been shown to reduce a number of variables associated with catastrophizing, including pain intensity, pain-related fear, and disability [45][46][47].…”

The Expression of Pain Behaviors in High Catastrophizers: The Influence of Automatic and Controlled Processes

“…22,36,39 Communicative pain behaviors included facial expressions such as grimacing or wincing and verbal or paraverbal pain expressions such as pain words, grunts, sighs, and moans. Protective pain behaviors included movements such as guarding, holding, touching, or rubbing.…”

“…Scores on the PCS and the MPQ-PRI are comparable to those that have been reported in previous research among patients with musculoskeletal pain conditions. 35,39 Work Output Associated With the Performance of the Lifting Task A 2-way (task condition  catastrophizing) mixed ANOVA was conducted to examine whether physical work (ie, work output scores) varied as a function of task condition and catastrophizing. Results of this analysis revealed a significant main effect for catastrophizing, F (1, 53) = 6.9, P < .05, indicating that work output scores were significantly lower in high catastrophizers (mean = 1.2, SD = .82) than in low catastrophizers (mean = 1.8, SD = .79).…”

“…Specifically, the CCM proposes that catastrophizers will display intentional and exaggerated pain behaviors in order to maximize proximity, support, and assistance from others in their social environment. 31,37 To date, support for the CCM has come primarily from studies showing that catastrophizing is associated with higher levels of pain behaviors, 34,38,39 and from studies showing that catastrophizers' pain behaviors are sensitive to variations in social context. 31 In previous studies, the degree of automaticity and cognitive control underlying catastrophizers' pain behaviors has not been systematically investigated.…”