The Structural Model of Relationships between Pain Vulnerability, Catastrophizing, Fear and Pain Adjustment in Patients with Chronic Musculoskeletal Pain

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Psychology,School of Literature, Lorestan University, Khorramabad, Iran

2 PhD Student, Department of Psychology, School of Literature, Lorestan University, Khorramabad, Iran

Abstract

Background: Nowadays, fear-avoidance model is the best model for the assessment and treatment of chronic musculoskeletal pain in which, the role of the pain vulnerability (neuroticism, experiential avoidance and negative affect) is not well defined. The purpose of present study was to evaluate the structural pattern of the relationships between the pain vulnerability, catastrophizing, fear of pain and pain adjustment (pain intensity and inability) in the framework fear-avoidance model.Methods: Patients with chronic musculoskeletal pain were selected from hospitals and private clinics in Isfahan city, Iran, during 2015 using convenience sampling method. They participated in the research by filling out six questionnaires: NEO Five-Factor Inventory (NEO-FFI), Positive and Negative Affect Schedule (PANAS), Acceptance and Action Questionnaire (AAQ), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia (TSK) and Graded Chronic Pain Scale (GCP). Data were analyzed using structural equation modeling method.Findings: Pain vulnerability had significant direct effects on catastrophizing and catastrophizing on fear of pain and fear of pain on pain adjustment (P < 0.001 for all). In addition, catastrophizing through pain vulnerability and fear of paintrough catastrophizing had indirect effects on pain adjustment; while the direct relationship between vulnerability and pain adjustment was not confirmed.Conclusion: The results of this research showed that pain vulnerability could predict pain adjustment in the framework fear-avoidance model. Therefore, reducing pain vulnerability can reduce pain intensity and inability in patients with chronic musculoskeletal pain.

Keywords


  1. Zhang Y, Deng G, Zhang Z, Zhou Q, Gao X, Di L, et al. A cross sectional study between the prevalence of chronic pain and academic pressure in adolescents in China (Shanghai). BMC Musculoskelet Disord 2015; 16: 219.
  2. Anno K, Shibata M, Ninomiya T, Iwaki R, Kawata H, Sawamoto R, et al. Paternal and maternal bonding styles in childhood are associated with the prevalence of chronic pain in a general adult population: the Hisayama Study. BMC Psychiatry 2015; 15: 181.
  3. Fernandez-de-las-Penas C, Hernandez-Barrera V, Alonso-Blanco C, Palacios-Cena D, Carrasco-Garrido P, Jimenez-Sanchez S, et al. Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine (Phila Pa 1976) 2011; 36(3): E213-9.
  4. Fazli B, Ansari H, Noorani M, Jafari SM, Sharifpoor Z, Ansari S. The prevalence of musculoskeletal disorders and its predictors among Iranians housewives. International Journal of Epidemiologic Research 2016; 3(1): 53-62.
  5. Vasudevan S. Multidisciplinary management of chronic pain: A practical guide for clinicians. New York, NY: Springer; 2015.
  6. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther 2011; 91(5): 700-11.
  7. Simons LE, Kaczynski KJ. The Fear Avoidance model of chronic pain: examination for pediatric application. J Pain 2012; 13(9): 827-35.
  8. Buer N, Linton SJ. Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population. Pain 2002; 99(3): 485-91.
  9. Gheldof EL, Crombez G, Van den Bussche E, Vinck J, Van Nieuwenhuyse A, Moens G, et al. Pain-related fear predicts disability, but not pain severity: a path analytic approach of the fear-avoidance model. Eur J Pain 2010; 14(8): 870-9.
  10. Bergbom S, Boersma K, Linton SJ. Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability. Behav Res Ther 2012; 50(11): 726-34.
  11. Sieben JM, Vlaeyen JW, Tuerlinckx S, Portegijs PJ. Pain-related fear in acute low back pain: the first two weeks of a new episode. Eur J Pain 2002; 6(3): 229-37.
  12. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007; 30(1): 77-94.
  13. Soriano J, Monsalve V, Gomez-Carretero P, Ibanez E. Vulnerable personality profile in patients with chronic pain: relationship with coping, quality of life and adaptation to disease. Int J Psychol Res 2012; 5(1): 42-51.
  14. Schmidt JE, Hooten WM, Carlson CR. Utility of the NEO-FFI in multi-dimensional assessment of orofacial pain conditions. J Behav Med 2011; 34(3): 170-81.
  15. Gaudiano BA, Herbert JD, Hayes SC. Is it the symptom or the relation to it? Investigating potential mediators of change in acceptance and commitment therapy for psychosis. Behav Ther 2010; 41(4): 543-54.
  16. McCracken LM, Morley S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. J Pain 2014; 15(3): 221-34.
  17. Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012; 153(6): 1144-7.
  18. Feldner MT, Hekmat H, Zvolensky MJ, Vowles KE, Secrist Z, Leen-Feldner EW. The role of experiential avoidance in acute pain tolerance: a laboratory test. J Behav Ther Exp Psychiatry 2006; 37(2): 146-58.
  19. Matthews G, Deary IJ, Whiteman MC. Personality Traits. 2nd ed. Cambridge, UK: Cambridge University Press; 2003.
  20. Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev 1989; 96(2): 234-54.
  21. Wong WS, Lam HM, Chen PP, Chow YF, Wong S, Lim HS, et al. The fear-avoidance model of chronic pain: assessing the role of neuroticism and negative affect in pain catastrophizing using structural equation modeling. Int J Behav Med 2015; 22(1): 118-31.
  22. Asmundson GJ, Norton PJ, Vlaeyen JW. Fear-avoidance models of chronic pain: an overview. In: Asmundson G, Vlaeyen J, Crombez G, editors. Understanding and treating fear of pain. 1st ed. New York, NY: Oxford University Press; 2004. p. 3-24.
  23. Wertli MM, Burgstaller JM, Weiser S, Steurer J, Kofmehl R, Held U. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review. Spine (Phila Pa 1976) 2014; 39(3): 263-73.
  24. Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain 2010; 148(3): 398-406.
  25. Von Korff M, Dworkin SF, Le Resche L. Graded chronic pain status: an epidemiologic evaluation. Pain 1990; 40(3): 279-91.
  26. Fielding R, Wong WS. The prevalence of chronic pain, fatigue, and insomnia in the general population of Hong Kong. Final report to the health, welfare and food bureau, government of the Hong Kong special administrative region, China. Hong Kong, China; School of Public Health, University of Hong Kong; 2008.
  27. Wong WS, Kwok HY, Luk KD, Chow YF, Mak KH, Tam BK, et al. Fear of movement/(re)injury in Chinese patients with chronic pain: Factorial validity of the Chinese version of the Tampa Scale for Kinesiophobia. J Rehabil Med 2010; 42(7): 620-9.
  28. Rahmati N, Asghari Moghaddam MA, Shaeiri MR, Paknejad M, Rahmati Z, Ghassami M, et al. Psychometric properties of the Tampa Scale for Kinesiophobia amongst Iranian patients with chronic persistent pain. Payesh Health Monit 2014; 13(2): 197-210. [In Persian].
  29. Davoodi I, Zargar Y, Mozafaripour E, Mola K. The relationship between pain catastrophizing, social support, pain-related anxiety, coping strategies and neuroticism, with functional disability in rheumatic patients. Health Psychology 2012; 1(1): 57-64. [In Persian].
  30. Asghari M, Golak N. The roles of pain coping strategies in adjustment to chronic pain. Clinical Psychology and Personality 2005; 1(10): 1-23. [In Persian].
  31. Costa PT, Jr, Mccrae RR. Reply to Eysenck. Pers Individ Dif 1992; 13(8): 861-5.
  32. Anisi J, Majdiyan M, Joshanloo M, Ghoharikamel Z. Validity and reliability of NEO Five-Factor Inventory (NEO-FFI) on university students. Journal of Behavioral Sciences 2012; 5(4): 351-5. [In Persian].
  33. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther 2011; 42(4): 676-88.
  34. Abasi E, Fti L, Molodi R, Zarabi H. Psychometric properties of Persian version of Acceptance and Action Questionnaire-II. Journal of Psychological Models and Methods 2013; 3(10): 65-80. [In Persian].
  35. Gomez R, Cooper A, Gomez A. Susceptibility to positive and negative mood states: test of Eysenck’s, Gray’s and Newman’s theories. Pers Individ Dif 2000; 29(2): 351-65.
  36. Besharat MA. Evaluating psychometric properties of Farsi version of the Positive and Negative Perfectionism Scale. Psychol Rep 2005; 97(1): 33-42.
  37. Hooman HA. Structural equation modeling with LISREL application. Tehran, Iran: Samt Publication; 2009. [In Persian].
  38. Jensen MP, Turner JA, Romano JM. Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning. Pain 2007; 131(1-2): 38-47.
  39. Rollman GB. Perspectives on hypervigilance. Pain 2009; 141(3): 183-4.
  40. Baranoff J, Hanrahan SJ, Kapur D, Connor JP. Acceptance as a process variable in relation to catastrophizing in multidisciplinary pain treatment. Eur J Pain 2013; 17(1): 101-10.
  41. Martinez MP, Sanchez AI, Miro E, Medina A, Lami MJ. The relationship between the fear-avoidance model of pain and personality traits in fibromyalgia patients. J Clin Psychol Med Settings 2011; 18(4): 380-91.
  42. Goubert L, Crombez G, Van Damme S. The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: a structural equations approach. Pain 2004; 107(3): 234-41.
  43. Ramirez-Maestre C, Lopez Martinez AE, Zarazaga RE. Personality characteristics as differential variables of the pain experience. J Behav Med 2004; 27(2): 147-65.
  44. Zautra A, Smith B, Affleck G, Tennen H. Examinations of chronic pain and affect relationships: applications of a dynamic model of affect. J Consult Clin Psychol 2001; 69(5): 786-95.
  45. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007; 133(4): 581-624.
  46. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 2008; 70(8): 890-7.
  47. Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine (Phila Pa 1976) 2005; 30(13): 1541-8.
  48. Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. Pain 2000; 84(1): 65-75.
  49. Baxter J, Newman A, Torres C, Eyer J, Thorn B. The role of psychosocial factors in the pain experience: the relationship between depression, catastrophizing and chronic pain. J Pain 2016; 17(4S): S97-S98.
  50. Kroenke K, Outcalt S, Krebs E, Bair MJ, Wu J, Chumbler N, et al. Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain. Gen Hosp Psychiatry 2013; 35(4): 359-65.
  51. Carter LE, McNeil DW, Vowles KE, Sorrell JT, Turk CL, Ries BJ, et al. Effects of emotion on pain reports, tolerance and physiology. Pain Res Manag 2002; 7(1): 21-30.
  52. Costa J, Pinto-Gouveia Jر. Experiential avoidance and self-compassion in chronic pain. J Appl Soc Psychol 2013; 43(8): 1578-91.
  53. Kashdan TB, Barrios V, Forsyth JP, Steger MF. Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies. Behav Res Ther 2006; 44(9): 1301-20.
  54. Zettle RD, Hocker TR, Mick KA, Scofield BE, Petersen CL, Song H, et al. Differential Strategies in Coping with Pain as a Function of Level of Experiential Avoidance. Psychological Record 2005; 55(4): 511-24.
  55. Turner JA, Anderson ML, Balderson BH, Cook AJ, Sherman KJ, Cherkin DC. Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain 2016; 157(11): 2434-44.
  56. Jensen MP, Smith AE, Alschuler KN, Gillanders DT, Amtmann D, Molton IR. The role of pain acceptance on function in individuals with disabilities: a longitudinal study. Pain 2016; 157(1): 247-54.
  57. Cook AJ, Brawer PA, Vowles KE. The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling. Pain 2006; 121(3): 195-206.