Pain Hypervigilance Research Articles

Analysis and relationship between the volume of upper limb lymphoedema and pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in breast cancer survivors.

Lymphedema of the upper limbs and persistent pain are frequent sequelae after surgical treatment of breast cancer. The aim of this paper was to analyze the upper limb volume, pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in patients with and without lymphoedema after breast cancer surgery. Secondly, we aimed to investigated the association between upper limb volume and these variables. Descriptive observational study. Faculty of Health Sciences of the University of Granada. Fifty-eight post-surgical breast cancer survivors, 29 with upper limb lymphoedema and 29 without lymphoedema. We measured upper limb volume (perimetric method). Also, pressure pain thresholds were assessed with a digital algometer, neural range of motion (neurodynamic test for radial, ulnar and median nerves), pain intensity (visual analogue scale), kinesiophobia, pain hypervigilance and catastrophizing (validated tests). To detect differences between the groups for the measurement variables we performed a t-test for independent samples analysis. A simple linear regression analysis adjusting for age and body mass index was performed to check the association among upper limb volume and pain variables in the group with lymphoedema. The analysis showed that lymphoedema group had lower pressure pain threshold bilaterally in the masseter (origin P≤0.036; insertion P≤0.046), temporalis (insertion P≤0.021), suboccipitalis (P≤0.036); second (P≤0.014), third (P≤0.001) and tenth rib (P≤0.001); affected side of the temporalis (origin P=0.025); temporomandibular joint (P=0.024); neural range of motion in the median nerve (P=0.047), ulnar (P=0.042) on the affected side and radial (P=0.039) on the unaffected side; and greater kinesiophobia (P=0.042). Linear regression analysis only showed a significant association between upper limb volume and neural range of motion in the radial nerve (P=0.020) in the lymphedema group. No significant associations were obtained for the rest of variables. These findings suggest that the presence of lymphoedema may contribute to an increased level of generalized mechanosensitivity and fear to movement in this population. Upper limb lymphedema can lead to heightened mechanosensitivity and movement-related fear in breast cancer survivors. Therefore, fast track rehabilitation approach should be focus in screening and rehabilitation methods for detection and control this sequalae.

Understanding the Associations between Executive Function and Psychological Variables in Fibromyalgia Syndrome: A Network Analysis Approach.

The aim of this study was to quantify the multivariate relationships between clinical, cognitive performance, executive functioning, and psychological outcomes in women with fibromyalgia (FMS) using network analyses. Demographic (age, height, weight), clinical (pain history, pain intensity, and related disability), neurocognitive (D2 Attention test, Rey-Osterrieth Complex Figure for visual perception, "Digits D/R/I" tests of the WAIS-IV battery for working memory, the 5-Digit Test for mental inhibition, the Symbol Search for processing speed and the Zoo Test for planning/decision making) and psychological (depressive symptoms, anxiety levels, sleep quality, pain hypervigilance) variables were collected in 129 women with FMS and 111 healthy women. Network analyses were conducted separately for each group to quantify the adjusted correlations between the modeled variables and to assess their centrality indices (i.e., connectivity with other symptoms in the network and their importance in the network). The network identified 74 associations in FMS women and 46 associations in controls with small differences. The strongest correlations in both groups were found between different attention variables: d2_CON with d2_C, d2_O with d_2TR, and d2_CON with d2_TA. The most central variables were d2_TA, d2_C, and d2_CON (highest strength centrality in both groups) and anxiety levels and pain hypervigilance (highest harmonic centrality in FMS women). The strength centrality of the network was stable for women with FMS (CScor0.7: 0.68) but not for healthy women (CScor0.7: 0.28). This study found that attention variables are most relevant within a neurocognitive network and that psychological variables are most important for the treatment of women with FMS. The clinical implications of the current findings, such as the development of treatments targeting these variables, are discussed.

Investigating the brain functional abnormalities underlying pain hypervigilance in chronic neck and shoulder pain: a resting-state fMRI study.

To investigate pain hypervigilance in individuals suffering from chronic neck and shoulder pain (CNSP) and its underlying brain mechanism. The evaluation of pain vigilance was conducted through the utilization of pain vigilance and awareness questionnaires. Voxel-wise regional homogeneity (ReHo) from 60 CNSP patients and 60 healthy controls (HCs) using resting-state fMRI data. Voxel-wise two-sample T-test was conducted to reveal the ReHo variations between CNSP and HC. Correlation analyses were utilized to reveal the connection between brain abnormalities and medical measurements. Furthermore, a mediation analysis was conducted to elucidate the pathway-linking changes in brain function with medical measurements. Our present study revealed three main findings. Firstly, patients with CSNP demonstrated a heightened vigilance of pain in comparison to healthy adults, a common occurrence among individuals with chronic pain conditions. Secondly, we observed brain abnormalities in various brain regions in CSNP patients, and these alterations were associated with the extent of pain vigilance. Lastly, the pain hypervigilance impact on the severity of pain was found to be controlled by regional neural activity in the anterior cingulate cortex (ACC) in subjects with CSNP. Our findings suggested that long-term repetitive nociceptive input caused by chronic pain further aggravates the pain intensity by impairing the vigilance-related pain processing within the anterior cingulate cortex in CNSP patients.

Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study

BackgroundAltered central pain processing (CPP) and dysautonomia might play a role in the clinical course of frozen shoulder and psychological factors, like pain catastrophizing and hypervigilance, might influence clinical variables in frozen shoulder. ObjectivesTo explore the clinical course of frozen shoulder regarding CPP, dysautonomia, pain catastrophizing, and hypervigilance and to explore whether longitudinal correlations between these outcomes and pain intensity were present. Designprospective longitudinal observational study. MethodParticipants with frozen shoulder were recruited at hospitals and general practitioner practices and followed for 9 months. They completed six questionnaires (about demographics, shoulder pain and disability, pain intensity, pain catastrophizing, pain hypervigilance, and autonomic symptoms) and underwent tactile sensitivity (allodynia), pressure pain thresholds (hyperalgesia), temporal summation, and conditioned pain modulation during four timeframes (3-month intervals). ResultsInitially, 149 participants with frozen shoulder were recruited and 88 completed all the measurements. An improvement from baseline to at least one follow-up measurement was found for shoulder pain and disability, pain intensity, pain catastrophizing, hypervigilance, and dysautonomia. A fair longitudinal correlation was found between pain intensity and catastrophizing and hypervigilance (r = 0.301–0.397). Poor longitudinal correlations were found between pain intensity and allodynia and hyperalgesia (r = −0.180-0.193), between pain catastrophizing and dysautonomia (r = 0.209) and between hypervigilance and hyperalgesia (r = −0.159). ConclusionPatients with frozen shoulder showed an early improvement that flattened with time in several pain and psychological variables over the course of 9 months. However, autonomic symptoms rather showed a late improvement over 9 months.

Deep Cervical Muscles and Functionality in Patients with Chronic Tension-Type Headache: An Observational Study.

Background and objectives: Chronic tension-type headache (TTH) is the type of headache with the highest prevalence. The involvement of musculoskeletal structures in TTH is supported by evidence in the scientific literature. Among these, deep cervical muscle strength appears to be related to the function of the cervical spine and the clinical characteristics of TTH. This study aimed to correlate anatomical, functional, and psychological variables in patients with TTH. Materials and methods: An observational descriptive study was carried out with 22 participants diagnosed with TTH for at least six months. The characteristics of headaches, including ultrasound-based deep neck flexor and extensor muscle thickness, range of motion (ROM), and pressure pain threshold (PPT), were recorded. We also conducted the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Craniocervical Flexion Test (CCFT). Results: Moderate–large negative correlations were found between the PVAQ and the muscle thickness of right deep flexors contracted (r = −0.52; p = 0.01), left multifidus contracted (r = −0.44; p = 0.04), right multifidus at rest (r = −0.48; p = 0.02), and right multifidus contracted (r = −0.45; p = 0.04). Moderate–large positive correlations were found between the CCFT score and the left cervical rotation ROM (r = 0.53; p = 0.01), right cervical rotation ROM (r = 0.48; p = 0.03), muscle thickness of left multifidus contracted (r = 0.50; p = 0.02), and muscle thickness of right multifidus at rest (r = 0.51; p = 0.02). The muscle thickness of the contracted right deep cervical flexors showed a moderate negative correlation with headache intensity (r = −0.464; p = 0.03). No correlations were found between PPT and the rest of the variables analyzed. Conclusions: In patients with TTH, a higher thickness of deep cervical muscles was associated with higher ROM and higher scores in the CCFT. In turn, the thickness of deep cervical muscles showed negative correlations with pain hypervigilance and headache intensity. These results contribute to a better understanding of the physical and psychosocial factors contributing to the development of TTH, which is useful for implementing appropriate prevention and treatment measures.

Cognitions and physical impairments in relation to upper limb function in women with pain and myofascial dysfunctions in the late stage after breast cancer surgery: an exploratory cross-sectional study

Purpose Upper limb (UL) function is one of the health outcomes that matters the most for women with breast cancer. However, a better understanding of the factors contributing to UL dysfunctions in the late stage after breast cancer surgery is needed. This study explores associations between impairment-related and cognition-related factors and UL function in women with pain and myofascial dysfunctions at the affected UL region in this late stage after breast cancer surgery. Methods In forty-one women, UL function (dependent variable) was evaluated by the Disabilities of Arm, Shoulder and Hand questionnaire. As independent impairment-related factors, relative excessive arm volume (perimetry), pain intensity (maximum score on the visual analogue scale past week) and humerothoracic elevation and scapular lateral rotation (kinematic analysis) were assessed. As independent cognition-related factors, pain catastrophizing (Pain Catastrophizing Scale) and pain hypervigilance (Pain Vigilance and Awareness Questionnaire) were evaluated. Bi-variable analyses and a stepwise regression analysis were used to explore associations. Results A higher pain intensity (r = 0.52; p < 0.001), more pain catastrophizing (r = 0.49; p < 0.001) and more pain hypervigilance (r = 0.40; p = 0.01) were related to more UL dysfunction. Pain intensity (p = 0.029) and pain catastrophizing (p = 0.027) explained furthermore 29.9% of variance in UL function. Conclusions Pain intensity and cognition-related factors are significantly associated with UL function in women with pain and myofascial dysfunctions, indicating the need of assessing pain beliefs in women in the late stage after breast cancer surgery. IMPLICATIONS FOR REHABILITATION Pain intensity and pain-related beliefs, including pain attention and catastrophizing, are related to the severity of upper limb dysfunctions in the late stage after breast cancer surgery. Impairments such as lymphedema and movement restrictions seem not related to upper limb function in the assessed sample. To understand upper limb dysfunctions in the late stage after breast cancer, assessing pain beliefs is needed.

The Result of Acute Induced Psychosocial Stress on Pain Sensitivity and Modulation in Healthy People

Background Pain can be influenced by several factors, including stress. Stress can have various reactions on pain. These reactions are influenced by several internal factors such as gender, age, and experience with stress or pain. Objectives To determine the effect of acute stress on mechanical hyperalgesia (with pressure pain thresholds [PPT]), endogenous pain facilitation (measured by temporal summation [TS]), and inhibition (measured by conditioned pain modulation [CPM]) in healthy people and to determine which factors are responsible for this stress result. Study design Pre-posttest design. Setting Healthy volunteers from Belgium. Methods One hundred and one healthy pain-free patients underwent a modified Trier Social Stress Test. Prior and following the stress manipulation, PPT, TS, and CPM efficacy were determined in the mm. trapezius and quadriceps and overall. Furthermore, possible explanatory factors, such as fear of pain, pain catastrophizing, pain hypervigilance, and daily activity levels, were assessed using questionnaires. Results We found a significant stress result on widespread pain sensitivity, with an increase of PPT (P 0.05), and a decrease in CPM efficacy (P Limitations The efficacy of the stress manipulation was not examined, and the lack of a control group prevented to examine a real stress-effect. Furthermore, no physiologic parameters were measured as possibly influencing internal factors for the stress-result. Conclusions The increase in PPT was not a clinically significant change, whereas the decrease in CPM was meaningful. None of the factors predicted the stress result in all experimental pain measurements, and the predictions that were observed only explained a small proportion of the observed effects.

A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting

IntroductionChronic and distressing genito-pelvic pain associated with vaginal penetration is most frequently due to provoked vestibulodynia (PVD). Cognitive behavioral therapy (CBT) significantly reduces genital pain intensity and improves psychological and sexual well-being. In general chronic pain populations, mindfulness-based approaches may be as effective for improving pain intensity as CBT. AimTo compare mindfulness-based cognitive therapy (MBCT) with CBT in the treatment of PVD. MethodsTo ensure power of 0.95 to find medium effect size or larger in this longitudinal design, we enrolled 130 participants. Of these, 63 were assigned to CBT (mean age 31.2 years), and 67 to MBCT (mean age 33.7 years). Data from all participants who completed baseline measures were analyzed, with intent-to-treat analyses controlling for years since diagnosis. Main Outcome MeasuresOur primary outcome was self-reported pain during vaginal penetration at immediate post-treatment and at 6 months’ follow-up. Secondary endpoints included pain ratings with a vulvalgesiometer, pain catastrophizing, pain hypervigilance, pain acceptance, sexual function, and sexual distress. ResultsThere was a significant interaction between group and time for self-reported pain, such that improvements with MBCT were greater than those with CBT. For all other endpoints, both groups led to similar significant improvements, and benefits were maintained at 6 months. Clinical ImplicationsMindfulness is a promising approach to improving self-reported pain from vaginal penetration and is as effective as CBT for several psychological endpoints. Strength & LimitationsA strength of the present study was the robust sample size (n = 130 women) who had received confirmed clinical diagnoses of PVD. ConclusionThe present study showed mindfulness to be as effective for most pain- and sexuality-related endpoints in the treatment of PVD.Brotto LA, Bergeron S, Zdaniuk B, et al. A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting. J Sex Med 2019;16:909–923.

What Do Different Measures of Pain Tell Us? A Comparison in Sexually Active Women With Provoked Vestibulodynia

IntroductionStudies of pain measurement in women with provoked vestibulodynia (PVD) use various methods of capturing pain intensity. The degree to which these different measures of pain correspond with one another is not known. AimTo compare 3 different measures of pain intensity in sexually active women with PVD participating in a clinical treatment study. MethodsA total of 64 women (mean age 30.9 years) provided baseline measures of pain intensity using (i) a numeric rating scale that provided a self-report of pain during recalled vaginal penetration; (ii) the pain subscale of the female sexual function index; and (iii) pain elicited with a vulvalgesiometer, an objective method of eliciting pain. Main Outcome MeasureCorrelations among these 3 measures of pain were moderate in size (range r = 0.39–0.61). Moreover, the numeric rating scale of pain was more likely to be associated with self-reported measures of pain catastrophizing and pain hypervigilance than were scores on the pain subscale of the female sexual function index or scores from the vulvalgesiometer. Clinical ImplicationsOverall, there was a moderate level of correlation between different often-used measures of pain in women with PVD. These findings suggest that, in addition to measuring a common dimension, these different measures tap into different aspects of women’s experiences with vulvovaginal pain, and researchers should consider how the chosen measure addresses their primary research question when selecting pain measures in future PVD research. Strengths & LimitationsA strength of this study was the large sample size (n = 64 sexually active women) who had received confirmed clinical diagnoses of PVD. 1 limitation of the findings is that our self-report outcome measures are based on retrospective ratings of pain over 4 weeks, and it is possible that other variables, such as mood, could have impacted scores on these measures. ConclusionThis study showed statistically significant and moderate correlations among 3 different pain measures widely used in PVD research and treatment. In addition, only 1 pain measure showed a significant independent association with emotion function measures. These findings provide a rationale for including multiple measures of pain and emotional function in treatment outcome studies of PVD.Wammen Rathenborg FL, Zdaniuk B, Brotto LA. What Do Different Measures of Pain Tell Us? A Comparison in Sexually Active Women With Provoked Vestibulodynia. J Sex Med 2019;16:278–288.

Mindfulness and Chronic Headache/Migraine: Mechanisms Explored Through the Fear-Avoidance Model of Chronic Pain.

To replicate a study by Schutze and colleagues on a headache sample, rather than a heterogenous chronic pain sample, investigating whether level of mindfulness predicts key components in the Fear-Avoidance Model of chronic pain (pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability); to investigate the relationships between level of mindfulness and headache/migraine pain intensity, frequency, and duration. Participants were 217 individuals who self-reported chronic headache/migraine (51 male, 166 female), aged between 18 and 65 years. Participants completed an online survey measuring demographics, mindfulness, the key components of the Fear-Avoidance Model, and headache pain intensity, duration, and frequency. Mindfulness had significant negative correlations (P<0.05) with all variables except headache pain intensity and headache frequency. Mindfulness significantly predicted negative affect, pain catastrophizing, fear of pain, pain hypervigilance, and headache duration (P<0.05). Mindfulness remained a significant predictor of negative affect and pain hypervigilance after controlling for other key components and background characteristics (P<0.05). Mindfulness did not moderate the relationship between pain intensity and pain catastrophizing (P=0.204). Findings suggest that mindfulness may be integrated into the Fear-Avoidance Model of chronic pain for individuals with chronic headache/migraine. Directions for future research are discussed.

Does pain hypervigilance further impact the lack of habituation to pain in individuals with chronic pain? A cross-sectional pain ERP study.

AimIn chronic pain, habituation is believed to be impaired, and pain hypervigilance can enhance the pain experience. The goal of this study was to determine whether pain hypervigilance further worsens habituation of event-related potentials, measured in a pain-rating protocol of 25 painful somatosensory electrical stimuli, in patients with chronic pain.MethodsPain hypervigilance was assessed with the Pain Vigilance Awareness Questionnaire and analyzed using the event-related fixed interval areas multilevel technique, which enables one to study within-session habituation. In a cohort of 111 participants, 33 reported chronic pain. This chronic pain group was compared with 33 pain-free individuals, matched for age and sex.ResultsThe relationship between pain status and habituation was not moderated by pain hypervigilance. Chronic pain status affected linear habituation and dishabituation (quadratic function) from 220 to 260 ms for nearly all electrodes, and from 580 to 640 ms for frontal electrodes. The effect of pain hypervigilance on habituation was observed primarily from 480 to 820 ms poststimulus for right-sided and central electrodes.ConclusionPain hypervigilance and chronic pain independently influence habituation to painful stimuli – although not synergistically. To confirm that these effects are mediated by separate pathways, further research is required, in which electroencephalography is combined with other modalities with adequate spatial resolution, such as functional magnetic resonance imaging.

Predictors of disability and absenteeism in workers with non-specific low back pain: A longitudinal 15-month study

The objective of this study was to identify baseline predictors of disability and absenteeism in workers with a history of non-specific low back pain (LBP). One hundred workers with a history of non-specific LBP participated in three evaluations (baseline, 7 and 15 months follow-up). Current and past history of LBP, clinical pain intensity, disability, absenteeism, fear-avoidance beliefs, pain catastrophizing, pain hypervigilance, work satisfaction and patient stratification based on "risk of poor clinical outcome assessment" (RPCO) were evaluated using questionnaires and interviews. In addition, cutaneous heat pain thresholds, cutaneous heat pain tolerance thresholds, conditioned pain modulation (CPM), trunk kinematics and muscle activity were measured during each evaluation. Logistic regression models were used to determine predictors of LBP disability and absenteeism at 15-months. Sixty-eight workers returned for the 15-month follow-up and among this sample, 49% reported disability and 16% reported absenteeism at follow-up. Baseline clinical pain intensity predicted disability (OR=1.08, 95%CI: 1.03-1.13) at 15-month while work satisfaction (OR=0.93, 95%CI: 0.87-0.99) and RPCO (OR=1.51, 95%CI: 1.05-2.16) predicted absenteeism. These results remained significant after adjustments for age, gender as well as type of work and intervention. This study highlights the importance of clinical pain and psychological factors in the prediction and potentially the prevention of future disability. Screening tools assessing these risk factors can be useful to evaluate workers with past history of low back pain.

Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty

Background and purposeMany psychological factors are known to influence pain perception. Among them, intolerance of uncertainty (IU) may play a key modulating role in situations where uncertainty prevails, especially uncertainty regarding the timing of painful events. The objective of this study was to explore the impact of individual differences in IU on pain perception during predictable and unpredictable stimulation timings. We hypothesized that people with high IU, as opposed to those with low IU, would perceive more pain when the timing of painful stimulations cannot be predicted, as compared to when they can. MethodsTwenty (20) healthy adults, aged between 18 and 35 years old, were recruited. Painful sensations were provoked using transcutaneous electrical stimulations of the right sural nerve. By measuring IU (Intolerance of Uncertainty Scale) and subjective pain (verbal numerical rating scale), it was possible to test the relationship between IU and pain perception, by simulating predictable and unpredictable painful experiences. This was done through cued shock interval (CSI) blocks, with either variable timing or fixed timings (long or short time frame). Self-administered questionnaires were also used to measure pain hypervigilance, pain catastrophizing, state anxiety, and trait anxiety. ResultsPearson correlations confirmed the presence of an association (r=0.63) between IU and the change in pain intensity provoked by unpredictable stimulation timings. Importantly, this association was significant only for stimulations provided at long CSIs, indicating that higher IU scores predicted higher pain intensity scores when stimulation timings became unpredictable, and when the cued delay was long. No association was found between pain scores and other psychological variables. ConclusionsOur results show that IU moderately correlates to the change in pain intensity provoked by unpredictable stimulation timings. High IU scores were associated with a worsening of the subjective pain experience, especially during long delays in an unpredictable situation. These observations suggest that IU could be considered as a psychological variable that is able to influence pain perception in certain situations. ImplicationsAssessing and addressing IU could be an added value in pain-related therapy, especially in chronic pain.

Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables.

Psychological variables and acute post-operative pain are of proven relevance for the prediction of persistent post-operative pain. We aimed at investigating whether pain-specific psychological variables like pain catastrophizing add to the predictive power of acute pain and more general psychological variables like depression. In all, 104 young male patients undergoing thoracic surgery for pectus excavatum correction were studied on the pre-operative day (T0) and 1week (T1) and 3months (T2) after surgery. They provided self-report ratings (pain-related: Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale=PASS, Pain Vigilance and Awareness Questionnaire=PVAQ; general psychological: Screening for Somatoform Symptoms, State-Anxiety Inventory-X1, Center for Epidemiologic Studies Depression Scale=CES-D). Additional predictors (T1) as well as criterion variables (T2) were pain intensity (Numerical Rating Scale) and pain disability (Pain Disability Index). Three months after surgery, 25% of the patients still reported clinically relevant pain (pain intensity ≥3) and over 50% still reported pain-related disability. Acute post-operative pain as well as general psychological variables did not allow for a significant prediction of persistent post-operative pain; in contrast, pain-related psychological variables did. The best single predictors were PASS for pain intensity and PVAQ for pain disability. Pain-related psychological variables derived from the fear-avoidance model contributed significantly to the prediction of persistent post-operative pain. The best possible compilation of these measures requires further research. More general psychological variables may become relevant predictors later in the medical history. Our results suggest that pain-specific psychological variables such as pain anxiety and pain hypervigilance add significantly to the prediction of persistent post-operative pain and might even outperform established predictors such as acute pain and general psychological variables. Clinicians might benefit from the development of time-economic screening tools based on these variables.

Psychological Predictors of Acute Postoperative Pain After Hysterectomy for Benign Causes.

Psychological parameters have been shown to contribute significantly to the development of acute postoperative pain (APOP). For the prediction of APOP in chest malformation patients and cancer patients, we found pain-specific psychological predictors to be of higher relevance than general psychological predictors. The current study aims to further substantiate these findings. In a sample of 73 middle-aged hysterectomy patients, 3 predictor sets were assessed 1 day before surgery: attentional biases (toward pain-related, social threat, and positive words in a dot-probe task), pain-related emotions and cognitions (pain anxiety, pain catastrophizing, and pain hypervigilance), and affective state variables (depression and somatization). APOP intensity rated 2 to 3 days after surgery and analgesic consumption during the first 48 postoperative hours were used as outcome measures. APOP intensity ratings were significantly explained by their best single predictors in a multiple regression analysis: social threat words of the dot-probe task, pain anxiety, and somatization (14.7% of explained variance). When comparing standardized β coefficients, pain-specific psychological predictors appeared to be of higher explanatory relevance than general psychological predictors. In contrast, analgesic consumption could not be significantly predicted by the psychological variables. Hysterectomy patients at risk for high APOP intensity could be characterized by the psychological variables used, whereas their predictive value for analgesic consumption was limited. The high predictive potency of pain-specific psychological variables should be considered for further improvement of pain management and prevention, because pain-specific variables such as pain anxiety can be the target of focal psychological interventions when preparing for surgery.

The net suppression effect of pain catastrophic cognition on anxiety sensitivity

IntroductionThe existing literature on chronic pain points to the effects anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear; however, the nature of the relationships remains unclear. The three dispositional factors may affect one another in the prediction of pain adjustment outcomes. The addition of one disposition may increase the association between another disposition and outcomes, a consequence known as suppressor effects in statistical terms.ObjectiveThis study examined the possible statistical suppressor effects of anxiety sensitivity, pain hypervigilance and pain catastrophizing in predicting pain-related fear and adjustment outcomes (disability and depression).MethodsChinese patients with chronic musculoskeletal pain (n = 401) completed a battery of assessments on pain intensity, depression, anxiety sensitivity, pain vigilance, pain catastrophizing, and pain-related fear. Multiple regression analyses assessed the mediating/moderating role of pain hypervigilance. Structural equation modeling (SEM) was used to evaluate suppression effects.ResultsOur results evidenced pain hypervigilance mediated the effects of anxiety sensitivity (Model 1: Sobel z = 4.86) and pain catastrophizing (Model 3: Sobel z = 5.08) on pain-related fear. Net suppression effect of pain catastrophizing on anxiety sensitivity was found in SEM where both anxiety sensitivity and pain catastrophizing were included in the same full model to predict disability (Model 9: CFI = 0.95) and depression (Model 10: CFI = 0.93) (all P &lt; 0.001) (see Figs. 3 and 4, Figs. 1 and 2).ConclusionsOur findings evidenced that pain hypervigilance mediated the relationship of two dispositional factors, pain catastrophic cognition and anxiety sensitivity, with pain-related fear. The net suppression effects of pain catastrophizing suggest that anxiety sensitivity enhanced the effect of pain catastrophic cognition on pain hypervigilance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A New Version of the Impairment and Functioning Inventory for Patients With Chronic Pain (IFI-R)

BackgroundFew instruments are available that have adequate psychometric properties for assessing daily functioning in patients with musculoskeletal pain. In addition, none of these instruments assesses the perceived decrease in levels of daily activities after the onset of pain. ObjectiveTo review the psychometric qualities of the Impairment and Functioning Inventory (IFI) for patients with chronic pain. DesignCross-sectional study. SettingFour public primary care centers and a public pain clinic. PatientsA total of 483 patients with back pain who were treated at primary care centers and 137 patients with various pain conditions who were treated at a pain clinic. MethodsTo analyze factorial validity, a confirmatory factor analysis was performed via structural equation modeling. To measure internal consistency, Cronbach's α coefficients were calculated. To assess convergent validity, Pearson correlation coefficients were computed between the 2 scales of the IFI and the measures of the Roland Morris Questionnaire. Criterion validity and generalizability were analyzed by regression analysis via structural equation modeling using the LISREL 8.30 software package. Main Outcome MeasuresThe IFI for patients with chronic pain. ResultsA revised version of the IFI (IFI-R) is presented that consists of 30 items with 2 related subscales: Daily Functioning and Impairment (perceived current level of functioning compared with the level of functioning before pain onset). Both subscales were significantly correlated with disability. Depression, pain intensity, and pain anxiety had a negative association with functioning and a positive association with impairment. On the other hand, pain catastrophizing had a negative association with functioning and pain hypervigilance had a positive association with impairment due to pain. ConclusionsThe IFI-R appears to be a valid and reliable measurement tool for the assessment of perceived daily functioning and impairment in people with chronic pain.

The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: a preliminary, cross-sectional analysis.

In the fear-avoidance model (FAM) of chronic pain, pain-related fear is one of the most prominent predictors of negative adjustment outcomes. While existing data point to the effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear, the nature of their multivariate relationships remains unclear. This study explored the possible mediating role of pain hypervigilance in the relationship of anxiety sensitivity and pain catastrophizing with pain-related fear, and their effects on quality of life (QoL) outcomes within the FAM framework. A sample of 401 Chinese patients with chronic musculoskeletal pain completed the standardized measures assessing the FAM components and QoL. Structural equation modeling (SEM) was used to evaluate six hypothesized models. Results of SEM showed adequate data-model fit [comparative fit indexes (CFIs) ranging from 0.92 to 0.94] on models which specified pain hypervigilance as mediator of anxiety sensitivity and pain catastrophizing with pain-related fear on two QoL outcomes (QoL-Physical and QoL-Mental). Results consistent with net suppression effects of pain catastrophizing on anxiety sensitivity were found in SEM when both anxiety sensitivity and pain catastrophizing were included in the same full model to predict QoL-Physical (CFI=0.95; Sobel z=8.06, p<0.001) and QoL-Mental (CFI=0.93; Sobel z=8.31, p<0.001). These cross-sectional analyses gave results consistent with pain hypervigilance, mediating the relationship of pain catastrophic cognition and anxiety sensitivity with pain-related fear. The net suppression effects of pain catastrophizing point to anxiety sensitivity, enhancing the effect of pain catastrophic cognition on pain hypervigilance. These findings elucidate how the interdependence of dispositional factors might influence pain adjustment and functioning.

Mindfulness-based Group Therapy for Women with Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is the most common cause of painful intercourse in women of reproductive age and research supports psychological approaches in the management of chronic pain. We developed a four-session group treatment for women with PVD that relied mostly on mindfulness meditation skills along with education and some discussion of cognitive theory. A total of 85 women were assigned either to immediate treatment (n = 62; mean age, 39 years) or to a 3-month wait-list condition followed by treatment (n = 23; mean age, 40 years). Questionnaires and a genital pain assessment were administered at pre- and post-treatment, and at 6 months follow-up. Women assigned to the two groups did not significantly differ on any measure at baseline. During the pretreatment wait-list period, there were significant improvements in pain self-efficacy, and non-significant improvements in feelings of helplessness, and sex-related distress. Pain self-efficacy, pain catastrophizing, genital pain induced by a cotton swab exam, pain hypervigilance, and sex-related distress all improved with treatment. There was no change in pain with intercourse. Pretreatment genital pain was the best predictor of post-treatment genital pain. Genital pain at 6-month follow-up was predicted by pretreatment genital pain, change in pain self-efficacy, and number of comorbid chronic pain conditions. Taken together, these findings support the use of a brief mindfulness-based program as a promising treatment for distressing genital pain.

Pain Hypervigilance is Associated with Greater Clinical Pain Severity and Enhanced Experimental Pain Sensitivity Among Adults with Symptomatic Knee Osteoarthritis

Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA.