Stefaan Van Damme

A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations

&NA; This study examined the factor structure of the Pain Catastrophizing Scale in three different Dutch‐speaking samples: 550 pain‐free students, 162 chronic low back pain patients, and 100 fibromyalgia patients. Confirmatory factor analyses were used to compare three different models of pain catastrophizing (one factor, two oblique factors, three oblique factors), and to investigate the invariance of the factor structure across the three different samples. The results indicated that a three‐factor oblique model with a four‐item rumination factor, a three‐item magnification factor, and a six‐item helplessness factor provided the best fit to the data in the three samples. Furthermore, it was found that this model could be considered as invariant across three samples (pain‐free students, chronic low back pain patients, and fibromyalgia patients) and across gender, indicating that the same processes are measured in different subgroups.

Fear-avoidance model of chronic pain: the next generation.

Objective:The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. Methods:A narrative review. Results:There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion:To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.

The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: a structural equations approach

&NA; The present study aimed at clarifying the precise role of pain catastrophizing, pain‐related fear and personality dimensions in vigilance to pain and pain severity by means of structural equation modelling. A questionnaire survey was conducted in 122 patients with chronic or recurrent low back pain. Results revealed that pain catastrophizing and pain‐related fear mediated the relationship between neuroticism and vigilance to pain. Furthermore, vigilance to pain was found to be associated with heightened pain severity. Finally, we found that neuroticism moderated the relationship between pain severity and catastrophic thinking about pain. The results strongly support the idea that vigilance to pain is dependent upon catastrophic thinking and pain‐related fear. Neuroticism is best conceived of as a vulnerability factor; it lowers the threshold at which pain is perceived as threatening, and at which catastrophic thoughts about pain emerge.

Hypervigilance to pain: An experimental and clinical analysis

A clinical feature of many chronic pain patients is persistent, distressing and preoccupying pain that cannot be explained easily by observable biomedical phenomena. Growing in popularity are explanations based on the idea of dysfunctional attentional processes. Patients are thought to display a ‘hypervigilance’ to pain and pain-associated information at the expense of the rest of life. Although seductive as an explanation for a class of effects, closer examination shows that there is a number of partial and competing explanations of this putative attentional effect, and different ways to operationalise it (Van Damme et al., 2004a,b). For just three examples: Puzzled by the observation that patients with widespread musculoskeletal pain have both lower pain and auditory thresholds than controls, McDermid et al. (1996) proposed that fibromyalgia patients are hypervigilant to stressors in general. In reviewing gender differences in pain experience, Rollman et al. (2004) suggested that hypervigilance may explain commonly found gender differences in the reporting of pain. In their model of fear-avoidance Vlaeyen and Linton (2000) presumed low back pain patients who fear (re)injury to be hypervigilant to pain; a hypervigilance that expedites escape and avoidance behavior. In this paper we offer conceptual clarification of the concept of vigilance, and propose a model of hypervigilance.

A neurocognitive model of attention to pain: Behavioral and neuroimaging evidence

READ – Unite de Readaptation et de Medecine physique, Universite catholique de Louvain, Louvain-la-Neuve & Brussels, 1200 Brussels, Belgium Department of Experimental-Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium Centre for Pain Research, University of Bath, UK Division of Brain, Imaging and Behaviour, Toronto Western Research Institute, University Health Network & Department of Surgery and Institute of Medical Science, University of Toronto, Canada Alan Edwards Centre for Research on Pain, Faculty of Dentistry, McGill University, Montreal, Canada

Keeping pain in mind: A motivational account of attention to pain

Attention is a key concept in many theories of pain perception. A clinically popular idea is that pain is more intense in persons who are hypervigilant for or bias their attention to pain information. So far, evidence for such bias in pain patients as compared to healthy persons is inconclusive. Furthermore, studies investigating the effects of distracting attention away from pain have shown contradictory results. In this review, we present a motivational perspective on attentional processing of pain that accounts for these inconclusive research findings. We argue that pain always has to be considered within a context of goal pursuit. From this perspective, two largely unexplored theoretical assumptions are introduced. First, when pain occurs during the pursuit of a certain goal, it may unintentionally capture attention although it is not relevant for the goal. Whether such unintentional attentional capture happens is not only dependent upon the characteristics of the pain but also on the characteristics of the focal goal. Second, attention to pain and pain-related information might be driven by a focal goal related to pain. Attentional processing of pain information will be particularly enhanced when the focal goal is related to pain management (e.g., attempting to gain control). Future research should systematically investigate the role of motivation and goal pursuit in the attentional processing of pain-related information. This motivational perspective offers a powerful framework to explain inter- and intra-individual differences in the deployment of attention to pain-related information.

Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: invariant two-factor model across low back pain patients and fibromyalgia patients.

Objectives(1) To investigate the factor structure of the Tampa Scale for Kinesiophobia (TSK) in a Dutch-speaking sample of chronic low back pain (CLBP) patients using confirmatory factor analysis, (2) to examine whether the internal structure of the TSK extends to another group of fibromyalgia (FM) patients, and (3) to investigate the stability of the factor structure in both patient groups using multi-sample analysis. Patients and MethodsTSK-data from 8 studies collected in Dutch and Flemish chronic pain patients were pooled. For 188 CLBP patients and 89 FM patients, complete data were available. Confirmatory factor analyses were performed to assess 4 models of kinesiophobia, and to examine which factor model provided the best fit. Furthermore, a multi-sample analysis was performed to investigate the stability of the factor structure in both patient groups. ResultsFor both CLBP and FM patients, the 2-factor model containing the factors “activity avoidance” and “pathologic somatic focus” was superior as compared with the 4-factor model containing the factors “harm,” “fear of (re)injury.” “importance of exercise,” and “avoidance of activity”. Moreover, the 2-factor model was found to be invariant across CLBP and FM patients, indicating that this model is robust in both pain samples. DiscussionAs the 2-factor structure provided the best fit of the data in both patient samples, we recommend to use this version of the TSK and its 2 subscales in both clinical practice and research. Based on the content of the items, the subscales were labeled “Harm” and “Fear-avoidance.”

Does imminent threat capture and hold attention

According to models of attention and emotion, threat captures and holds attention. In behavioral tasks, robust evidence has been found for attentional holding but not for attentional capture by threat. An important explanation for the absence of attentional capture effects is that the visual stimuli used posed no genuine threat. The present study investigated whether visual cues that signal an aversive white noise can elicit attentional capture and holding effects. Cues presented in an attentional task were simultaneously provided with a threat value through an aversive conditioning procedure. Response latencies showed that threatening cues captured and held attention. These results support recent views on attention to threat, proposing that imminent threat captures attention in everyone.

Disengagement from pain: the role of catastrophic thinking about pain.

&NA; This paper reports an experimental investigation of attentional engagement to and disengagement from pain. Thirty‐seven pain‐free volunteers performed a cueing task in which they were instructed to respond to visual target stimuli, i.e. the words ‘pain’ and ‘tone’. Targets were preceded by pain stimuli or tone stimuli as cues. Participants were characterized as high or low pain catastrophizers, using self‐reports. We found that the effect of cueing upon target detection was differential for high and low pain catastrophizers. Analyses revealed a similar amount of attentional engagement to pain in both groups. However, we also found that participants high in pain catastrophizing had difficulty disengaging from pain, whereas participants low in pain catastrophizing showed no retarded disengagement from pain. Our results provide further evidence that catastrophic thinking enhances the attentional demand of pain, particularly resulting in difficulty disengaging from pain. The clinical implications of these findings are discussed.

Attentional bias to pain-related information: A meta-analysis

Summary Individuals who experience chronic pain display an attentional bias towards pain‐related words or pictures, but the bias is small and largely variable in effect. Abstract This meta‐analysis investigated whether attentional bias, that is, the preferential allocation of attention to information that is related to pain, is a ubiquitous phenomenon. We also investigated whether attentional bias effects are related to the methodological quality of the study, to procedural differences in their measurement, or to individual differences in pain severity, pain‐related fear, anxiety, and depression. Results indicated that individuals who experience chronic pain (n = 1023) display an attentional bias towards pain‐related words or pictures, but this bias was of a small effect size (d = 0.134), and did not differ from that in control groups (d = 0.082; n = 1398). No evidence was found for an attentional bias towards pain‐related words and pictures for acute pain (d = 0.049), procedural pain (d = 0.142), and experimental pain (d = 0.069). However, research in which attentional bias towards signals of impending experimental pain in healthy volunteers was investigated, revealed an attentional bias of medium effect size (d = 0.676). Moderator analyses in the chronic pain group identified important procedural variables that affected the presence and magnitude of an attentional bias towards pain‐related words and pictures, that is, type and exposure time of pain‐related information. None of the individual difference variables affected the magnitude of the attentional bias. Implications of current findings and future directions are discussed.