Lower Catastrophizing Research Articles

Pain and Coping Strategies as Determinants of Malnutrition Risk in Lung Cancer Patients: A Cross-Sectional Study.

Progressive cachexia and malnutrition severely impact the physical and mental condition of cancer patients. Pain is a prognostic factor for shorter survival in cancer patients, and coping strategies are crucial for adapting to treatment and dietary regimens. This study assessed pain levels, pain-related beliefs, and coping strategies as factors increasing malnutrition risk in 257 lung cancer patients. Sociodemographic and clinical data were collected from medical records. The Mini Nutritional Assessment (MNA), Visual Analog Scale (VAS), Beliefs about Pain Control Questionnaire (BPCQ), and Coping Strategies Questionnaire (CSQ) were used. Overall, 42.8% of patients were at risk of malnutrition, and 17.5% were malnourished. Nutritional status negatively correlated with CSQ domains: reinterpretation of pain (RP: rho = -0.194; p = 0.002), catastrophizing (CP: rho = -0.414; p = 0.001), ignoring pain (IP: rho = -0.198; p = 0.001), praying/hoping (PH: rho = -0.253; p < 0.001), and coping self-statements (CS: rho = -0.172; p = 0.006); and BPCQ domains: the power of doctors (PD: rho = -0.196; p = 0.002) and VAS (rho = -0.451; p < 0.001). Nutritional status positively correlated with CSQ domains: pain control (PC: rho = 0.499; p < 0.001) and the ability to reduce pain (AR: rho = 0.512; p < 0.001). In multivariate regression analysis, a better nutritional status was associated with a younger age (β = -0.094; p < 0.001), non-small-cell lung cancer (NSCLC) (β = 1.218; p = 0.037), a greater ability to reduce pain (CSQ-AR) (β = 0.901; p < 0.001), lower catastrophizing (CSQ-CP) (β = -0.165; p = 0.001), and lower pain perceived (VAS) (β = 0.639; p < 0.001). Statistical analyses included Spearman's correlation and multivariate regression with a significance level of p < 0.05. Patients with a normal nutritional status had reduced doctor involvement in pain control, less frequent negative coping strategies, and more common positive coping strategies. A normal nutritional status correlates with lower perceived pain. A better nutritional status is linked to a younger age, NSCLC, lower pain levels, greater pain reduction ability, and lower scores in pain catastrophizing.

Pain Catastrophizing Moderates the Relationship Between Pain Sensitivity and Clinical Pain in Adolescents With Functional Abdominal Pain

Pain catastrophizing has been linked to amplified pain sensitivity assessed using quantitative sensory testing (QST) in adults; pediatric data are limited, particularly in youth with functional abdominal pain (FAP). With increasing use of QST to evaluate somatosensory function and predict pain outcomes, we examined the associations between QST and clinical pain in adolescents with FAP and tested the moderating effects of pain catastrophizing. Seventy-seven adolescents (mean age 16.6 years, 85.7% female, 72.7% White, 90.8% non-Hispanic) who fulfilled diagnostic criteria for FAP completed QST assessment (pressure pain threshold and tolerance, heat pain threshold, conditioned pain modulation) and measures of abdominal pain intensity, pain interference, and pain catastrophizing. Adjusting for age and sex, only higher heat pain threshold was associated with higher abdominal pain intensity (Beta per 1-standard deviation = .54, P = .026). Contrary to hypothesis, for youth with higher pain catastrophizing, higher pressure pain tolerance was associated with greater abdominal pain intensity, but associations were not significant for youth with lower catastrophizing (P = .049). Similarly, for those with higher pain catastrophizing (in contrast to lower pain catastrophizing), higher pressure pain thresholds and tolerance were associated with higher pain interference (P = .039, .004, respectively). Results highlight the need to investigate the influence of pain catastrophizing on QST. PerspectiveThis study demonstrated unexpected findings of pain catastrophizing moderating the relationships between pressure pain threshold and tolerance, and clinical pain in adolescents with FAP. This raised questions regarding our understanding of psychological contributions to QST findings in pediatric populations with chronic pain.

A potential link between inflammatory profiles, clinical pain, pain catastrophizing and long-term outcomes after total knee arthroplasty surgery.

Chronic postoperative pain after total knee replacement (TKR) is a major clinical problem. It is still unclear if specific inflammatory mediators are associated with long-term postoperative pain complications. The current exploratory study aimed to (1) evaluate a multiplex of inflammatory mediators 5 years after TKR surgery in patients with different degrees of postoperative pain intensities and (2) study any association of the markers with clinical pain intensity, cognitive and functional outcomes. Plasma samples were collected 5 years after TKR surgery from 76 knee patients (43 females; 33 males) and analysed for 44 inflammatory markers. Pain (using visual analogue scale, VAS), the pain catastrophizing scale (PCS) and the Oxford knee score (OKS) were evaluated. Patients were categorized as high or low groups based on VAS, PCS and OKS scores. Associations between inflammatory markers, VAS, PCS and OKS were analysed and the marker expressions were compared between groups. Pearson's correlations found 12 biomarkers associated with VAS (p < 0.05), 4 biomarkers with PCS and 3 biomarkers with OKS (p < 0.05). Four markers were altered in patients suffering from high compared to low chronic postoperative pain, three markers were altered in high compared to low catastrophizers and three markers were altered in patients with poor functional scores (p < 0.05). The present exploratory study suggests that low-grade inflammation might be present in a subset of patients with high pain, high catastrophizing and low function 5 years after TKR. These exploratory results provide insights into some of the long-term postoperative complications after TKR surgery. This exploratory study evaluated a subset of inflammatory markers and the association to clinical pain intensity, knee function and pain catastrophizing in patients 5 years after total knee replacement surgery. Our results provide insights into the understanding of the underlying mechanisms that may drive the long experience of pain after TKR surgery.

Pain catastrophizing levels differentiate between common diseases with pain: HIV, fibromyalgia, complex regional pain syndrome, and breast cancer survivors.

Pain catastrophizing is a core psychological factor determining pain experience. We addressed the question of whether patients with different pain syndromes group into different pain catastrophizing phenotypes. A total of 727 patients with chronic pain associated with four primary syndromes: Breast cancer (BC) survivors (n = 400), fibromyalgia (FM, n = 52), complex regional pain syndrome (CRPS, n = 155), and HIV (n = 120) were first studied for differences in levels of pain catastrophizing (Pain Catastrophizing Scale, PCS) and pain intensity by analysis of variance. Subsequently, individual scores of the PCS subscales "rumination", "magnification," and "helplessness" from the pooled cohorts were submitted to multivariate k-means clustering to explore subgroups. Three clusters defined by the level of catastrophizing were identified. The "low catastrophizing" cluster (n = 377) included most of the BC patients (71.0%) and the "moderate catastrophizing" cluster (n = 256) most of the FM patients (61.5%). HIV (31.9%) and CRPS (44.7%) patients were over-represented in the "high catastrophizing" cluster (n = 94) with the highest catastrophizing tendencies in all dimensions. These patients reported more helplessness than the patients in the two other clusters. The primary syndrome causing the pain has an impact on self-reported pain-related catastrophizing. Helplessness is a predominant feature in HIV and CRPS patients and therefore an important target in pain rehabilitation.

Association of pain catastrophizing with labor pain and analgesia consumption in obstetrical patients

IntroductionPain catastrophizing is an exaggerated negative orientation to painful stimuli which in obstetric patients is associated with fear of overwhelming labor pain and negative pain-related outcomes. This study aimed to quantitatively examine the association of pain catastrophizing with maternal labor pain outcomes. MethodsWe conducted a prospective observational study of women admitted for a vaginal trial of labor. Subjects completed the 13-item Pain Catastrophizing scale (PCS) questionnaire (scored 0 to 52, higher scores representing greater catastrophizing). Pain was assessed at baseline and at request for neuraxial labor analgesia. Labor and postpartum pain intensity was assessed as the average area under the pain intensity by time curve. Pain at request for analgesia, labor pain, postpartum pain, analgesic consumption, and quality of recovery was compared between high (PCS ≥ 17) and low catastrophizing groups. ResultsData from 138/157 (88%) subjects were included in the analysis. Median (IQR) pain scores at request for analgesia were 9 (8,10) and 8 (6,9), a difference of 1 (95% CI 0 to 2.5, P = 0.008) in high-catastrophizing and in low-catastrophizing groups, respectively. Adjusted pain during labor, postpartum pain and opioid analgesic use were not significantly different. High-catastrophizers reported less comfort, ability to mobilize and less control during hospitalization. Post-discharge there were no differences in pain or analgesic use. ConclusionWe did not observe greater labor or post-delivery pain or increased analgesic use in high-catastrophizing parturients. High catastrophizers reported greater pain when requesting analgesia, which is consistent with the role of catastrophizing in intensifying the experience of pain.

Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute?

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

The Interactive Effect of Pain Catastrophizing and Experimental Pain on Working Memory Performance as a Function of Cognitive Load

Both pain and negative affect (e.g., pain catastrophizing) interrupt and demand attentional resources, which implicates working memory (WM)—the short-term maintenance and manipulation of information. While these factors may not lead to observable WM performance deficits on easy cognitive tasks, an increase in cognitive load (difficulty) may make it more difficult to conserve accuracy. However, few studies have examined pain, pain catastrophizing, and cognitive load concurrently to evaluate their interactive effect on WM. 42 healthy undergraduate students aged 18-22 completed a WM task (n-back) under randomly ordered pain and no-pain thermal stimulation conditions. Participants responded when the current stimulus matched the stimuli presented n positions back in the sequence, with load increasing from n=1 to n=3. Performance was evaluated using hits (correct responses) and false alarms (incorrect responses). Participants also completed the Pain Catastrophizing Scale. Linear mixed effect models were employed to evaluate the interactive effect of pain catastrophizing, experimental pain, and cognitive load on WM performance. We found a significant three-way interaction among pain catastrophizing, pain condition, and cognitive load on false alarms (b = -.12, SE = .047, t = -2.54, p = .012), 95% CI [-.21, -.029]. Under low load, low catastrophizers had fewer false alarms than high catastrophizers under both pain conditions. However, under high load, low catastrophizers had fewer false alarms than high catastrophizers when pain was on, but more false alarms than high catastrophizers when pain was off. Our findings suggest a complex relationship between pain and WM performance, dependent on task difficulty and individual differences in pain catastrophizing. Results suggest that while catastrophizing alone may not consume enough resources to significantly affect accuracy, even under high load, the combination of pain and catastrophizing overwhelms the increased effort needed to maintain performance under high load, leading to decreased accuracy.

The Influence of Chronic Pain and Catastrophizing on Patient Outcomes in an Athletic Therapy Setting.

Chronic pain is a challenge for Athletic Trainers and Athletic Therapists working in a clinical or university setting. The fear avoidance model, including catastrophizing, is well established in other health professions but is not established in Athletic Training and Athletic Therapy and may affect rehabilitation outcomes. To measure the influence of catastrophizing on rehabilitation outcomes of patients being treated in an Athletic Therapy setting. Prospective single group pre-post design. Student Athletic Therapy clinic. A total of 92 patients were evaluated at initial assessment, and 49 were evaluated at follow-up. All participants completed self-reported function questionnaires to assess level of injury and then received individualized treatments for a variety of musculoskeletal injuries. All measures were completed at initial assessment and at follow-up approximately 6 weeks later. The authors measured function using a variety of patient self-reported functional questionnaires: the Disability of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; the Neck Disability Index; and the Oswestry Disability Index depending on injury site. Catastrophizing was measured using the Pain Catastrophizing Scale. Function significantly improved from the initial assessment to the follow-up (P > .001). Patients with acute pain experienced a significantly greater improvement in function between the initial assessment and follow-up compared with participants with chronic pain (P = .050). Those with high catastrophizing presented with lower levels of function at initial assessment (66.8%) and follow-up (72.1%) compared with those with low catastrophizing (80.8% and 87.0%, respectively). Similar to other studies in other professions, the function of patients with chronic pain does not improve as much compared with patients recovering from acute pain in an Athletic Therapy setting. It is important to measure patient-reported outcomes to evaluate patient rehabilitation progress. Rehabilitating patients with chronic pain is a challenge, and pain catastrophizing should be evaluated at the initial assessment since catastrophizing is associated with worse function.

Persistent Post-Mastectomy Pain: The Impact of Regional Anesthesia Among Patients with High vs Low Baseline Catastrophizing

Persistent Post-Mastectomy Pain (PPMP) varies both in its severity and impact, with psychosocial factors such as catastrophizing conferring greater risk. Preoperative regional anesthesia (RA) is an important non-opioid therapy, but with variable success at preventing PPMP in previous reports. We previously reported that RA was associated with lower acute post-mastectomy pain and opioid use, but more prominently among patients with higher baseline catastrophizing. The current longitudinal investigation at 3, 6, and 12 months postop aimed to detect differential long-term impact of RA on PPMP among patients with high vs low catastrophizing. In this prospective observational study, patients (n=123) completed preoperative psychosocial assessment and underwent mastectomy either with (n=56) or without (n=67) preoperative RA. Generalized estimating equation (GEE) regression analysis assessed impact of baseline catastrophizing, RA, and their interaction, on the primary outcome of pain severity index, as well as secondary outcomes including cognitive and emotional impact of pain, and persistent opioid use. We observed a significant interaction between the effect of catastrophizing and RA on PPMP. Specifically, RA was associated with reduced pain severity and pain impact 3, 6, and 12 months postoperatively, but only among those with high baseline catastrophizing scores. In addition, both RA and lower catastrophizing scores were associated with lower incidence of persistent opioid use. The efficacy of therapies to prevent PPMP may be importantly influenced by pain-modulatory psychosocial characteristics. These findings underscore the importance of considering individual patient factors when applying preventive treatments, and of including their assessment in future trials.

A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain-Related Outcomes.

Risk constructs based on psychological risk factors (eg, pain catastrophizing, PC) and sensitization risk factors (eg, pressure pain threshold, PPT) are important in research and clinical practice. Most research looks at individual constructs but does not consider how different constructs might interact within the same individual. An evaluation of the cumulative impact of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological (PC) and sensitization (PPT) risk factors on pain-related outcomes (activity avoidance, pain severity, and disability) considering covariates. We included 109 participants (70.60% women; mean±SD age 53.6±12.3years) with chronic musculoskeletal pain for data analysis, who completed all measures of this study. Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability, and pain severity). Subgroups were constructed by dichotomizing of PC and PPT scores, resulting in four groups: (1) low catastrophizing and low sensitivity (N=26), (2) high catastrophizing and low sensitivity (N=27), (3) low catastrophizing and high sensitivity (N=25), and (4) high catastrophizing and high sensitivity (N=31). One-way analysis of variance (ANOVA) revealed significant group differences (P<0.05, η2 =0.08 to 0.14) in all outcomes of this study (except functional avoidance), and post hoc analysis indicated the significant differences are between group 1 and 4. A cumulative impact is reflected by large effect sizes between group 1 and 4 (d=0.8 to 1). The group 2 and 3 (one risk dimension groups: either high-PC or high-PPT) represent 47% of the total participants. The study suggests both higher level of PC and pressure sensitivity have a cumulative impact on risk screening for pain-related outcomes, considering gender in functional avoidance (task-related outcome). A clinical presentation with high-PC (one dimension of risk) is not associated with high-PPT (another dimension of risk). This finding has important clinical and theoretical implications.

Pain resilience, pain catastrophizing, and executive functioning: performance on a short-term memory task during simultaneous ischemic pain.

Among pain researchers there is a growing interest in the relationship between psychological resilience and pain experience. Whereas much of this work has focused on individual differences in pain perception or sensitivity, an equally important dimension of resilience is the capacity to persist with goal-directed activity despite experiencing pain. Consistent with this latter focus, the current study examined how pain resilience and pain catastrophizing combine to moderate the effects of ischemic pain on short-term memory task performance. Using a within-subjects design, 121 healthy participants completed four trials of a Corsi block-tapping task with pain exposure during the second and fourth trials. Results indicated that a combination of high pain resilience and low pain catastrophizing was associated with better task performance during the second pain exposure. These findings confirm existing evidence that resilience can moderate performance during pain, and offer new evidence that resilience and catastrophizing interact to shape this effect.

Disability is associated with catastrophizing and not with pain intensity in patients with low back pain: A retrospective study

Low back pain (LBP) is the leading cause of years lived with disability at a global scale. The development and chronicity of LBP are influenced by multiple factors, and among them is catastrophizing. We are unaware of the impact that catastrophizing may have on pain and disability in our population. We also lack the tools that allow us to determine in which cases catastrophizing should be assessed. The primary objective is to compare the disability and pain intensity values at baseline in low back pain patients with high and low catastrophizing. The secondary objectives are to analyse the correlation between variables and determine disability variance, and develop a prediction model to identify patients with high catastrophizing. This is a retrospective study. We included the baseline data of patients with LBP. A PCS score ≥ 23 was classified as "high catastrophizing." A total 121 medical sheets were analysed. Patients with high catastrophizing showed greater disability, with no differences in pain intensity. The PCS value explained 20% of the variance of disability, and pain was 1%. A cut-off point of 11 in the RMQ allowed us to identify patients with high and low catastrophizing, with an accuracy of 76.67%. LBP patients with high catastrophizing reported greater disability than those with low catastrophizing, with no differences as to pain intensity. The PCS was the most relevant variable to explain variability in the RMQ. The RMQ allowed us to identify patients with high and low catastrophizing.

Back pain in adolescents with idiopathic scoliosis: the contribution of morphological and psychological factors.

To define the relationship between 3D radiological features, psychological factors, and back pain prevalence and intensity in patients with adolescent idiopathic scoliosis (AIS). Consecutive AIS patients answered self-reported questionnaires and underwent simultaneous posterior-anterior and lateral scans of the spine (EOS Imaging, Paris, France). 3D reconstructions of the spine and pelvis reported 18 parameters in the coronal, sagittal, and axial plane. Hundred and twenty-four patients with AIS were included in the study. Overall, 90% of AIS patients reported having some back pain over the last 6months and 85.8% over the last 30days. Pain intensity in the last month was reported to be mild in 37.5%, moderate in 31.8%, moderate to severe in 24.3%, and severe in 6.54% of cases. Location of back pain was associated with location of main curve (P = 0.036). Low back pain was associated with higher lumbar apical AVR and lower lumbar lordosis (P < 0.05). Independent risk factors for back pain in AIS were pain catastrophizing (B = 0.061, P = 0.035), poorer self-reported state of mental health (B = - 0.872, P = 0.023), decreased thoracic kyphosis (B = - 0.033, P = 0.044) and greater pelvic asymmetry (B = 0.146, P = 0.047). There was a significant association between self-reported pain intensity in the last 24h and levels of catastrophizing. Pain catastrophizing level influenced the relationship between deformity severity and pain intensity. In low catastrophizers, there was a significant association between greater deformity severity and higher pain levels. Back pain in AIS is multifactorial and associated with psychological and morphological parameters. Pain catastrophizing is an important construct in AIS-related pain and should be taken into consideration when evaluating these patients.

The moderating role of pain catastrophizing on the relationship between partner support and pain intensity: a daily diary study in patients with knee osteoarthritis.

The objective of this study was to examine the day-to-day associations between partner support, pain catastrophizing and pain intensity in individuals with end-stage knee osteoarthritis. In this microlongitudinal cohort study, participants (N = 124) with end-stage knee osteoarthritis completed baseline measures of trait pain catastrophizing and negative affect. Participants also provided daily diary assessments of partner support, pain catastrophizing and pain intensity for a period of 7days using a personal digital assistant. Multilevel analyses revealed that day-to-day fluctuations in pain catastrophizing were associated with pain intensity. Data from multilevel analyses indicated that the main effect of partner support was not significantly associated with pain intensity. Results also indicated the interactions between partner support and both trait and state pain catastrophizing were significant, suggesting that both trait and state pain catastrophizing moderated the relationship between daily partner support and pain intensity. That is, on days when participants experienced low levels of partner support, high catastrophizers reported higher levels of pain intensity than low catastrophizers. In the presence of higher levels of partner support, pain intensity did not differ between high and low catastrophizers. These results are consistent with the Communal Coping Model of pain catastrophizing, and highlight the interpersonal context within which pain catastrophizing impacts pain outcomes. These findings also suggest that future interventions designed to specifically target the dynamic between pain catastrophizing and partner support may improve pain outcomes in individuals with end-stage knee OA.

Chronic Pain Patients' Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli.

Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus. Materials and Methods: Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results: Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs. Conclusions: The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed.

Physical and psychological paths toward less severe fibromyalgia: A structural equation model.

Previous research suggested isolated associations of physical and psychological factors with fibromyalgia severity. Integration of physical and psychological, experienced and observed, modifiable factors associated with fibromyalgia severity in a single model will reveal therapeutic paths toward less severity of disease. We aimed to examine an encompassing model of determinants of fibromyalgia severity. This observational, population-based cross-sectional study included 569 people with fibromyalgia. An integrative model of fibromyalgia severity was tested by using structural equation modelling. This model included 8 factors: resilience, catastrophizing, active lifestyle, declarative memory, subjective fitness, objective fitness, psychological distress, and physical fatigue. Two core paths were associated with reduced fibromyalgia severity: 1) a psychological path connecting high resilience and low catastrophizing with low distress and 2) a physical path, connecting a more active lifestyle (directly and via high objective and subjective physical fitness) with low fatigue. Additional interconnecting paths especially suggested a connection from the psychological to physical path. Our model explained 83% of the fibromyalgia severity. The present model integrated the complexity of mutually influencing factors of fibromyalgia severity, which may help to better understand the disease. It emphasised the importance of: 1) physical factors and psychological factors and their interconnections, 2) patients' experiences and clinical measurements, and 3) positive and negative signs such as physical fitness and distress. Future longitudinal and experimental research should aim at testing the causal direction of the associations in the model as well as the clinical implications suggested by the model. For instance, to reduce fatigue, exercise should enhance not only objective fitness but also fitness-related perceptions. Reducing distress and fatigue seems crucial for lowering fibromyalgia severity.

Catastrophizing and chronic low back pain: A functional magnetic resonance study

Pain depends on the interaction of cognitive, and emotional factors. Individuals with negative coping strategies such as catastrophizing are prone to develop chronic pain syndromes, and poor functional outcomes. This maladapted behavior may be caused by abnormalities in attention systems and amplification of pain processing. Low back pain (LBP) is a disabling pain syndrome, but it is poorly known how catastrophizing affects brain activity. To explore catastrophizing neural correlates in LBP, we performed an fMRI study to verify the central pain system (pain matrix), and anticipation responses. Under unpredictable stimuli, we expected to see catastrophizing LBP showing lower ability to disengage attention to pain and lower pain threshold. We studied 43 LBP and 27 C subjects. LBP responded catastrophizing questionnaires (FABQ, CSQ). We used a pressure-pain device, to deliver stimuli in the thumbnail. Pain thresholds detected a priori, for moderate pain. Subjects performed 2 event-related fMRI experiments: 1 - Supraliminal Pain for the pain matrix study; 2 – Variable Pain for anticipation at unpredictable stimuli. T2* images acquired in a 3 T Siemens scanner. FMRI data was preprocessed and carried out using FSL tool. Corrected cluster significance threshold: P = 0.05. Both groups were similar for demographics. LBP had lower threshold for pressure stimulus. Both groups activated pain matrix areas, and had the same pattern during anticipation. When covarying with FABQ during experiment 2, LBP showed greater posterior cingulate cortex activation, indicating that in LBP, FABQ reduces brain activity. LBP had lower pain threshold, suggesting central sensitization. Although both groups activated the pain matrix and had the same anticipation pattern, catastrophizing LBP had decreased activity in posterior cingulate cortex, suggesting negative coping skill influences pain appraisal in anticipation. The area belongs to the attention system and antinociception pathways in healthy subjects. Our results are in line with previous data showing greater posterior cingulate activity in low catastrophizers.

(155) - State catastrophizing is associated with facilitation of spinal nociception during conditioned pain modulation (CPM)

Pain catastrophizing is associated with enhanced pain and also reduces the efficacy of pain inhibitory processes. Interestingly, prior work suggests pain catastrophizing does not exert its hyperalgesic effects via descending facilitation of spinal nociception, because several studies have failed to find a relation with the nociceptive flexion reflex (NFR, a physiological marker of spinal nociception). The present study further explored this issue by examining the relationship between situation-specific (state) pain catastrophizing and conditioned pain modulation (CPM) of pain ratings and the NFR in 198 healthy, pain-free participants. CPM was assessed from painful electric stimulations (test stimuli) delivered to the ankle before, during, and after participants placed their hand in painfully cold water (10°C; conditioning stimulus). Pain ratings and NFR magnitudes were assessed in response to test stimuli. Immediately following CPM, participants filled out the Pain Catastrophizing Scale with instructions to report on their catastrophic thoughts during the cold water. Three groups (low, medium, and high catastrophizing) were formed from their responses. Results found state catastrophizing did not influence CPM of pain ratings even though mean pain ratings varied linearly with catastrophizing (more catastrophizing = more pain). By contrast, CPM of NFR was influenced by catastrophizing such that significant inhibition of NFR was only observed in the low catastrophizing group. No NFR inhibition was found in the medium group and significant NFR facilitation was found in the high group. These findings imply that central modulatory mechanisms are altered by greater catastrophizing, shifting the balance toward descending facilitation during CPM and a generalized perceptual hyperalgesia. As such, individuals that catastrophize may be at risk for chronic pain.

The role of catastrophizing in vulvovaginal pain: Impact on pain and partner responses over time

The aim of this prospective study was to explore the role of catastrophizing in vulvovaginal pain. The study entails two research questions. The first question was whether catastrophizing predicts the occurrence of vulvovaginal pain. The second question focused on exploring the links between catastrophizing, partner responses and pain. Five hundred and ten women filled out questionnaires at two measurement points, 10 months apart. The women were divided into three groups based on levels of catastrophizing. To study the first research question, the groups were used as predictors of pain at follow‐up. To study the second research question, the groups were compared regarding their perceived solicitous partner responses. Subsequently, two mediation models were tested to explore whether catastrophizing mediated the relationship between solicitous partner responses and pain, cross‐sectionally and longitudinally. Baseline levels of catastrophizing distinguished between pain and no pain 10 months later. High catastrophizers reported higher levels of solicitous partner responses than low catastrophizers. The mediation analyses revealed catastrophizing as a significant mediator between solicitous partner responses and pain, cross‐sectionally and over time. The findings support catastrophizing as being an important factor in women with vulvovaginal pain, cross‐sectionally and over time.

Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain.

Study Design Retrospective cross-sectional cohort of military patients with musculoskeletal pain. Background Body diagrams are used to document symptoms and can also serve as a proxy to assess psychological influence. However, literature to support this is conflicting. Objectives To (1) examine the unique contribution of pain and nonpain symptom distribution to magnitude of self-reported pain intensity and disability, and (2) assess the moderating influence of psychological factors and body diagram score on concurrent pain intensity and disability. Methods Pain, numbness, and tingling were denoted on a body diagram at initial evaluation. Fear-avoidance beliefs, pain catastrophizing, and region-specific self-reported disability measures were collected. The contributions of pain and nonpain symptom distribution to pain intensity and disability were assessed to determine which body diagram symptom scoring method (pain only, nonpain, or composite) was appropriate for subsequent analyses. Hierarchical linear regression analyses were then used to determine the moderating effects of the Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire and the body diagram score on concurrent pain and disability. Results The Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire explained between 16% and 17% of the variance in pain intensity, and 8% of variance in disability (all, P<.001). The composite symptom score explained an additional 4% to 5% variance in concurrent disability and pain intensity (all, P<.001). The Pain Catastrophizing Scale moderated the relationship between body diagram score and pain intensity. The positive relationship between composite symptom score and concurrent pain intensity is stronger for patients with low catastrophizing. Conclusion The clinical utility of body diagrams with low symptom distribution may be improved by concomitant assessment of pain catastrophizing and warrants further longitudinal investigation. Level of Evidence Symptom prevalence, level 2b. J Orthop Sports Phys Ther 2017;47(2):88-96. Epub 5 Nov 2016. doi:10.2519/jospt.2017.6778.