Pain catastrophizing is a robust predictor of heightened pain report. However, theoretical models addressing mechanisms of catastrophizing are lacking. The purpose of this study was to examine whether high and low catastrophizers manifest differential psychophysiological arousal patterns in an experimental laboratory pain setting. Gender differences and covariates were also examined. Participants were 102 undergraduate students (56 female, 46 male) at Queen’s University recruited from the Psychology 100 subject pool aged 17-28 years (M = 18.44, SD = 1.40). After deleting participants with missing data, n = 95 for pain report/psychological variables, and n = 93 for psychophysiological measures. Participants were pre-screened using the Pain Catastrophizing Scale (PCS) from which individuals were selected from the top third (i.e., PCS score ≥ 24) and the bottom third (i.e., PCS score ≤ 13) of the distribution to represent high and low catastrophizers respectively. Participants completed measures of depression and anxiety before participating in a cold pressor task. Participants’ heart rate (HR) and galvanic skin response (GSR) were recorded during periods of baseline (3 minutes), pain induction (1 minute), and pain recovery (10 minutes). The Short-Form McGill Pain Questionnaire (SF-MPQ) was completed following the recovery period. Results showed that catastrophizing was related to greater pain intensity during pain induction and during pain recovery, as well as greater retrospective sensory and affective reports of pain. Women reported greater pain intensity during pain induction, during pain recovery, and greater retrospective reports of sensory pain. These effects were significant even when controlling for depression and anxiety. With regard to psychophysiological arousal, catastrophizing was related to higher HR during pain induction. There also appeared to be trends suggesting that catastrophizing may also be associated with HR before and after pain induction. Results provide partial support for an appraisal model of catastrophizing and may be useful in informing future models implicating catastrophizing in the development and maintenance of chronic pain. / Thesis (Master, Psychology) -- Queen's University, 2008-07-04 16:02:48.514

Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. Research has demonstrated that women with PVD display both allodynia and hyperalgesia to pain at vulvar and non-vulvar sites, as well as reduced psychosocial functioning. The goal of this study was to use a multi-method approach (interview, questionnaires, sensory testing, and fMRI) to examine group differences between women with PVD (N=15) and healthy control women (N=15). Results will allow for improved understanding of the interaction between psychosocial and neurobiological underpinnings of this disorder, which can contribute to the creation of better treatment strategies. Variables included psychophysical and psychosocial measures, as well as neural activations associated with painful pressure, painful words, and psychosocial functioning. Differences between subgroups of PVD, based on temporal onset, were also examined. There were no robust group differences in neural activation during the application of pain or pain words. This finding is consistent with many studies that match groups on pain intensity ratings, as opposed to amount of pressure applied. Painful pressures and painful words resulted in greater neural activation than neutral words or touch; however, there were no group differences for the word conditions. Women with PVD reported increased psychosocial dysfunction, including higher levels of anxiety and catastrophizing. Significant correlations were found between these psychosocial variables and areas of the brain associated with pain modulation and attention (e.g., PFC). Examination of PVD subgroups revealed differences in neural correlates of anxiety and catastrophizing during painful stimulation. This finding adds to the literature suggesting that women with primary PVD experience greater dysfunction than women with secondary PVD. Overall, these studies support findings of pain processing in the general pain literature, as well as supporting PVD as a chronic pain condition. They also add to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain by examining their relationship with neural activations. Future research should examine brain functioning in PVD women pre- and post-treatment as well as examining neural correlates of other psychosocial variables that contribute to the pain experience (e.g., somatization). / Thesis (Ph.D, Psychology) -- Queen's University, 2013-01-30 09:14:09.652

Pain catastrophizing emerges in the literature as one of the most important psychological determinants of both pain itself and the negative outcomes commonly associated with it. However, despite decades of research confirming the impact of catastrophizing, there are still areas that remain unexplored or in which the surface has only been scratched. The overall aim of this dissertation was to expand existing knowledge about catastrophizing and to advance the theoretical framework around the concept. The role of catastrophizing was explored in three distinct areas: during pain in childbirth, in exposure treatment for back pain patients, and in a problem solving context. The findings from the three studies confirmed the vital role of catastrophizing in these areas. Firstly, catastrophizing played a critical role in pain in childbirth; women who catastrophized reported labor pain as more intense and the subsequent recovery period as longer than women who did not catastrophize. Secondly, catastrophizing was identified as a moderator of treatment effect in exposure in vivo for back pain patients with pain-related fear; patients who catastrophized were not helped by the exposure. Thirdly, catastrophizing played a role in a problem solving context; although this is in line with contemporary models such as the misdirected problem solving model, the results suggested a somewhat different pathway to this previous model. Taken together, these findings underscore the instrumental role of catastrophizing in diverse areas and imply a need for catastrophzing to be assessed and addressed in clinical contexts. In addition, the findings highlight a need for further development of the theoretical framework around catastrophizing as well as treatment interventions that directly target catastrophizing. Based on these needs, a new model of catastrophizing was proposed – a model of catastrophizing from a process perspective. In this model, the proposed function of catastrophizing is to down-regulate negative affect, as a form of internal avoidance. The model is a complement to existing theoretical models and provides a framework for developing treatment interventions that directly target catastrophizing, for example by problem solving skills training. Successful interventions for people who catastrophize would lead to several gains – for the individual in less suffering and increased ability to handle pain problems, and for society as a whole in reduced costs for health care for these individuals.

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Indiana University-Purdue University Indianapolis (IUPUI) / There is a well-documented bidirectional relationship between pain and cognitive dysfunction, especially working memory. Despite this extensive body of research, the pain–working memory relationship is poorly understood. Pain catastrophizing – exaggerated negative cognitive and emotional responses towards pain – may contribute to working memory deficits by occupying finite, shared cognitive resources, but this has yet to be investigated. The present study sought to clarify the role of pain catastrophizing (assessed as both a trait-level disposition and state-level process) in working memory dysfunction. Healthy undergraduate participants were randomized to an ischemic pain or control task, during which they completed verbal and non-verbal working memory tests. They also completed measures of state- and trait-level pain catastrophizing. Mediation analyses indicated that state-level pain catastrophizing mediated the relationships of pain group to both verbal and non-verbal working memory, such that participants in the pain group (vs. the control group) catastrophized more about their pain, which then resulted in worse verbal and non-verbal working memory performance. In moderated mediation analyses, trait-level pain catastrophizing moderated this mediation effect for both verbal and non-verbal working memory. Those participants in the pain group who reported greater tendency to catastrophize about pain in general exhibited greater catastrophizing in-the-moment during the pain task, thereby leading to worse verbal and non-verbal working memory performance. These results provide evidence for pain catastrophizing as a putative mechanism and moderating factor of working memory dysfunction in pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep), and develop interventions to ameliorate cognitive dysfunction by targeting pain catastrophizing.

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Placebo’s (positive expectancies producing positive outcomes) and nocebo’s (negative expectancies producing negative outcomes) are real and measurable effects. Real as these effects may be, predicting individuals that may be susceptible to placebo/nocebo effects has been inconsistent. The present study examined whether measures designed to assess somatization (MSPQ), catastrophizing (PCS) and childhood trauma (CTQ) would predict placebo and nocebo membership. In addition, measures designed to assess anxiety (ASI) anxiety about pain (PASS) and depression (BDI) were evaluated to determine whether anxiety or depression mediates responsiveness. The Hargreaves Thermal Withdrawal test and the submaximal effort tourniquet technique were employed as pain vehicles for the measurement of group differences. No significant effects of planned analyses were observed. However, unplanned analyses of childhood trauma subscales indicated that physical and emotional abuse predicted placebo response. Additionally, emotional neglect trended toward predicting nocebo responsiveness. These results indicate that further studies, correcting for weaknesses, is warranted.

<p>Based on a biopsychosocial model of mammography pain, the current study assessed if specific biological and psychosocial factors were associated with higher reported mammography pain in early stage breast cancer survivors. One hundred and twenty-seven women completed questionnaires assessing demographic information, cancer treatment history, ongoing breast pain, mammography-related anxiety, and social support immediately prior to receiving a mammogram. They then completed questionnaires assessing mammography pain and mammography-related pain catastrophizing immediately following the mammogram. Using path modeling and mediation analyses, relations among these variables were examined. Results revealed that mammography-related pain catastrophizing was related to higher mammography pain directly, while ongoing breast pain, lower social support quantity, and lower perceived quality of social support related to higher mammography pain indirectly through mammography-related pain catastrophizing. Moderated mediation analyses found that the mediation effects of mammography-related pain catastrophizing were significantly different at varying levels of perceived quality of social support, with more pronounced negative effects for those with higher quality support than those with lower quality support. The theoretical, clinical, and research implications of these findings are discussed.</p> / Dissertation