What do you expect? Catastrophizing mediates associations between expectancies and pain‐facilitatory processes

Abstract

Background Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. Methods In this cross‐sectional study, participants (437 chronic low back pain [CLBP] patients, 115 controls) completed self‐report measures of pain intensity, pain expectancies and pain catastrophizing before undergoing psychophysical pain‐testing procedures designed to assess mechanical TS of mechanical pain. Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of pain catastrophizing on the association between pain expectancies and TS of pain. Results Temporal summation of pain was significantly associated with pain expectancies (r = 0.113) and pain catastrophizing (r = 0.171) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain expectancies and TS of pain in CLBP patients (ab = 0.309, 95% CI = 0.1222–0.5604), but not in healthy controls (ab = −0.125, 95% CI = −0.5864 to 0.0244). Conclusions The findings from this study suggest that compared to controls, CLBP patients show increased sensitivity to mechanical pain procedures and enhanced pain‐facilitatory processing, proving further evidence for changes in central nervous system pain processing in CLBP patients. Our results also suggest that pain catastrophizing may be the mechanism by which pain expectancies are associated with TS of pain in CLBP patients. Significance Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.

Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation

“…9,50,63 Contrastingly, previous studies report psychological status (self-reports and experimental induction of acute stress) negatively influence the CPM effect in healthy and symptomatic individuals. 8,23,26,27,50,86 However, adjusting for the PCS-helplessness in this study did not significantly influence the variance of PA or SB on CPM effects. Since participants in this study had lower scores in PCS and other psychological attributes, the role of psychological confounding on the observed relationship cannot be entirely ruled out.…”

“…11,28 This perceptual component is supported by our data showing significant positive correlations between MTS scores, PCS scores, and pain severity/interference. 8,16,65,66 Thus, peripheral mechanisms of TS and perceptions might have confounded the relationship between PA/SB and MTS scores.…”

Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study

“…Earlier studies have investigated pathways among smaller numbers of contextual variables and suggested, for example, that self-efficacy mediates the impact on osteoarthritis pain of practitioners communicating positive expectancies, 35 affective aspects of the therapeutic relationship may shape Open access patient expectancies in chronic pain, 70 and expectancies might impact pain via reduced catastrophising in chronic back pain. 33 The current results further suggest contextual factors reduce back-related disability in part by enhancing patient self-efficacy for coping with pain, reducing the perceived threat of pain and reducing psychosocial distress. This is broadly consistent with the fear avoidance model 34 and social cognitive theory.…”

“…Such components include: positive and empathetic patient-practitioner relationships and a strong patient-practitioner alliance [4][5][6][7][8][9][10] (patient-practitioner relationship); patients' outcome expectancies and perceived treatment credibility 9 11-16 (patient beliefs); musculoskeletal practitioners' beliefs about pain [17][18][19][20][21][22] and outcome expectancies 23 (practitioner beliefs); good organisational environments (eg, collegiality) 24 , the physical-sensory environment (eg, music) 25 and the healthcare sector [26][27][28] (environment), although evidence of effects of healthcare sector on patient outcomes is mainly qualitative. Contextual components might impact patient outcomes via (1) behavioural pathways (eg, improved self-management), 29 30 but see also Haanstra et al who found that adherence accounted for only a small proportion of the relationship between expectancies and pain outcomes, 31 (2) psychosocial pathways (eg, reconceptualising pain as less threatening [32][33][34] ; increased selfefficacy 35 36 ) and/or (3) neurophysiological pathways. [37][38][39][40][41] The focus in this study was on psychosocial pathways; more details on how these were hypothesised to operate are provided in our published protocol.…”

Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma‐related beliefs

“…It is well established that pain catastrophizing (PC) is associated with pain severity and interference (Quartana, Campbell, & Edwards, ). There is also evidence from accident victims that catastrophizing, and PC in particular, mediates the relationship between pain intensity and PTSD (Andersen, Karstoft, Brink, & Elklit, ; Carriere, Martel, Meints, Cornelius, & Edwards, ; Pedler, Kamper, & Sterling, ). TRBs can be viewed as a form of catastrophizing, and are associated with higher levels of PTSD, comorbidity and functional impairment in trauma‐exposed individuals (Heron‐Delaney, Kenardy, Charlton, & Matsuoka, ; Ozer, Best, Lipsey, & Weiss, ).…”