APS Press Room
News Highlights from The Journal of Pain • January 2007
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
SEX AND PAIN RELATED PSYCHOLOGICAL VARIABLES ARE ASSOCIATED WITH THERMAL PAIN SENSITIVITY FOR PATIENTS WITH CHRONIC LOW BACK PAIN
Steven Z. George, Virgil T. Wittmer, Roger B. Fillingim and Michael E. Robinson
University of Florida
There have been many published studies comparing and evaluating thermal pain sensitivity in healthy subjects, but not much research has been conducted on those with clinical pain syndromes. The authors studied 33 patients with low back pain to explore whether sex differences existed for thermal pain sensitivity and if sex, fear avoidance beliefs and/or pain catastrophizing influenced thermal-pain sensitivity. This is known as the Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP).
The authors hypothesized that women with chronic low back pain would exhibit elevated pain sensitivity in response to evoked pain stimuli and that fear-avoidance beliefs and catastrophizing would significantly influence pain sensitivity all subjects regardless of gender. The authors defined fear avoidance beliefs as comprising an individual's pain experiences, present stress level, pain behavior and personality traits. Catastrophizing was described as a general negative expectation that experienced pain will inevitably result in the worst possible outcome.
Based on self-report questionnaires of the study subjects, the authors concluded that sex differences were evident in this group as women showed lower pain tolerance. However, the survey results also indicated that fear avoidance beliefs were the only unique influence on first-pulse response to pain stimuli in both women and men. Therefore, fear avoidance was associated with immediate thermal pain sensitivity.
IS HIGH FEAR OF PAIN ASSOCIATED WITH ATTENTIONAL BIASES FOR PAIN RELATED OR GENERAL THREAT?
Gordon J. G. Asmundson and Heather D. Hadjistravropoulos
University of Regina, Canada
The intent of this study was to review and clarify past mixed research findings related to establishing fear of pain as a critical variable stimulating hypervigilance and vulnerability to the disabling effects of pain. A previous study had found that fear of pain was associated with faster detection of weak electrical stimuli regardless of clinical status.
The researchers reviewed recently published dot-probe data from 36 patients with musculoskeletal pain and from 29 healthy subjects. They concluded that patients with high pain fear levels displayed hypervigilance for all word types presented during the dot-probe task compared to those with low fear levels. The high pain fear subjects were almost exclusively musculoskeletal pain patients.
It appears from the data that high pain fear is associated with a general hypervigilance for potentially threatening stimuli. Fear of pain, therefore can be used to categorize people more or less vulnerable to the disabling effects of pain, as those with high fear are likely to selectively react to all potentially threatening stimuli in their environment.
MUSCULOSKELATAL PAIN IN PRIMARY HEALTH CARE: SUBGROUPS BASED ON PAIN INTENSITY, DISABLITY, SELF EFFICACY AND FEAR AVOIDANCE VARIABLES
Eva Denison, Pernilla Asenlof, Maria Sandborgh and Per Lindberg
Department of Public Health and Caring Sciences, Uppsala University, Sweden
Persistent pain is commonly treated in the primary care setting and musculoskeletal pain is the most frequently reported type of pain. The purpose of this study was to identify and describe subgroup profiles of these patients based on self-reported pain intensity, disability, self efficacy, fear of movement and catastrophizing.
The researchers evaluated self-report questionnaires given to two groups of 215 and 161 patients at the start of physical therapy. Three subgroups were identified in the first group and replicated in the second. They were labeled as "high self-efficacy and low fear avoidance," "low self-efficacy and low fear-avoidance" and "low self-efficacy and high fear avoidance."
The authors stated that members of the high self-efficacy and low fear avoidance group was the largest subgroup in both samples, and therapeutic management of these patients could be based on a general fitness approach in which they would be expected to self manage extensively. For those with a combination of high pain levels and disability and low self-efficacy, the authors recommended a treatment approach that would enhance self-efficacy beliefs regarding the performance of desired activities by focusing on mastery of required motor skills. For the third subgroup, characterized by high pain levels and disability and high fear avoidance, they advocated an approach that assesses what movements or activities elicit fear and follow up with gradual activity increases to reduce catastrophizing and fear and to enhance self-efficacy.