Pain Anxiety Symptoms Scale Research Articles

Depression and anxiety levels increase chronic musculoskeletal pain in patients with Alzheimer's disease.

During the next decades a rapid increase is expected in the number of patients with dementia suffering from pain who often take less medication compared to normal elderly, due to several diagnostic barriers. Comorbid mood disorders result in great difficulties in pain assessment and further treatment. Twenty five patients with Alzheimer's disease, comorbid mood disorders, and chronic musculoskeletal pain (experimental group) and thirty one patients with Alzheimer's disease and chronic musculoskeletal pain without comorbid mood disorders (control group) were examined. The assessment tools used were Geriatric Pain Measure, Patient Health Questionnaire, Pain Assessment in Advanced Dementia, Mini Mental State Examination and Pain Anxiety Symptom Scale. Statistical analysis was performed by SPSS v17.0, using the Pearson correlation and the multiple linear regression analysis. The correlation between mood disorders and levels of pain intensity in the experimental group was found to be statistically higher than that in the control group (p<.001). Among all quantitative variables, highly significant correlation (p<.001) was observed between stress and depression symptomatology (r =.550, p<.001) in the experimental group. Normal regression analysis was used to assess possible differences between demographic data and PASS scores. Scores in fearful thinking and physiological responses scales of PASS were higher in female than male (p=.014), whereas scores in the cognitive anxiety scale of PASS have shown a highly significant positive correlation with years of education (p<.001). It seems that depression and anxiety are associated with chronic musculoskeletal pain intensity in dementia, thus need to be taken into consideration by health professionals for patient's management.

痛みに対する不安症状尺度（PASS）-20日本語版の作成と妥当性の検討

痛みに対する不安症状尺度（PASS）-20日本語版の作成と妥当性の検討

Risk Factors for Continued Opioid Use One to Two Months After Surgery for Musculoskeletal Trauma

The aim of this study was to determine factors associated with self-reported ongoing use of opioid medication one to two months after operative treatment of musculoskeletal trauma. Operatively treated patients (n = 145) with musculoskeletal trauma were evaluated one to two months after surgery. Patients indicated if they were taking opioid pain medication and completed several psychological questionnaires: the Center for Epidemiologic Studies Depression Scale, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale, and the Posttraumatic Stress Disorder Checklist, civilian version. The Numeric Rating Scale was used to measure pain intensity. Disability was measured with use of the Short Musculoskeletal Function Assessment Questionnaire and injury severity was measured with use of the Abbreviated Injury Scale. Patients who scored higher on the catastrophic thinking, anxiety, posttraumatic stress disorder, and depression questionnaires were significantly more likely (p < 0.001) to report taking opioid pain medications one to two months after surgery, regardless of injury severity, fracture site, or treating surgeon. The magnitude of disability as measured by the Short Musculoskeletal Function Assessment score was significantly higher (p < 0.001) in the patients who reported using opioids (40 points) compared with those who reported not using opioids (24 points). A logistic regression model not including pain intensity found that the single best predictor of reported opioid use was catastrophic thinking (odds ratio, 1.12 [95% confidence interval, 1.07 to 1.18]), which explained 23% of the variance (p < 0.001). Patients who continue to use opioid pain medication one to two months after surgery for musculoskeletal trauma have more psychological distress, less effective coping strategies, and greater symptoms and disability than patients who do not take opioids, irrespective of injury, surgical procedure, or surgeon.

Ethnicity and Interdisciplinary Pain Treatment

The purpose of this study was to identify ethnic differences in interdisciplinary pain treatment outcome and whether these differences occur while controlling for the effects of demographics, psychosocial, and secondary gain. We assessed a sample of 116 (Caucasian, African American, and Latino/a) chronic pain patients who participated a 4-week interdisciplinary pain treatment program. Outcome measure included pretreatment, post-treatment, and change scores on the Multidimensional Pain Inventory, Pain Anxiety Symptom Scale 20, Chronic Pain Acceptance Questionnaire, Coping Strategies Questionnaire-revised, and the Center for Epidemiologic Studies Depression Scale-short form. Analysis of covariances revealed that after accounting for educational and sex differences, ethnic minorities differed from Caucasians on a number of treatment outcome measures at pre- and post-treatment [F's≥5.38; P's<0.01]. At pretreatment, Latino/a's endorsed greater levels of pain-related anxiety, pain severity, and pain catastrophizing than Caucasians. Both Latino/a's and African Americans reported greater use of prayer at pre- and post-treatment, with Caucasians showing the greatest decrease in the use of prayer in response to treatment. At post-treatment, African Americans had higher level of depression and lower levels of reported activity than Caucasians. Results support the notion that ethnic differences in pain treatment outcome exist. Further, ethnic minority groups appear to have greater levels of distress compared to Caucasians. However, African Americans, Latino/a's and Caucasians demonstrated similar improvements on all outcome measures, with exception of the use of prayer. Future studies should begin to explore the mechanisms to explain why ethnic group differences in pain treatment outcome occur.

AB0640 Pain catastrophizing and pain anxiety are associated with pain severity and with both neuropathic and fibromyalga pain phenotypes in PSS patients

BackgroundAnxiety and depression are frequently associated with Sjogren’s syndrome and pain is a common complaint. Patients who experience these problems find their symptoms frightening and possibly more disabling than the...

Nocebo hyperalgesia induced by social observational learning

Nocebo effects can be acquired by verbal suggestion, but it is unknown whether they can be induced through observational learning and whether they are influenced by factors known to influence pain perception, such as pain anxiety or pain catastrophizing. Eighty-five female students (aged 22.5±4.4years) were randomly assigned to one of three conditions. Participants in the control condition (CC) received information that an ointment had no effect on pain perception. Participants in the verbal suggestion condition (VSC) received information that it increased pain sensitivity. Participants in the social observational learning condition (OLC) watched a video in which a model displayed more pain when ointment was applied. Subsequently, all participants received three pressure pain stimuli (60seconds) on each hand. On one hand, the ointment was applied prior to the stimulation. Numerical pain ratings were collected at 20-second intervals during pain stimulation. The participants filled in questionnaires regarding pain-related attitudes (Pain Anxiety Symptoms Scale, Pain Catastrophizing Scale, and Somatosensory Amplification Scale). Participants in the OLC showed higher pain ratings with than without ointment. Pain ratings within the CC and the VSC were at the same level with and without ointment. In the VSC, the pain ratings were higher than in the CC with and without ointment. The nocebo response correlated with pain catastrophizing but not with pain anxiety or somatosensory amplification. A nocebo response to pressure pain was induced by observational learning but not by verbal suggestion. This finding highlights the importance of investigating the influence of observational learning on nocebo hyperalgesia.

Predictive utility of the pain sensitivity questionnaire

There are large individual differences in pain perception, and pain responsiveness or pain sensitivity is a potentially useful construct for understanding individual variability in the experience of pain. Recently, the Pain Sensitivity Questionnaire (PSQ) has been developed as a simple and economical alternative to more time-consuming experimental testing methods that involve expensive equipment. This project further investigated aspects of the psychometric properties of the PSQ. 539 undergraduate students (72% females, age M = 21.3 +/- 3.7 yrs) completed a variety of self-report instruments assessing emotional functioning (depression, anxiety, perceived stress), personality traits (e.g., neuroticism, optimism, anxiety sensitivity), pain per se (e.g., Short Form-McGill Pain Questionnaire-2), and other potentially relevant pain-related measures (e.g., Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Fear of Pain Questionnaire-Short Form, Illness/Injury Sensitivity Index).

Predictors of pain following total knee arthroplasty

Predictors of pain following total knee arthroplasty

Chronic pain and anxiety: a treatment outcome comparison of patients with anxiety in an interdisciplinary pain rehabilitation program

Anxiety symptoms are often overlooked or deemphasized for chronic pain patients, and research on effective treatments for patients with both chronic pain and anxiety is minimal. This study attempts to determine the prevalence of various anxiety disorders within this population, and compare treatment outcomes of those with or without anxiety following an intensive (3-week) interdisciplinary pain rehabilitation program. Mayo Clinic IRB approved this retrospective study comparing patients with and without anxiety from March 2009 to Dec. 2011. The presence of an anxiety disorder was determined by diagnoses given from responses to the Mini-International Neuropsychiatric Interview. Pain-related anxiety and pain catastrophizing were assessed with the Pain-Anxiety Symptoms Scale and the Pain Catastrophizing Scale. Pain severity, mood and functioning were assessed with the Multidimensional Pain Inventory, Pain Catastrophizing Scale, SF-36 Health Survey and Center for Epidemiological Studies-Depression scale. Significant differences in age, gender, ethnicity, andmarital statuswere foundbetween anxiety and non-anxiety groups.Within this sample, panic disorder (with andwithout agoraphobia; 16%) was the most prevalent anxiety disorder. Upon admission significant differences were found in most treatment outcomes with chronic pain patients with anxiety faring worse. Upon discharge, those with anxiety significantly scored worse than those without anxiety in pain-anxiety symptoms (p<.01), pain catastrophizing (p<.05), depression (p<.001), and life control (p<.05). Upon follow-up, significant differences in depression (p<.001) were found with the anxiety group rating higher. This study concludes that patients with the presence of anxiety or an anxiety disorder responded favorably with improved functioning following interdisciplinary rehabilitation pain treatment. Yet, those with anxiety tended to show poorer outcomes than those without the presence of an anxiety disorder. Interdisciplinary pain rehabilitation programs should address anxiety disorders and provide tools for patients to manage and cope with anxiety in healthy ways to further improve outcomes.

Sex differences in the relationship between maternal fear of pain and children&amp;#39;s conditioned pain modulation

BackgroundParental behaviors, emotions, and cognitions are known to influence children’s response to pain. However, prior work has not tested the association between maternal psychological factors and children’s responses to a conditioned pain modulation (CPM) task. CPM refers to the reduction in perceived pain intensity for a test stimulus following application of a conditioning stimulus to a remote area of the body, and is thought to reflect the descending inhibition of nociceptive signals.MethodsThe present study examined sex differences in the association between maternal anxiety about pain and children’s CPM responses in 133 healthy children aged 8–17 years. Maternal pain anxiety was assessed using the Pain Anxiety Symptoms Scale-20. In addition to the magnitude of CPM, children’s anticipatory anxiety and pain-related fear of the CPM task were measured.ResultsSequential multiple linear regression revealed that even after controlling for child age and general maternal psychological distress, greater maternal pain anxiety was significantly related to greater CPM anticipatory anxiety and pain-related fear in girls, and to less CPM (ie, less pain inhibition) in boys.ConclusionThe findings indicate sex-specific relationships between maternal pain anxiety and children’s responses to a CPM task over and above that accounted for by the age of the child and the mother’s general psychological distress.

Gabapentin reduces preoperative anxiety and pain catastrophizing in highly anxious patients prior to major surgery: a blinded randomized placebo-controlled trial

Gabapentin is increasingly being used for the treatment of postoperative pain and a variety of psychiatric diseases, including chronic anxiety disorders. Trials have reported mixed results when gabapentin has been administered for the treatment of preoperative anxiety. We tested the hypothesis that gabapentin 1,200 mg vs placebo would reduce preoperative anxiety in patients who exhibit moderate to high preoperative anxiety. A blinded randomized controlled trial was conducted from September 2009 to June 2011 at the Toronto General Hospital. Following ethics approval and informed consent, 50 female patients with a 0-10 numeric rating scale (NRS) anxiety score of greater than or equal to 5/10 consented to receive either gabapentin 1,200 mg (n = 25) or placebo (n = 25) prior to surgery. Randomization was computer generated, and the Investigational Pharmacy was responsible for the blinding and dispensing of medication. All patients and care providers, including physicians, nurses, and study personnel, were blinded to group allocation. Before administering the study medication, baseline anxiety levels were measured using a NRS, the Spielberger State-Trait Anxiety Inventories, the Pain Catastrophizing Scale, and the Pain Anxiety Symptoms Scale-20. Baseline pain intensity (0-10 NRS) and level of sedation (0-10 NRS and Richmond Agitation-Sedation Scale [RASS]) were also measured. Two hours after the administration of gabapentin or placebo (prior to surgery), patients again rated their anxiety, pain, and sedation levels using the same measurement tools as at baseline. The main outcome was a reduction in preoperative anxiety. Forty-four patients (22 treated with gabapentin 1,200 mg and 22 treated with placebo) were included in the analysis of the primary outcome. Analysis of covariance in which pre-drug NRS anxiety scores were used as the covariate showed that post-drug preoperative NRS anxiety (Effect size, 1.44; confidence interval [CI] 0.19 to 2.70) and pain catastrophizing (Effect size, 0.43; CI 0.12 to 0.74) scores were significantly lower in the gabapentin group than in the placebo control group, respectively. Post-drug sedation (Effect size, -3.02; CI -4.28 to -1.77) and RASS (Effect size, 0.41; CI 0.12 to 0.71) scores were significantly higher in the gabapentin group than in the placebo group, respectively. Administration of gabapentin 1,200 mg prior to surgery reduces preoperative NRS anxiety scores and pain catastrophizing scores and increases sedation prior to entering the operating room. These results suggest that gabapentin 1,200 mg may be a treatment option for patients who exhibit high levels of preoperative anxiety and pain catastrophizing; however, the sedative properties of the medication and the possibility of delayed postoperative discharge in the elective ambulatory population need to be considered.

Does sex moderate the relationship between anxiety and pain?

Objectives : Sex differences exist in the relationship between anxiety and pain, although findings are mixed. One reason could be because a number of anxiety measures have been used. Therefore, this study aimed to identify the core components within commonly used pain anxiety measures, and see whether these components are differentially related to sensation and pain thresholds in men and women. Design, main outcome measures : One hundred and eighty-nine healthy adults (119 female) completed the Fear of Pain Questionnaire, Pain Catastrophising Scale, Pain Anxiety Symptoms Scale, Anxiety Sensitivity Index-3 and the Depression Anxiety Stress Scale. Thermal sensation and pain thresholds, mechanical sensation and pressure pain thresholds were also collected. Results : A Principal Components Analysis of anxiety measures revealed three constructs: general distress, cognitive intrusion and fear of pain from injury/insult. Sex did not moderate the relationship between these anxiety constructs and sensation/pain thresholds. However, a significant main effect of sex was found to predict thermal pain thresholds. Conclusion : Preliminary indications suggest that pain anxiety dimensions can be reduced to three core constructs, and used to examine pain sensation. However, sex did not moderate this relationship. Further research is required to establish the extent and strength of sex differences in the relationship between anxiety and pain.

Factors Associated with Incomplete DASH Questionnaires

Missing data are unavoidable in clinical research. Older age, female gender, and fewer years of education are risk factors for missing items in a questionnaire. This study assessed the differences between patients with complete and incomplete Disabilities of the Arms, Shoulder and Hand (DASH) questionnaires in terms of demographics and psychological factors. We analyzed a convenience sample of 1,204 patients enrolled in eight prospective studies. The DASH and the Pain Catastrophizing Scale were completed by all patients. The Center for Epidemiologic Studies Depression scale, Patient Health Questionnaire, Pain Anxiety Symptoms Scale, and an ordinal pain scale were completed by 745, 493, 545, and 391 patients, respectively. Bivariate analysis and binary logistic regression were used to determine risk factors for incomplete (one or more unanswered question) or invalid (more than three unanswered questions) DASH questionnaires. Thirty-one percent of patients did not complete all questions on the DASH. Patients with an incomplete DASH were older, had fewer years of education, and had higher levels of catastrophic thinking, depression, and pain anxiety. Age and catastrophic thinking were retained in the best logistic regression models of predictors of both incomplete and invalid DASH questionnaires. The observation that patients who complete disability questionnaires are different from patients who do not may affect the interpretation of clinical research. Computer adaptive testing may be preferable to avoid incomplete questionnaires. Prognostic Level II.

Relationship Between Pain and Post-Traumatic Stress Symptoms in Palliative Care

ContextPrevious research suggests that patients receiving palliative care may simultaneously experience poorly managed pain and post-traumatic stress disorder (PTSD)-related symptoms as a result of their deteriorating health. ObjectivesTo: 1) examine predictors of PTSD-related symptoms in patients requiring palliative care; 2) assess whether anxiety, depression, pain catastrophizing, and pain anxiety mediate the relationship between pain interference and PTSD-related symptoms; and 3) evaluate the impact of these variables on pain interference and PTSD-related symptoms. MethodsOne hundred patients receiving palliative care at one of two palliative care sites in London, ON, Canada, completed the PTSD Checklist—Civilian version (PCL-C), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory-Short Form (BPI-SF), and the Pain Anxiety Symptoms Scale-20 (PASS-20). Hierarchical multiple regressions were used to examine HADS-Anxiety, HADS-Depression, PCS and PASS-20 scores as predictors of PCL-C scores; and mediation analyses were used to test the effect of HADS-Anxiety, HADS-Depression, PCS, and PASS-20 on the relationship between BPI-SF interference and PCL-C. Mediators that significantly affected this relationship in the individual mediator models were entered into a multiple mediator model. ResultsOnly pain anxiety and pain catastrophizing emerged as significant mediators of the relationship between pain interference and PTSD-related symptoms. After being entered in a multiple mediator model, pain anxiety emerged as the strongest mediator. ConclusionThe findings of the present study reveal that pain and PTSD-related symptoms are important concerns in palliative care, and that pain must be addressed to best meet the needs of this population.

Temperament Traits and Chronic Pain: The Association of Harm Avoidance and Pain-Related Anxiety

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.

Association between Individual DASH Tasks and Restricted Wrist Flexion and Extension after Volar Plate Fixation of a Fracture of the Distal Radius

Symptoms and psychosocial factors are suggested to account for more of the variation in disability than physical impairment, but perhaps less so at the level of specific tasks. This study assessed the influence of impaired wrist motion on specific tasks on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Sixty-three patients with an operatively treated fracture of the distal radius completed the Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale, and Center for Epidemiologic Studies Depression Scale (CES-D) just before surgery and the DASH questionnaire 3months after surgery. Nine questions on the DASH were selected as potentially sensitive to changes in wrist motion and evaluated in bivariate and multivariable analyses. In multivariable models of factors associated with specific tasks, only "Open a tight or new jar" was affected by wrist flexion and PCS accounting for 33% of the variation. Motion, pain, and PCS were significant predictors of the DASH score. Among the eight tasks not related to wrist motion, 33% of the variation in disability with writing was accounted for by PCS and limb dominance; 20% of disability preparing a meal by pain, CES-D, and PCS; 14% of disability with making a bed by pain and CES-D; and 23% of changing a light bulb overhead by age, pain, and fracture type. After volar plate fixation of a fracture of the distal radius, upper extremity disability based on select items from the DASH questionnaire correlated minimally with impairment of wrist motion, even at the level of specific tasks. Prognostic Level II.

To What Degree do Shoulder Outcome Instruments Reflect Patients’ Psychologic Distress?

Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores. We asked (1) to what degree shoulder outcome instruments reflect patients' psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified. We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments. Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments. Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications. Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Factor Structure and Psychometric Properties of the Chinese Version of the 20-Item Pain Anxiety Symptoms Scale (ChPASS-20)

ContextThe Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated. ObjectivesThis study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity. MethodsA total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics. ResultsConfirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach’s αs: 0.72–0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159)=11.97, P<0.001], pain intensity [F(4,161)=2.47, P<0.05], and pain disability [F(4,191)=5.47, P<0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient=0.21, P<0.05) emerged as a significant independent predictor of concurrent pain disability. ConclusionOur data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population.

Ganglions of the hand and wrist: determinants of treatment choice

The aim of this study was to determine whether psychological factors (depression, catastrophic thinking, and pain anxiety) and pain intensity are associated with choice of operative treatment. Ninety new patients with a ganglion cyst on their hand or wrist completed psychological questionnaires (Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale, and Center for the Epidemiological Study of Depression instrument) and an ordinal measure of pain intensity. After a minimum of 4 months, patients were contacted to determine if they chose operative treatment, to rate their pain intensity, and to complete the Disabilities of the Arm, Shoulder, and Hand questionnaire. Younger patients were more likely to choose operative treatment. Psychological factors were associated with pain intensity at enrolment, but not with treatment choice. Operative treatment did not result in less pain intensity or disability, or higher satisfaction compared with non-operative treatment.

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.