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Little is known about the mechanisms by which pain catastrophizing may be associated with opioid use outcomes. This study aimed to investigate the potential mediating role of beliefs about the appropriateness of pain medicines for pain treatment on the association between pain catastrophizing and prescription opioid use in a community chronic non-cancer pain (CNCP) sample. Individuals (N = 420) diagnosed with CNCP participated in a cross-sectional online self-report study with validated measures of pain medication beliefs, pain catastrophizing, and current prescription opioid use. Two parallel multiple mediator analyses with percentile-based bootstrapping examined pathways to both prescription opioid use and high-dose use (≥ 100mg oral morphine equivalents/day), while controlling for pain intensity and other relevant covariates. Pain medication beliefs significantly mediated the association between pain catastrophizing and prescription opioid use (CI = 0.011, 0.033). A similar pattern of findings was found for high-dose opioid use, with pain medication beliefs significantly mediating the pain catastrophizing-high-dose use association (CI = 0.006, 0.050). Pain medication beliefs are a potentially modifiable psychological mechanism by which pain catastrophizing is associated with opioid use, including high-dose use. These findings have important implications for personalizing prevention and treatment programs.

Previous research has shown that depression is associated with adverse recovery outcomes following work-related musculoskeletal injury. Treatment outcome expectancies have also been shown to predict recovery trajectories following musculoskeletal injury. The present study examined the role of positive and negative treatment outcome expectancies as mediators of the relation between depressive symptoms and treatment outcome for individuals receiving physical therapy for a musculoskeletal injury. The study sample consisted of 153 individuals who had sustained a work-related musculoskeletal injury to the back or neck within 6 months of enrolment. Participants completed self-report measures of depressive symptom severity, pain severity, and treatment outcome expectancies prior to treatment; pain severity was assessed again after 4 weeks of treatment. The results of this study were consistent with previous research showing significant relations between depressive symptom severity, pain severity and treatment outcome expectancies. Bootstrapping mediation analyses separately assessed the mediating roles of positive and negative treatment outcome expectancies on the relation between depressive symptoms and pain severity. Findings revealed that positive treatment outcome expectancies mediated the relation between depressive symptoms and pain severity, whereas negative treatment outcome expectancies did not. Discussion addresses potential pathways through which positive treatment outcome expectancies might influence pain outcomes. The findings suggest that intervention techniques aimed at increasing positive treatment outcome expectancies, rather than decreasing negative treatment outcome expectancies, might contribute to better recovery outcomes for individuals experiencing pain and depressive symptoms following a work-related musculoskeletal injury.

Purpose The purpose of the present study was to conduct a preliminary evaluation of the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with comorbid pain and depression. Methods The design of the study was a single-arm non-randomized trial. The sample consisted of 66 work-disabled individuals with comorbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice, and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. Results The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were “very” or “completely” satisfied with their involvement in the treatment program. Significant reductions in pain (Cohen’s d = 0.71), depression (d = 0.86), catastrophic thinking (d = 1.1), and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, and perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. Conclusions Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with comorbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with comorbid pain and depression. Trial registration ClinicalTrials.gov: NCT0517442. Retrospectively registered.

Background Numerous investigations have revealed significant relations between pain and fatigue in individuals with persistent pain conditions. However, the direction of influence between pain and fatigue remains unclear. Shortcomings of design and analytic approaches used in previous research limit the nature of conclusions that can be drawn about possible causal or directional relations between pain and fatigue. The present study investigated the temporal relation between changes in pain and changes in fatigue in individuals with musculoskeletal pain enrolled in a 10-week behavioral activation intervention. On the basis of previous findings, it was hypothesized that analyses would support a bi-directional relation between pain and fatigue. Methods The study sample consisted of 104 individuals with chronic musculoskeletal pain participating in a 10-week standardized rehabilitation intervention. Measures of pain intensity and fatigue were completed pre-, mid-, and post-treatment. The three-wave data panel permitted examination of the direction of influence between pain and fatigue through the course of the intervention. A random-intercept cross-lagged panel model (RI-CLPM) was used to examine the temporal relation between pain and fatigue. Results Consistent with previous research, cross-sectional analyses of pre-treatment data revealed significant correlations between measures of pain and fatigue. Significant reductions in pain and fatigue were observed through the course of treatment (d = 0.33 and d = 0.66, p p = 0.02; mid to post-treatment β = 0.36, p = 0.001); however, fatigue did not predict later pain severity. Conclusions Discussion addresses the processes that might underlie the temporal relation between pain and fatigue. Clinical implications of the findings are also discussed.

Introduction: Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of postsurgical reductions in pain severity, depressive symptoms, and disability to the prediction of reductions in perceptions of injustice. Methods: The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain, and disability at their presurgical evaluation, and at 1-year follow-up. Results: The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of postsurgical reductions in perceived injustice. Discussion: The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients with persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.

Junie S Carriere,1 Marc-Olivier Martel,2,3 Ming-Chih Kao,4 Michael JL Sullivan,5 Beth D Darnall4 1Department of Psychology, 2Faculty of Dentistry, 3Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada; 4Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA; 5Faculty of Health and Behavioural Sciences, University of Queensland, Herston, QLD, Australia Background and purpose: Perceived injustice has been defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame and a sense of unfairness. Recent findings have identified perceived injustice as an important risk factor for pain-related outcomes. Studies suggest that perceived injustice is associated with opioid prescription in patients with pain conditions. However, the mechanisms by which perceived injustice is linked to opioid prescription are not well understood. The primary objective of this study was to examine the potential mediating roles of pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription among patients with chronic pain. Methods: This cross-sectional study used a sample of 344 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of perceived injustice, pain intensity, depressive symptoms, pain behavior and opioid prescription. Bootstrapped multiple mediation analyses were used to examine the mediating role of patients’ pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription. Results: Consistent with previous research, we found a significant association between perceived injustice and opioid prescription. Interestingly, results revealed that pain behavior was the only variable that mediated the association between perceived injustice and opioid prescription. Conclusion: This study was the first to examine the mechanisms by which perceived injustice is associated with opioid prescription in patients with chronic pain. We found that pain behavior, rather than pain intensity and depressive symptoms, mediated the association between perceived injustice and opioid prescription. Future research in this area should employ a longitudinal research design in order to arrive at clearer causal conclusions about the relationships between pain behavior, perceived injustice and opioid prescription. Keywords: perceived injustice, pain intensity, depression, pain behavior, opioids, chronic pain, CHOIR

OBJECTIVES: Increasing pain during physical activity is an important, but often poorly assessed, barrier to engaging in activity-based rehabilitation among people with chronic musculoskeletal pain. Preliminary work has addressed this problem by developing new clinical measures of sensitivity to physical activity (SPA). Indices of SPA are generated by evaluating how pain changes in relation to brief physical tasks. Three strategies have been identified for structuring SPA-related physical tasks (self-paced, standardized, and tailored). This cross-sectional study aimed to comparatively estimate the extent of the 3 SPA tasks' evoked pain responses, predictive value of pain severity and pain interference, and their underlying psychological and sensory constructs, among 116 adults with chronic musculoskeletal pain.MATERIALS AND METHODS: Testing included questionnaires, quantitative sensory testing, and the 3 SPA measures (self-paced, standardized, and tailored). The primary analysis estimated the predictive value of each SPA measure for pain severity and pain interference. Correlational analyses were first conducted between all variables of interest to determine what variables will be included in the hierarchical regression analysis, which in turn was conducted for each outcome.RESULTS: Analyses revealed that the tailored SPA index was most effective at evoking activity-related pain, was uniquely associated with temporal summation of pain, and was a unique predictor of pain and pain-related interference, even when controlling for established psychological and sensory risk factors.DISCUSSION: This study further emphasizes SPA as an important and unique attribute of the pain experience and reveals the added value of using a tailored approach to assess SPA.

For the majority of patients with osteoarthritis, total hip (THA) arthroplasty results in a significant reduction in pain, emotional distress, and disability and a significant improvement in their quality of life. Little is known about how these recovery-related changes impact the spouse or the marital relationship. Methods: Twenty-nine couples whose spouse underwent a THA (29 THA) participated in a semi-structured retrospective interview designed for this study. They were each asked to recall the level of pain before and after surgery and to provide a numerical rating score for questions pertaining to the level of disability in seven different activities of daily living. Couples were also asked to list in order of importance the five ways in which the surgery affected their overall quality of life. Results: The spouses estimated their partner’s pain, both pre- and postoperatively, to be significantly higher level than the patient’s perception. The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (72%), because their partner had less suffering (59%), they had more independence/less caregiving (55%), it improved their marital relationship (52%), they had a better social/family life (28%), and they were able to travel (28%). Conclusions: This study indicates that THA result in a significant improvement in quality of life not only for the patients, but also for their spouses.

Introduction: The pain catastrophizing scale (PCS) is the most widely used tool to assess pain catastrophizing. The aim of this study was to translate, culturally adapt, and validate the PCS questionnaire in Arabic. Methods: A systematic translation process was used to translate the original English PCS into Arabic. After the pilot study, we validated our version among patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations with Brief Pain Inventory [BPI]), and face validity. Results: A total of 113 subjects (50 men, 63 women) were included in the study. Cronbach's α was 0.94 (95% confidence interval [CI]: 0.92–0.96), and interclass correlation coefficients was 0.83 (95% CI: 0.77–0.89) for the total scale. There was no statistically significant difference in the total PCS scores between patients who reported experiencing current pain and those who did not. Among patients who reported having current pain, pain severity was weakly associated with the total PCS scores (r = 0.22, P = 0.03). PCS and its subscales were not statistically significantly associated with any of the BPI items. Nonetheless, patients who were diagnosed with neuropathic pain had statistically significantly higher scores on the total PCS, rumination, and helplessness subscales. Most patients found the PCS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain catastrophizing. Conclusion: Our translated version of PCS is reliable and valid for use among Arabic-speaking patients.

Background. Past decades have seen a surge of studies investigating the role of spouses in chronic illness. The present study explored an interpersonal model of health-related quality of life in chronic pain settings. Spouse personality was tested as a moderator of pain intensity-to-health associations in patients with chronic pain. Methods. This is a cross-sectional study. Participants were 185 noncancer chronic pain patients and their spouses. Patients were mostly females (58.4%). Mean age was approximately 56 years for patients and spouses. Patients completed a measure of pain intensity, health-related quality of life, and personality. Spouses also reported on their personality characteristics. Spouse personality was used as the moderator in the relationship between patients’ pain intensity and health status. Patient personality was used as a covariate in the moderation analyses. Results. Spouse neuroticism moderated the relationship between pain intensity and physical health status, while spouse introversion moderated the pain-to-mental health association. Conclusions. Results support the idea that the relationship between a chronic stressor, namely, chronic pain, and health-related quality of life may be complex and contextually determined by spousal characteristics. Clinical implications are discussed in the context of couples.

Recent research has revealed robust cross-sectional and prospective associations among perceived injustice, pain, disability, and depressive symptoms in patients with chronic pain. To date, research has proceeded from the assumption that perceived injustice arises as a consequence of debilitating injury or illness. However, it is possible that perceived injustice might have trait-like characteristics, persisting even in the absence of an injustice-related eliciting event. The aim of the present study was to develop and test a measure of trait perceived injustice (Trait Injustice Experience Questionnaire [T-IEQ]). The item content of the T-IEQ was drawn from the original IEQ and adapted for relevance to a noninjury context. A sample of 118 healthy undergraduates completed the T-IEQ, measures of just world belief, and trait forgiveness prior to participating in an experimental pain procedure. Pain intensity, pain behavior, and emotional responses were recorded during the painful induction. The T-IEQ had good internal consistency and test−retest reliability. The validity of the T-IEQ was supported by significant associations with measures of just world belief and trait forgiveness. The T-IEQ was also associated with pain intensity, pain behavior, and ratings of sadness and anger. Anger mediated the relation between the T-IEQ and pain outcomes. The results of the present study suggest that individuals vary in their trait-like propensity to experience negative life events as unjust and that trait perceived injustice contributes to adverse pain outcomes. Perspective The present findings suggest that perceived injustice might reflect an enduring tendency to experience negative life events as unjust. The findings also suggest that trait perceived injustice is associated with higher ratings of pain intensity and anger and more pronounced displays of pain behavior.

The current study employed a twin paradigm to examine the genetic and environmental contributions to pain catastrophizing as well as the observed association between pain catastrophizing and cold pressor task (CPT) outcomes. Male and female monozygotic (n=206) and dizygotic twins (n=194) from the University of Washington Twin Registry completed a measure of pain catastrophizing and performed a CPT challenge. As expected, pain catastrophizing emerged as a significant predictor of several CPT outcomes, including cold pressor immersion tolerance, pain tolerance, and delayed pain rating. The heritability estimate for pain catastrophizing was found to be 37% with the remaining 63% of variance attributable to unique environmental influence. Additionally, the observed associations between pain catastrophizing and CPT outcomes were not found attributable to shared genetics or environmental exposure, suggesting a direct relationship between catastrophizing and experimental pain outcomes. This study is the first to examine the heritability of pain catastrophizing and potential processes by which pain catastrophizing is related to experimental pain response.

Investigations have shown that expectancies are significant prognostic indicators of recovery outcomes following whiplash injury. However, little is currently known about the determinants of recovery expectancies following whiplash injury. The purpose of the present study was to examine the cross-sectional and prospective correlates of recovery expectancies in individuals admitted to a rehabilitation program for whiplash injury.Participants (N=96) completed measures of recovery expectancies, psychosocial variables, symptom severity, symptom duration, and disability at time 0 (admission) and time 1 (discharge).Consistent with previous research, more positive recovery expectancies at time 0 were related to reductions in pain at time 1 (r=-0.33, P0.01). Scores on measures of pain catastrophizing, fear of movement and reinjury, and depression were significantly correlated with recovery expectancies. Pain severity, duration of work disability, and neck range of motion were not significantly correlated with recovery expectancies. Over the course of treatment, 40% of the sample showed moderate to large changes (an increase of ≥20%) in recovery expectancies, there were small changes (20%) in 30% of the sample, and negative changes in 20% of the sample. A hierarchical regression showed that decreases in fear of movement and reinjury (β=-0.25, P0.05) and pain catastrophizing (β=-0.23, P0.05) were associated with increases in recovery expectancies through the course of treatment.The discussion addresses the processes linking pain-related psychosocial factors to recovery expectancies and makes recommendations for interventions that might be effective in increasing recovery expectancies.

Workers with low back pain (LBP) may benefit from wearing a lumbar belt (LB), but the biomechanical and psychological mechanisms involved are not fully understood. Two types of flexible LB (extensible and non-extensible) were compared to a control condition (no LB) regarding pain-related (pain, fear of pain and catastrophizing) and biomechanical (range of motion - ROM) outcomes related to two tasks: maximal trunk flexion-extension and manual material handling. Healthy controls and participants with LBP were tested. During both tasks, the two LBs reduced the lumbar ROM in participants with LBP in the same way as healthy controls. This was observed even at the beginning of the trunk flexion movement, allowing generalization to many work tasks, that is to say tasks performed with small or deep trunk flexion. The two LBs reduced pain, fear of pain and catastrophizing in subjects with LBP. That may help a gradual re-exposure to physical work activities (disability prevention perspective), or maintaining these activities (secondary prevention perspective), following a LBP episode.

Objective: To describe the clinical and personal factors associated with work status, distress regarding work status, and the desire to resume employment and receive help to address work challenges reported by women living with advanced breast cancer. Design: Descriptive statistics and univariate and multivariate logistic regression were used to explore factors related to employment challenges in this secondary analysis of an existing dataset. Setting: Participants were recruited from an outpatient oncology clinic specializing in breast cancer at a free-standing comprehensive cancer center. Participants: English-speaking women older than 18 years living with metastatic breast cancer with intact mental status and Karnofsky Performance Scale scores between 40 and 90 (N=163). Intervention: Not applicable. Main Outcome Measures: Dependent variables included (1) continued employment if working at the time of cancer diagnosis; (2) interest in resuming employment if working at the time of cancer diagnosis and now no longer working; (3) distress regarding vocational limitations; and (4) interest in receiving help to resume work. Results: Seventy percent of the sample was working before their cancer diagnosis (n=114), yet only 21% (n=35) was working when surveyed. Lower functional status and higher symptom burden were strongly and consistently associated with lack of work retention, distress related to vocational role limitations, and desire for help in addressing limitations (all P values

The dominant socioaffective model of empathy has emphasized the overlap between brain mechanisms involved in the encoding and the decoding of internal states. The role of dispositional empathy has been extensively studied in this research, but several other individual factors fundamental to communication processes have been largely ignored. We studied the effects of dispositional expressiveness in chronic back pain patients to determine if the decoding of communicative and noncommunicative information signaling pain in others would be enhanced in individuals displaying a spontaneous propensity to consistently express more pain during a behavioral-observational naturalistic standardized lifting task performed on 2 separate occasions. Blood oxygenation level–dependent signal change was measured in response to pictures showing facial pain expressions and hands/feet in pain-evoking situations in chronic back pain patients and healthy controls. Vicarious brain responses to others’ pain were comparable between groups. However, more expressive patients rated others’ pain higher and showed stronger vicarious pain responses in the right ventral part of the inferior frontal gyrus, the right insula, and the midbrain. Activity in the right insula correlated positively with both the patients' expressiveness (encoding) and the intensity of the pain perceived in the images (decoding), suggesting that this structure linked the dispositional expressiveness with vicarious pain perception. Importantly, these effects were independent from dispositional empathy and were found with both communicative (facial expression) and noncommunicative (hand and foot) cues. These results suggest that dispositional expressiveness is a self-related factor that facilitates vicarious pain processing and might reflect individual tendencies to rely on social coping strategies. Perspective This article shows that pain expressivity in chronic pain patients increased the vicarious brain responses and the sensibility to others' pain. These results may help provide empirical support for better defining models of pain communication in chronic pain patients.

Nearly 20 years ago the Fear Avoidance Model (FAM) was advanced to explain the development and persistence of disabling low back pain. The model has since inspired productive research and has become the leading paradigm for understanding disability associated with musculoskeletal pain conditions. The model has also undergone recent expansion by addressing learning, motivation and self-regulation theory [10,34]. In contrast to these extensions, however, one relatively constant aspect of the model is the recursive series of fear-related cognitive, affective, and behavioral processes shown in Figure 1 [31,32,34]. Despite the endurance and popularity of these cyclical relationships their level of empirical support remains unclear. For instance, recent prospective studies have failed to support the proposed sequential relationships between psychological risk factors [5,36]. Also, the validity of several fundamental assumptions that underlie these cyclical relationships has yet to be fully examined, including the characterization of fear as phobia, the inextricable link between pain and disability, and the independence of disability from pain-related physiological processes. As the FAM continues to evolve, it is critical to clarify whether its cyclical relationships should be retained. The purpose of this topical review is to evaluate the empirical support and theoretical assumptions of the FAM’s cyclical relationships and to highlight implications for future theoretical advancement. Open in a separate window Figure 1 Graphical Display of the Fear Avoidance Model (reproduced from Vlaeyen and Linton, 2000 & 2012 [32,34])

This study sought to determine whether repetition-induced summation of activity-related pain (RISP) could be demonstrated in healthy individuals in response to experimentally induced musculoskeletal pain. This study also assessed the effects of transcutaneous electrical nerve stimulation on RISP. The relation between the index of RISP and psychological factors such as catastrophizing and fear of pain was also explored. The sample consisted of 56 healthy (35 women, 21 men) participants who underwent 2 testing sessions, separated by 24 hours. In the first session, musculoskeletal pain was induced with a delayed-onset muscle soreness protocol. During the second session, participants were randomly assigned to the transcutaneous electrical nerve stimulation or placebo condition and were asked to rate their pain as they lifted a series of 18 weighted canisters. An index of RISP was derived as the change in pain ratings across repeated lifts. Approximately 25% of participants showed evidence of RISP. Results also revealed that transcutaneous electrical nerve stimulation attenuated the RISP effect. Psychological measures (fear of pain, catastrophizing) were not significantly correlated with the index of RISP, but the index of RISP was significantly correlated with a measure of physical tolerance. Discussion addresses the clinical implications of the findings as well as the potential mechanisms underlying RISP. Perspective This study showed that RISP could be demonstrated in healthy individuals in response to experimentally induced musculoskeletal pain with delayed-onset muscle soreness. Transcutaneous electrical nerve stimulation led to a significant reduction in RISP.

Individual differences in pain sensitivity and reactivity are well recognized but the underlying mechanisms are likely to be diverse. The phenomenon of stress-induced analgesia is well documented in animal research and individual variability in the stress response in humans may produce corresponding changes in pain. We assessed the magnitude of the acute stress response of 16 chronic back pain (CBP) patients and 18 healthy individuals exposed to noxious thermal stimulations administered in a functional magnetic resonance imaging experiment and tested its possible contribution to individual differences in pain perception. The temperature of the noxious stimulations was determined individually to control for differences in pain sensitivity. The two groups showed similar significant increases in reactive cortisol across the scanning session when compared with their basal levels collected over 7 consecutive days, suggesting normal hypothalamic–pituitary–adrenal axis reactivity to painful stressors in CBP patients. Critically, after controlling for any effect of group and stimulus temperature, individuals with stronger cortisol responses reported less pain unpleasantness and showed reduced blood oxygenation level-dependent activation in nucleus accumbens at the stimulus onset and in the anterior mid-cingulate cortex (aMCC), the primary somatosensory cortex, and the posterior insula. Mediation analyses indicated that pain-related activity in the aMCC mediated the relationship between the reactive cortisol response and the pain unpleasantness. Psychophysiological interaction analysis further revealed that higher stress reactivity was associated with reduced functional connectivity between the aMCC and the brainstem. These findings suggest that acute stress modulates pain in humans and contributes to individual variability in pain affect and pain-related brain activity.

Recent theories have suggested that chronic pain could be partly maintained by maladaptive physiological responses of the organism facing a recurrent stressor. The present study examined the associations between basal levels of cortisol collected over seven consecutive days, the hippocampal volumes and brain activation to thermal stimulations administered in 16 patients with chronic back pain and 18 healthy control subjects. Results showed that patients with chronic back pain have higher levels of cortisol than control subjects. In these patients, higher cortisol was associated with smaller hippocampal volume and stronger pain-evoked activity in the anterior parahippocampal gyrus, a region involved in anticipatory anxiety and associative learning. Importantly, path modelling-a statistical approach used to examine the empirical validity of propositions grounded on previous literature-revealed that the cortisol levels and phasic pain responses in the parahippocampal gyrus mediated a negative association between the hippocampal volume and the chronic pain intensity. These findings support a stress model of chronic pain suggesting that the sustained endocrine stress response observed in individuals with a smaller hippocampii induces changes in the function of the hippocampal complex that may contribute to the persistent pain states.

The present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men) with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.

Prospective cohort.(1) To determine the trajectory of depressive symptoms over the course of physical therapy, (2) to identify variables that best predict the resolution of depressive symptoms, and (3) to explore the relationship between recovery from depressive symptoms and long-term outcomes.Twenty-five percent to 50% of patients referred to physical therapy for orthopaedic injuries suffer from symptoms of depression. Depressive symptoms have been identified as an influential risk factor for problematic response to physical therapy. Despite these findings, there is a dearth of research specifically exploring the trajectory and determinants of patients' depressive symptoms over the course of physical therapy, which has impeded the evidence-based management of patients with depressive symptoms.One hundred six patients with work-related musculoskeletal injuries and symptoms of depression received 7 weeks of physical therapy and were followed 1 year after treatment onset. Pain intensity, depressive symptoms, and other psychosocial factors were evaluated throughout treatment, and data were collected at 1-year follow-up.Depressive symptoms resolved in 40% of patients, and resolution was linked to pain and disability at 1-year follow-up. Persistence of depressive symptoms at treatment completion was predicted by elevated levels of depressive symptoms and pain catastrophizing at pretreatment, and by lack of improvement in levels of depressive symptoms and pain self-efficacy at midtreatment.For many patients, depressive symptoms resolve over the course of physical therapy, and resolution is associated with long-term improvements in pain and disability. These findings will help identify patients whose depressive symptoms are least likely to respond to physical therapy and may therefore warrant additional treatment.

In the present study, patients with musculoskeletal pain conditions (n = 55) were filmed while performing a lifting task designed to elicit pain behaviors. Patients were asked to perform the lifting task twice, under 2 distinct conditions. In the first condition, patients were asked to rate their pain while lifting a series of weights. In the second condition, patients were asked to estimate the weight of the objects they lifted. The weight estimation condition was conceived as a way to increase the cognitive load associated with the lifting task. The primary purpose of the present study was to examine whether manipulation of cognitive load differentially influenced the expression of pain behaviors in high and low catastrophizers. During the pain rating condition, results indicated that high catastrophizers displayed significantly higher levels of communicative and protective pain behaviors than low catastrophizers. During the weight estimation condition, however, high and low catastrophizers no longer differed in the expression of communicative pain behaviors. These results suggest that increasing cognitive load during a pain-eliciting task may interfere with the expression of communicative pain behaviors in high catastrophizers. The discussion addresses the potential role of automatic and cognitive control processes in the expression of pain behaviors. Perspective The present study provides new insights into the processes that might underlie the expression of pain behaviors in patients with high levels of catastrophizing. Our findings could have implications for the management of patients presenting with pain conditions, particularly those with high levels of catastrophizing.

The purpose of the present research was to examine the feasibility of a telephonic occupational rehabilitation program. A sample of 23 individuals with chronic musculoskeletal pain was enrolled in the telephonic version of the Progressive Goal Attainment Program (PGAP-Tel). The PGAP-Tel is a risk-targeted intervention designed to reduce pain-related disability consequent to musculoskeletal injury. Treatment outcomes of PGAP-Tel were compared to a group of individuals with chronic musculoskeletal pain, who participated in the face-to-face format of the PGAP. Results showed that PGAP-Tel was acceptable to the majority of participants (76%) to whom it was offered. There were indications that engagement and adherence issues were more problematic in PGAP-Tel than in the face-to-face intervention. Both groups showed comparable reductions in pain, depression, fear of symptom exacerbation, and self-reported disability. Participants in the face-to-face intervention showed greater reduction in catastrophic thinking than participants in PGAP-Tel. Finally, 26% of participants in PGAP-Tel had resumed some form of employment at treatment termination compared to 56% of the participants in the face-to-face intervention. Given the low cost of the PGAP-Tel intervention and the accessibility advantages of a telephonic delivery, this type of intervention might be an important resource for targeting occupational disability in rural or remote communities when face-to-face services are not available.

Background Psychosocial variables such as fear of movement, depression, and pain catastrophizing have been shown to be important prognostic factors for a wide range of pain-related outcomes. The potential for a cumulative relationship between different elevated psychosocial factors and problematic recovery following physical therapy has not been fully explored. Objective The purpose of this study was to determine whether the level of risk for problematic recovery following work-related injuries is associated with the number of elevated psychosocial factors. Design This was a prospective cohort study. Methods Two hundred two individuals with subacute, work-related musculoskeletal injuries completed a 7-week physical therapy intervention and participated in testing at treatment onset and 1 year later. An index of psychosocial risk was created from measures of fear of movement, depression, and pain catastrophizing. This index was used to predict the likelihood of experiencing problematic recovery in reference to pain intensity and return-to-work status at the 1-year follow-up. Results Logistic regression analysis revealed that the number of prognostic factors was a significant predictor of persistent pain and work disability at the 1-year follow-up. Chi-square analysis revealed that the risk for problematic recovery increased for patients with elevated levels on at least 1 psychosocial factor and was highest when patients had elevated scores on all 3 psychosocial factors. Limitations The physical therapy interventions used in this study were not standardized. This study did not include a specific measure for physical function. Conclusions The number of elevated psychosocial factors present in the subacute phase of recovery has a cumulative effect on the level of risk for problematic recovery 1 year later. This research suggests that a cumulative prognostic factor index could be used in clinical settings to improve prognostic accuracy and to facilitate clinical decision making.

The prevalence of neuropathic pain approaches 10% in Canada and the United States. Given the aging population and the increasing survival rates following interventions for neuropathic pain, the prevalence of neuropathic pain conditions is expected to rise significantly over the next 20 years. Although pharmacological interventions represent the dominant treatment approach for neuropathic pain, as many as 50% of patients are partially or completely refractory to the available treatments. Pain catastrophizing has been associated with heightened pain experiences in patients with neuropathic pain conditions; however, the clinical relevance of the relationship between catastrophizing and poor treatment outcomes is, to date, unclear. Accordingly, using a numerical rating scale, this study aimed to examine this relationship in patients with varied neuropathic pain conditions who completed a measure of catastrophizing before initiating a course of topical analgesic.BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain.OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end-of-treatment pain ratings were below 4/10.METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three-week trial examining the efficacy of topical analgesics for neuropathic pain.RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (≥2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end-of-treatment pain ratings below 4/10.CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication.

BACKGROUND: Numerous investigations report that depressive symptoms frequently coexist with persistent pain. However, evidence suggests that symptoms of depression are not an inevitable consequence of pain. Diathesis-stress formulations suggest that psychological factors interact with the stress of pain to heighten the risk of depressive symptoms. Perceptions of injustice have recently emerged as a factor that may interact with the stress of pain to increase depressive symptoms.OBJECTIVES: The purpose of the present study was to examine whether perceived injustice moderates the relationship between pain and depressive symptoms.METHODS: A total of 107 individuals with persistent musculoskeletal pain completed self-report measures of pain severity, depressive symptoms, perceived injustice and catastrophizing.RESULTS: A hierarchical regression analysis revealed that the interaction between pain severity and perceived injustice uniquely contributed an additional 6% of the variance to the prediction of depressive symptoms, beyond the main effects of these variables. Post hoc probing indicated that pain was significantly related to depressive symptoms at high, but not low levels of perceived injustice. This finding remained statistically significant even when controlling for pain catastrophizing.CONCLUSIONS: The results suggest that perceived injustice augments the relationship between pain severity and depressive symptoms. The inclusion of techniques specifically targeting perceptions of injustice may enhance the effectiveness of interventions aimed at reducing symptoms of depression for individuals presenting with strong perceptions of injustice.

We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.

Experimental pain research indicates ethnic differences in pain experience. Most of the cross-cultural pain research studied African Americans and Hispanics with little data available for Asian groups. This study examined differences in pain catastrophizing, pain attitudes, and pain responses between Chinese and European Canadian young adults. Prior to completing a cold-pressor (CP) task, 80 Chinese and 80 European Canadian undergraduate students were administered measures of pain catastrophizing and pain attitudes, including stoicism and cautiousness. Pain threshold, pain tolerance, and pain intensity were measured during the CP task. The Short Form-McGill Pain Questionnaire was administered immediately postimmersion to measure sensory and affective pain. While there was no group difference in pain threshold and pain intensity, Chinese participants displayed lower pain tolerance and reported higher SF-MPQ-Affective than European Canadians. Regarding psychological variables, there was no difference in stoicism and cautiousness between groups, but Chinese participants reported greater pain catastrophizing. Mediational analysis indicated that pain catastrophizing mediated the group differences in SF-MPQ-Affective score. The implications of the findings and future research were discussed. Perspective The study found ethnic differences in cold-pressor responses, in which Chinese undergraduates reported higher levels of pain compared to their Euro-Canadian counterparts. The finding that pain catastrophizing mediated the ethnic difference in SF-MPQ-Affective scores indicated the importance of examining the role of catastrophizing in pain reports from Chinese and Euro-Canadian patients.

Introduction: Sensitivity to Movement-Evoked Pain is a pain summation phenomenon identified in various chronic pain populations. Objectives: This study investigated the validity of a procedure used to assess pain summation in response to a repeated lifting task in individuals with whiplash injuries. Methods: Sixty-five participants completed measures of pain severity and duration, Temporal Summation (TS) of pinprick pain, pain catastrophizing and fear of movement, and work-related disability before lifting a series of 18 weighted canisters. An index of Sensitivity to Movement-Evoked Pain was computed as the increase in pain reported by participants over successive lifts of the weighted canisters. An index of TS was computed by dividing the pain reported in response to the final pinprick by the pain reported in response to the 1st pinprick in a train of 10 pinpricks. Results: Analyses replicated previous findings showing a repetitive lifting task–induced pain summation in approximately 20% to 25% of a sample of individuals with whiplash injuries. Analyses also revealed significant correlations between SMEP, TS, and pain-related psychological variables. Hierarchical regression analyses showed that TS and pain catastrophizing made significant unique contributions to the prediction of SMEP. These findings join a growing body of research on movement-evoked pain in persistent spinal pain conditions. Conclusion: The repeated lifting task used in this study successfully induced pain summation in a group of patients with whiplash injuries.

Purpose: The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression. Methods: The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention. Results: At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes. Conclusions: The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.

This study examined the relations between attachment styles and pain severity/depression in adolescents. Analyses examined whether anxiety and the 3 dimensions of pain catastrophizing mediated the associations between attachment styles, pain severity and depression. A total of 382 high-school students completed questionnaires assessing attachment styles, catastrophizing, depression, anxiety and, for those who reported pain during the last month, pain severity. Results revealed that secure attachment was associated with lower levels of pain severity, depression, pain catastrophizing and anxiety. Preoccupied and fearful attachment styles were associated with heightened pain severity, depression, pain catastrophizing and anxiety. Dismissing attachment style was only associated with high levels of depression and anxiety. Regression analyses revealed that anxiety and the helplessness dimension of pain catastrophizing mediated the relations between secure, preoccupied and fearful attachment styles and pain severity. Moreover, anxiety and the rumination dimension of pain catastrophizing mediated the relation between secure, preoccupied and fearful attachment styles and depression. These findings suggest that anxiety, pain catastrophizing and attachment styles are related processes but nevertheless make independent contributions to the prediction of pain severity and depression. In addition, these findings suggest that attachment styles and cognitive-affective factors might increase the risk of problematic outcomes in adolescents with pain conditions. Theoretical and clinical implications of these results are discussed. Perspective The results of this study revealed that anxiety and the helplessness dimension of pain catastrophizing mediated the relation between attachment and pain severity whereas anxiety and rumination mediated the relation between attachment and depression. Attachment style and cognitive-affective factors might increase vulnerability for problematic pain outcomes in adolescents.

OBJECTIVE: To examine the psychometric properties of theIndex de l’incapacité reliée à la douleur, a French-Canadian version of the Pain Disability Index (PDI).METHODS: A total of 176 chronic pain patients (94 women, 82 men) completed the French-Canadian version of the PDI (PDI-CF), as well as other pain-related measures. A subset of 52 patients (27 women, 25 men) also completed a lifting task designed to assess physical tolerance and pain behaviour.RESULTS: Confirmatory factor analysis of the PDI-CF supported the two-factor structure of the original PDI. Reliability analyses revealed that the PDI-CF total score had a high degree of internal consistency, comparable with the original PDI. The PDI-CF total score was significantly correlated with self-reported pain, pain catastrophizing, depressive symptoms, fear of movement or (re)injury, lift duration and pain behaviours.CONCLUSIONS: The results suggest that the PDI-CF is a reliable and valid measure of self-reported disability that is psychometrically similar to the original scale.

Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation analyses to study the brain mediators of pain facial expressions and the perception of pain intensity (self-reports) in healthy individuals and patients with chronic back pain (CBP). Behavioral data showed that the relation between pain expression and pain report was disrupted in CBP. In both patients with CBP and healthy controls, brain activity varying on a trial-by-trial basis with pain facial expressions was mainly located in the primary motor cortex and completely dissociated from the pattern of brain activity varying with pain intensity ratings. Stronger activity was observed in CBP specifically during pain facial expressions in several nonmotor brain regions such as the medial prefrontal cortex, the precuneus, and the medial temporal lobe. In sharp contrast, no moderating effect of chronic pain was observed on brain activity associated with pain intensity ratings. Our results demonstrate that pain facial expressions and pain intensity ratings reflect different aspects of pain processing and support psychosocial models of pain suggesting that distinctive mechanisms are involved in the regulation of pain behaviors in chronic pain.

BACKGROUND: As the North American population ages, the prevalence of knee osteoarthritis and the surgical interventions (ie, total knee arthroplasty [TKA]) aimed at correcting pain and disability will also rise proportionally. Therefore, efforts to better understand the factors associated with surgical outcomes are warranted. To date, no studies have examined the impact of psychosocial factors on acute postoperative TKA pain.OBJECTIVES: The primary objective was to examine the associations among catastrophizing, negative mood, demographics and acute postoperative pain following TKA. Ancillary analyses examined the association of preoperative psychological variables with postoperative pain.METHODS: Patients completed questionnaire packages 2 h before their surgery and on three consecutive postoperative days while in the hospital. The questionnaire packages included the Short Form –McGill Pain Questionnaire, the Pain Catastrophizing Scale and the Shortened Version of Profile of Mood States. The Mini-Mental State Examination was also administered. Demographic data were extracted from patients’ medical charts.RESULTS: Associations among catastrophizing, negative mood and pain were established. Regressions showed that younger age predicted greater preoperative and postoperative day 1 pain; catastrophizing predicted preoperative and postoperative day 2 pain; and negative mood predicted postoperative day 3 pain. Catastrophizing and negative mood were highly correlated at several assessment points. Preoperative variables did not predict postoperative pain.CONCLUSION: These results have postoperative pain management implications. Heightened attention to psychosocial variables, such as postoperative catastrophizing and negative mood, may be useful in identifying patients at risk for greater postoperative pain.

The present study examined whether pain catastrophizing and pain-related fear predict the experience of pain in body regions that are not targeted by an experimental muscle injury protocol. A delayed-onset muscle soreness (DOMS) protocol was used to induce pain unilaterally in the pectoralis, serratus, trapezius, latissimus dorsi, and deltoid muscles. The day after the DOMS protocol, participants were asked to rate their pain as they lifted weighted canisters with their targeted (ie, injured) arm and their nontargeted arm. The lifting task is a nonnoxious stimulus unless participants are already experiencing musculoskeletal pain. Therefore, reports of pain on the nontargeted arm were operationalized as pain in response to a nonnoxious stimulus. Eighty-two healthy university students (54 men, 28 women) completed questionnaires on pain catastrophizing and fear of pain and went through the DOMS protocol. The analyses revealed that catastrophizing and pain-related fear prospectively predicted pain experience in response to a nonnoxious stimulus. The possible mechanisms underlying this effect and clinical implications are discussed. Perspective: Pain catastrophizing and fear of pain prospectively predict the pain experience in response to a nonnoxious stimulus. The pattern of findings is consistent with the predictions of current models of generalization of pain-related fear. (C) 2015 by the American Pain Society

Pain catastrophizing and fear of movement have been identified as key predictors of prolonged work disability after whiplash injury. However, little is known about the processes by which pain catastrophizing and fear of movement affect return to work. This study investigated the mediating role of expectancies on the relations between pain catastrophizing and return to work, and between fear of movement and return to work after whiplash injury. The study sample consisted of 154 individuals with whiplash injury who were enrolled in a multidisciplinary pain rehabilitation program. Participants completed measures of pain catastrophizing, fear of movement, and return-to-work expectancies after admission to a rehabilitation program. A follow-up telephone interview was used to assess work status 1 year after discharge. Consistent with previous research, analyses revealed that expectancies, pain catastrophizing, and fear of movement were significant predictors of return to work at 1-year follow-up. Regression analyses (bootstrapping) revealed that expectancies partially mediated the relation between catastrophizing and return to work. Expectancies completely mediated the relation between fear of movement and return to work. The significant predictive and mediating role of expectancies on return to work argues for the inclusion of expectancies as a specific target of intervention for individuals with whiplash injury. Perspective The findings suggest that expectancies might be part of the pathways by which pain catastrophizing and fear of movement affect return-to-work outcomes after whiplash injury. The findings argue for greater attention to return-to-work expectancies as a risk factor for problematic recovery outcomes as well as a target of intervention.

Background: A double-blind, randomized, placebo-controlled 3-week study evaluated the efficacy of topical 2% amitriptyline, 1% ketamine, and a combination of both in treating patients with neuropathic pain. Methods: Ninety-two patients with diabetic neuropathy, postherpetic neuralgia, or postsurgical/posttraumatic neuropathic pain with allodynia, hyperalgesia, or pinprick hypesthesia were randomly assigned to receive one of four creams (placebo, 2% amitriptyline, 1% ketamine, or 2% amitriptyline‐1% ketamine combined). The primary outcome measure was change in average daily pain intensity (baseline week vs. final week) using an 11-point numerical pain rating scale. Secondary outcomes included the McGill Pain Questionnaire, measures of allodynia and hyperalgesia, and patient satisfaction. Results: A reduction in pain scores of 1.1‐1.5 units was observed in all groups, and there was no difference between groups. Blood concentrations revealed no significant systemic absorption. Minimal side effects were encountered. Conclusion: This randomized, placebo-controlled trial examining topical 2% amitriptyline, 1% ketamine, and a combination in the treatment of neuropathic pain revealed no difference between groups. Optimization of doses may be required, because another study has revealed that higher concentrations of these agents combined do produce significant analgesia. NEUROPATHIC pain is now understood to involve neural responses in which both peripheral and central mechanisms contribute to the generation of spontaneous pain and evoked aspects of pain, including allodynia and hyperalgesia. 1– 4 The involvement of peripheral mechanisms suggests the use of topical approaches in the treatment of neuropathic pain. Both capsaicin 5,6 and local anesthetics 7–9 can be useful in the relief of neuropathic pain when administered locally to peripheral sites as a cream or a patch, respectively. Additional novel drug classes may also be effective in alleviating neuropathic pain after topical administration. 10 Therefore, tricyclic antidepressants have been shown to produce a peripherally mediated antinociception in preclinical models of ongoing and neuropathic

Anger has long been recognized as an integral part of pain experience [1,19]. Reviews highlight the deleterious effect of anger on social, clinical, and functional outcomes [9,22,32]. Anger has been discussed as an aversive emotional state ranging from mild irritation to fury [25], and comprising specific cognitive attributions and action tendencies [21,34]. Anecdotal and empirical data suggest that anger is commonplace among chronic pain sufferers [32]. In their 2003 review, Greenwood et al. [22] identified anger as an important target of research and behavioral management; since that review, research has highlighted biopsychosocial mechanisms through which anger may affect pain experience [5,9,33]. However, to date, no systematic line of research has addressed the cognitive dimensions of anger in chronic pain. We believe that elucidating these facets of anger in pain sufferers might strengthen the empirical foundation for more effective treatment. Although not exhaustive, the current review highlights potential sources of anger among pain sufferers by drawing on conceptualizations from existing social psychological theory and newly evolving lines of research. On this basis, we discuss the role of anger in treatment settings, and possible frameworks for research and intervention.

OBJECTIVES:To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury.PARTICIPANTS:A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work-related soft-tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups.METHODS:Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain-related disability.RESULTS:Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain-related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits.DISCUSSION:The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.

UNLABELLED: The present study examined the prospective value of pain catastrophizing, fear of pain, and depression in the prediction of multisite musculoskeletal pain following experimentally induced delayed-onset muscle soreness (DOMS). The study sample consisted of 119 (63 females, 56 males) healthy university students. Measures of pain catastrophizing, fear of pain, and depression were completed prior to the DOMS induction procedure. Analyses revealed that pain catastrophizing and fear of pain prospectively predicted the experience of multisite pain following DOMS induction. Analyses also revealed that women were more likely to experience multisite pain than men. There was no significant relation between depressive symptoms and the experience of multisite pain. The discussion addresses the mechanisms by which pain catastrophizing and fear of pain might contribute to the spreading of pain. Clinical implications of the findings are also addressed. PERSPECTIVE: The results of this experimental study suggest that pain catastrophizing and fear of pain might increase the risk of developing multisite pain following musculoskeletal injury. ispartof: Journal Of Pain vol:15 issue:11 pages:1156-1165 ispartof: location:Maastricht, The Netherlands. status: published