Beverly E. Thorn

An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description

Abstract A cold pressor task (CPT) was used with 203 college students (112 women and 91 men) in a study of sex differences in pain response. Physiological measures were taken before and after pain induction, and sex‐differentiating personality traits were assessed with the Personal Attributes Questionnaire (PAQ). The Pain Catastrophizing Scale (PCS) was given with standard instructions prior to the CPT, and it was re‐administered after the CPT with modified instructions to assess catastrophic thinking during the CPT. Hypotheses were formulated into an explanatory model that was evaluated by path analysis. Pain induction elevated blood pressures and cortisol levels for both sexes, but systolic blood pressure reactivity and cortisol response were greater in men, even with sex differences in CPT tolerance times controlled statistically. Post‐CPT PCS scores were positively related to pain ratings and negatively related to tolerance, but baseline PCS scores did not predict tolerance or pain ratings. Pre‐PCS scores were not well correlated with post‐PCS scores (r=0.46) and underestimated post‐PCS scores, particularly for women. The Sex difference on the post‐CPT PCS was largely attributable to the PAQ personality trait of Emotional Vulnerability. The differential results obtained from assessing catastrophizing before and after the CPT emphasized the importance of specifying the context in which catastrophizing is assessed (both timing and instructions). Theoretical considerations in the construct of catastrophizing are also highlighted, including, but not limited to, the confounding of variables such as pain intensity and unpleasantness.

Catastrophizing and perceived partner responses to pain.

&NA; This study examined the relationship between catastrophizing and patient‐perceived partner responses to pain behaviors. The Catastrophizing subscale of the Cognitive Coping Strategy Inventory and the West Haven–Yale Multidimensional Pain Inventory were completed by 62 adult chronic pain patients. Consistent with past research, catastrophizing and patient‐perceived solicitous partner behaviors were positively correlated with negative pain outcomes. The communal coping theory of catastrophizing suggests that catastrophizing might be undertaken to solicit support and empathy from others. However, catastrophizing was not related to perceived solicitous partner behavior in this study. Rather, catastrophizing was associated with perceived punishing partner responses. Implications are that catastrophizing and perceived solicitous partner behaviors are independently associated with pain and that catastrophizing may not be reinforced by empathy from significant others.

Pain Assessment and Management in Cognitively Impaired Nursing Home Residents: Association of Certified Nursing Assistant Pain Report, Minimum Data Set Pain Report, and Analgesic Medication Use

OBJECTIVES: The primary purpose of this preliminary study was to investigate the associations between certified nursing assistant (CNA) report of pain, Minimum Data Set (MDS) report of pain, and analgesic medication use in cognitively impaired nursing home residents.

Effects of stress on methyltransferase synthesis: an important DNA repair enzyme.

The enhancement of tumor development following acute stress has been demonstrated in some animal studies. This study was designed to explore mechanisms that would account in part for the relationship between stress and tumor development at the level of DNA repair, using a rat model. Forty-four rats were given the carcinogen dimethylnitrosamine in their drinking water, and half were randomly assigned to a rotational stress condition. The levels of methyltransferase, a DNA repair enzyme induced in response to carcinogen damage, were significantly lower in spleens from the stressed animals. These data suggest that stress may impair DNA repair.

The relation between pain beliefs, negative thoughts, and psychosocial functioning in chronic pain patients.

Abstract Cognitions and beliefs appear important in predicting adjustment to chronic pain. The current study examines how cognitions and beliefs are related to psychosocial functioning. One hundred and sixty‐three chronic pain out‐patients were assessed. Regression analyses were performed using scores on the Pain Beliefs and Perceptions Inventory and the Inventory of Negative Thoughts in Response to Pain as predictor variables and responses to the West Haven Yale Multidimensional Pain Inventory as criterion variables. Pain cognitions and pain beliefs were correlated. After controlling for demographics, employment status and pain severity, pain beliefs and cognitions accounted for a significant amount of the variance in general activity, pain interference, and affective distress. Negative cognitions, particularly negative self‐statements, were more predictive of outcome than pain beliefs. Although these data are correlational, they provide additional support for a biopsychosocial model of adjustment to chronic pain.

Path model of psychological antecedents to pain experience: experimental and clinical findings.

Objectives:Two studies are described addressing how anxiety, fear of pain, and catastrophizing impact on pain experience. Methods:In study 1, 66 undergraduates (34 men, 32 women) completed measures of state and trait anxiety, fear of pain, and catastrophizing prior to participating in a cold pressor procedure. In study 2, 60 undergraduates (30 men, 30 women) completed the same measures and participated in dental hygiene treatment and rated the pain they experienced during a scaling procedure (removing deposits from the tooth surface). Results:In both studies, fear of pain and catastrophizing were significantly correlated with pain intensity ratings, and fear of pain and catastrophizing were correlated with each other. Trait anxiety was correlated with catastrophizing but not with fear of pain or pain. Path analyses revealed significant paths from trait anxiety to state anxiety, from trait anxiety to catastrophizing, and from catastrophizing to pain intensity ratings. Discussion:The findings suggest that although fear of pain and catastrophizing are related constructs, catastrophizing provides unique predictive ability for pain ratings, while fear of pain does not. Clinical and theoretical implications of these findings are discussed.

Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain.

Objective:To examine the effects of personality and pain catastrophizing upon pain tolerance and pain ratings and to examine the impact of an experimental pain induction on subsequent ratings of catastrophizing. Method:Two hundred nineteen college students participated in a cold pressor task. Sex-differentiating personality constructs were measured by the Extended Personal Attributes Questionnaire. The Pain Catastrophizing Scale was given before and after the cold pressor task. Results:A path-analytic model fit the data well and permitted tests of explanatory relationships. Mediational analyses demonstrated that sex differences in catastrophizing were explained by the Personal Attributes Questionnaire Masculinity–Femininity and Verbal Passive-Aggressiveness scales. Pain tolerance and pain ratings differed significantly between men and women, but Masculinity–Femininity partially mediated those sex–pain relationships. Additionally, higher pain ratings and lower pain tolerance were independently associated with increased catastrophizing after the cold pressor task. Conclusions:The results suggest that sex differences in catastrophizing and pain responsivity are partially accounted for by the dispositional tendency to describe oneself as emotionally vulnerable. The findings also suggest that pain catastrophizing may be situational as well as dispositional.

Recognizing, assessing, and intervening with problems of professional competence.

THIS ARTICLE WAS AUTHORED by members of a workgroup on students with competence problems associated with the Council of Chairs of Training Councils, which is affiliated with the Education Directorate of the American Psychological Association. Nadine J. Kaslow and Nancy J. Rubin took primary responsibility for crafting this manuscript. Nadine J. Kaslow is the workgroup chair. To the extent possible, the remaining authors are listed in the order of their contributions: Nadine J. Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; Nancy J. Rubin, Department of Psychiatry and Behavioral Medicine, University of Alabama School of Medicine—Tuscaloosa Campus; Linda Forrest, Counseling Psychology and Human Services, University of Oregon; Nancy S. Elman, Psychology in Education, University of Pittsburgh; Barbara A. Van Horne, Department of Psychology, University of Wisconsin-Madison; Sue C. Jacobs, Applied Health and Educational Psychology, Oklahoma State University; Stephen K. Huprich, Department of Psychology, Eastern Michigan University; Sherry A. Benton, Counseling Services, Kansas State University; Victor F. Pantesco, Department of Clinical Psychology, Antioch University New England; Stephen J. Dollinger, Department of Psychology, Southern Illinois University; Catherine L. Grus, Education Directorate, American Psychological Services; Stephen H. Behnke, Ethics Office, American Psychological Association; David S. Shen Miller, Counseling Psychology and Human Services, University of Oregon; Craig N. Shealy, Department of Graduate Psychology, James Madison University; Laurie B. Mintz, Educational, School, and Counseling Psychology, University of Missouri-Columbia; Rebecca Schwartz-Mette, Department of Psychology, University of Missouri-Columbia; Kristi Van Sickle, Department of Psychology, James A. Haley VA Hospital in Tampa; Beverly E. Thorn, Department of Psychology, University of Alabama. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Nadine J. Kaslow, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Grady Hospital, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail: nkaslow@emory.edu Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 5, 479–492 0735-7028/07/

Targeted treatment of catastrophizing for the management of chronic pain

12.00 DOI: 10.1037/0735-7028.38.5.479

Communal coping model of catastrophizing: conceptual model building

Pain catastrophizing refers to a negative mental set brought to bear during the experience of pain. Individuals who catastrophize often feel helpless about controlling their pain, ruminate about painful sensations, and expect bad outcomes. Not surprisingly, such individuals often fail to improve with treatment. This paper provides an assessment tool and outlines a cognitive-behavioral group treatment approach for chronic pain that is specifically designed to reduce catastrophizing. Principles from stress management, cognitive therapy for depression, assertiveness training, and communal coping models are incorporated within the treatment framework to address specific needs posed by catastrophizing. Suggestions are provided for organizing treatment sessions and for assigning homework based on treatment principles.