Abstract
ObjectiveAnxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA), is associated with pain-related anxiety.MethodsOne hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI) of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20). Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS). The Beck Depression Inventory (BDI) was used to control for the influence of depression on the personality measurement.ResultsThe HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales.ConclusionHarm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.
Highlights
Anxiety disorders are common in chronic pain patients
The Harm Avoidance (HA) total score was associated with Pain Anxiety Symptoms Scale-20 (PASS-20), but the association became non-significant after controlling for depression
The HA4 Fatigability subscale was associated with the PASS scales
Summary
Anxiety disorders are common in chronic pain patients. Anxiety-associated interpretations of pain, such as pain-catastrophizing, are important determinants of disability in pain patients. Excessive fear of pain contributes to physical inactivity and disuse which further worsen the disability and increase the pain experience [1]. Pain-related catastrophic interpretations and avoidance behaviour may function as a risk factor in the development process from acute to chronic pain [1,2]. Personality related factors may partly explain the variation by enhancing vulnerability to anxiety. Among the most widely used personality models is the one presented by Robert Cloninger. Human personality is formed by temperament which is a biologically based emotional construct of personality, and character which represents a more mature personality part that develops through social learning and maturing processes. The temperamental traits are considered to be moderately heritable, present in early life, and have stability over the life span [3]
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