Experimental reduction of pain catastrophizing modulates pain report but not spinal nociception as verified by mediation analyses

Abstract

Pain catastrophizing is associated with enhanced pain; however, the mechanisms by which it modulates pain are poorly understood. Evidence suggests that catastrophizing modulates supraspinal processing of pain but does not modulate spinal nociception (as assessed by nociceptive flexion reflex [NFR]). Unfortunately, most NFR studies have been correlational. To address this, this study experimentally reduced catastrophizing to determine whether it modulates spinal nociception (NFR). Healthy pain-free participants (N = 113) were randomly assigned to a brief 30-minute catastrophizing reduction manipulation or a control group that received pain education. Before and after manipulations, 2 types of painful stimuli were delivered to elicit (1) NFR (single trains of stimuli) and (2) temporal summation of NFR (3 stimulations at 2 Hz). After each set of stimuli, participants were asked to report their pain intensity and unpleasantness, as well as their situation-specific catastrophizing. Manipulation checks verified that catastrophizing was effectively reduced. Furthermore, pain intensity and unpleasantness to both stimulation types were reduced by the catastrophizing manipulation, effects that were mediated by catastrophizing. Although NFRs were not affected by the catastrophizing manipulation, temporal summation of NFR was reduced. However, this effect was not mediated by catastrophizing. These results indicate that reductions in catastrophizing lead to reductions in pain perception but do not modulate spinal nociception and provides further evidence that catastrophizing modulates pain at the supraspinal, not the spinal, level.

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

“…In addition, the level of change in catastrophizing was associated with the change in pain, which is suggestive of a direct pain-enhancing mechanism [62]. Moreover, a reduction in catastrophizing led to reductions in pain report in healthy individuals, which was found to be modulated at the supraspinal level [63]. Finally, providing failure feedback to healthy participants, which may be similar to creating a feeling of helplessness, has been shown to lead to an increase in pain reports [64].…”

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

“…This is consistent with numerous studies showing that pain catastrophizing is associated with pain facilitation (eg, Refs 23,56,57) and extends this work to demonstrate that experimental reductions in pain catastrophizing leads to a reduction in pain. 59 Furthermore, formal mediation analysis found that the reductions in pain intensity and unpleasantness were at least partially mediated by the reductions in pain catastrophizing. Given that changes in catastrophizing were experimentally manipulated, this provides evidence that pain catastrophizing can produce pain facilitation and that reducing catastrophizing can reverse this facilitation.…”

“…57 Like our previous studies, 46,47,59 the PCS was administered using modified instructions to assess situation-specific catastrophizing ("Thinking back to your experience during the electric stimulations, please indicate the degree to which you had these thoughts and feelings"). This allowed us to eliminate participants who did not catastrophize at baseline and to evaluate changes in pain catastrophizing that resulted from the cognitivebehavioral techniques.…”

“…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.…”

Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain

“…5,37,39,41,50 The assessment of altered central pain processing using quantitative sensory testing typically includes the measurement of pain intensity or pain thresholds after the application of painful stimuli. 39,41 However, the perception of pain is subjective, which may cause unwanted variation in test results depending on various factors that are difficult to control during the assessment, such as catastrophizing, 18,42,43,52 cognitive attention, 7 and hormonal status. 19 Novel methods based on more objective parameters would be desirable.…”