Role of anxiety sensitivity in pain-related fear and avoidance

Abstract

Anxiety sensitivity (AS) is the fear of anxiety-related bodily sensations, arising from beliefs that the sensations have harmful consequences. There has been a good deal of research on the role of AS in anxiety disorders, and only recently have investigators begun to assess its role in other conditions. In a preliminary report, Asmundson and Norton (1995) found that chronic back-pain patients with high AS (n = 14), compared to those with lower AS (n = 56), reported greater pain-related fear, and tended to have greater avoidance. The present study further investigated the role of AS in pain-related fear and escape/avoidance. Patients with chronic musculoskeletal pain (N = 259) completed measures of AS, pain severity, and pain-related fear and escape/avoidance. Structural equation modeling supported the prediction that AS directly exacerbates fear of pain, even after controlling for the effects of pain severity on fear of pain. Support also was found for the prediction that AS indirectly promotes pain-related escape/avoidance via its influence on fear of pain. This indirect effect was significant even when controlling for the direct influence of pain severity on pain-related escape/avoidance. These results suggest that AS plays an important role in pain-related fear and escape/avoidance in people with chronic pain.

PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models

“…In the case of PTSD, the degree of alarm caused by the stressor itself combined with alarm related to the anxiety sensations arising from the stressor amplifies the emotional reaction and thereby increases the risk of developing PTSD (58). In the case of chronic pain, it also appears that anxiety sensitivity amplifies fear, anxiety, and associated avoidance responses when pain-related experiences occur, thereby increasing the likelihood that pain will be maintained over time (21,(64)(65)(66). When the traumatic stressor and pain-precipitating event are the same or occur in close temporal proximity, anxiety sensitivity may amplify the collective response and may increase vulnerability for development of both conditions.…”

A Short Version of the Pain Anxiety Symptoms Scale (PASS‐20): Preliminary Development and Validity

“…To summarize some pertinent findings, scores from the PASS have been shown to correlate with general measures of pain severity, anxiety and depression (1,14,15); disability (1,12); passive range of motion and anxiety ratings during a physical examination (11); greater catastrophizing responses to pain (4,10), and fewer pain coping responses (10,15); anxiety sensitivity (16,17), hypervigilance and preoccupation with pain (13); and general physical complaints (8), and reduced lifting and carrying capacity (14). We have shown that PASS scores predict disability better than, and beyond variance attributed to, depression, general anxiety or pain (1).…”

An examination of the relationship between chronic pain and post-traumatic stress disorder

“…For example, Asmundson and Norton found that patients with higher anxiety sensitivity were more likely to experience greater anxiety and fear of pain, more negative affect, and greater avoidance of activities [48]. Asmundson and Taylor found that anxiety sensitivity directly increased fear of pain [49]; however, anxiety sensitivity indirectly influenced avoidance and escape behaviors through fear of pain. More recently, Zvolensky, Eifert, Lejuez, Hopko, and Forsyth evaluated anxiety sensitivity, depression, and pain severity as potential predictors of pain-related fear in a heterogeneous chronic pain population [50].…”