Pain-related fear in low back pain: a prospective study in the general population.

A cognitive behavioural account of chronic low back pain (CLBP) proposes that the relationship between pain catastrophizing and functional disability is mediated by fear of movement/(re)injury. Several clinical studies already demonstrated the contribution of pain catastrophizing and fear of movement/(re)injury in the development and maintenance of CLBP. This study included people with low back pain (LBP) in the general population, and aimed to investigate whether fear of movement/(re)injury mediated the relationship between pain catastrophizing and functional disability, by examining several prerequisites for mediation. Data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort (DMC(3)) study were used, including 152 people suffering from LBP who completed both a follow-up questionnaire and a baseline questionnaire 6 months previously. This study was unable to demonstrate that the relationship between pain catastrophizing and functional disability was mediated by fear of movement/(re)injury, since the prerequisite that pain catastrophizing and functional disability were related, was not fulfilled. However, pain catastrophizing was significantly related to fear of movement/(re)injury 6 months later, above and beyond other contributing variables such as fear of movement/(re)injury already present at baseline. On its turn, fear of movement/(re)injury was related to functional disability, in addition to pain intensity. Although this study leaves some indistinctness concerning the actual relationships between pain catastrophizing, fear of movement/(re)injury, and functional disability, it does provide some evidence for the contributing role of these factors in LBP in the general population.

Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community.

UNLABELLED: By elaborating on previous prospective and cross-sectional research, the primary aim of this study was to examine in the general community whether pain catastrophizing predicts the development of chronic pain complaints and other consequences of pain. The following health index values were examined as consequences of pain: specialist consultation, use of pain medication, and absenteeism. It was also examined whether these relationships were moderated by the number of pain problems and by pain intensity. The results demonstrated a generally low level of catastrophizing and a small but significant effect of catastrophizing on the development of chronic pain complaints. With respect to the health index values, no significant effects of catastrophizing were found, nor were the relationships between catastrophizing and chronicity and the health index values moderated by the number of pain problems or by pain intensity. PERSPECTIVE: Because in the general community the level of catastrophizing is low, its role in the development of future pain problems is probably limited in this type of setting. More practically, the Pain Catastrophizing Scale, used to measure pain catastrophizing, is probably of limited use as a screening instrument in the general community. The disappointing results may indicate that, depending on the specific setting (eg, clinical, outpatient, or community) the role of pain catastrophizing is either more or less prominent.

The causal status of pain catastrophizing: an experimental test with healthy participants.

In the current study we report findings on the effects of experimentally induced catastrophizing about pain on expected pain, experienced pain and escape/avoidance behavior during a cold pressor task in a sample of healthy participants. It was hypothesized that increasing the level of catastrophizing would result in a higher level of expected pain, a higher level of experienced pain, and a shorter duration of ice-water immersion. Also, it was hypothesized that these relations might be stronger for participants who already catastrophized about pain prior to the experiment. The results demonstrated that despite the successful attempt to induce catastrophizing, this neither significantly affected expected pain, experienced pain, and duration of ice-water immersion, nor were these relations moderated by the pre-experimental level of catastrophizing. Although the level of catastrophizing was successfully manipulated, more similar experiments are necessary in order to give a more definite answer on the possible causal status of pain catastrophizing.

Pain catastrophizing and general health status in a large Dutch community sample.

The aim of the present study was to examine the association between pain catastrophizing and general health status in a Dutch adult community sample, including various subgroups of people with musculoskeletal pain in the analyses. For exploratory reasons this study partly replicated previous studies of the factor structure, reliability, and validity of the Pain Catastrophizing Scale (PCS). Results demonstrated that across different pain subgroups, catastrophizing uniquely contributed variance to the prediction of the various aspects of general health status beyond the variance explained by pain intensity, age, gender, and chronicity. Across subgroups strongest associations were found between catastrophizing and mental health, general health perception, social functioning, and vitality. Furthermore, the association between catastrophizing and the various aspects of general health status was not moderated by the chronicity of the pain. Results of the confirmatory factor analysis statistically confirmed a three-factor model of the PCS, which was invariant across different subgroups of people with musculoskeletal pain. Inter-factor correlations were high, and the incremental explanatory power of the three-factor model over that of a one-factor model was only marginal. This implies that a one-factor model might be justifiable as well, at least in the general community. Across various pain subgroups the reliability of the PCS total and subscales was adequate. Additional evidence for the concurrent validity of the PCS was found as well.

Pain catastrophizing is associated with health indices in musculoskeletal pain: a cross-sectional study in the Dutch community.

Cross-sectional associations were examined between pain catastrophizing and several health indices in 1,164 people with musculoskeletal pain from a Dutch community sample. Health indices included in the present study were specialist consultation, use of medication, and absenteeism or work disability. The results demonstrate that for people with a current episode of musculoskeletal pain, pain catastrophizing, pain intensity, and the presence of multiple pain locations were significantly associated with specialist consultation, use of pain medication, and absenteeism or work disability. The authors conclude that the role of pain itself has perhaps been underestimated in recent models of chronic pain-related disability. Some clinical implications and suggestions for further research are given.