Personality and temperament correlates of pain catastrophizing in young adolescents

A matter of personality and point of view: How the interplay of reinforcement sensitivity and general attitudes towards pain impacts the responsivity to acute pain

BACKGROUND

The relatively stable individual differences reflected in Grey's revised reinforcement sensitivity theory (rRST), with foundations in neurophysiology and learning theory, appear particularly applicable to the study of pain. However, remarkably little research has been conducted in this area. In acute pain, activation of the behavioural approach system (BAS), the behavioural inhibition system (BIS) and the fight, flight, freezing system might depend on an individual's evaluation of pain. It was thus hypothesised that higher-order interactions of rRST traits and pain attitudes affect pain responsiveness.

METHODS

To investigate relationships between rRST traits and pain attitudes and to identify patterns between clusters of participants, we conducted a study in which N = 275 healthy participants filled in Reuter and Montag's rRST-Q and the General Attitudes Towards Pain Inventory (GATPI). Experimental (pressure, electrical, thermal) and self-report data of pain responsiveness were collected in a subsample (N = 113).

RESULTS

We found significant correlations between rRST-Q and GATPI subscales of up to r = 0.34. Two clusters were identified, significantly differing in rRST-Q and GATPI scores. Pain avoiders, characterized by high BIS, flight, freezing and negative pain attitudes, were found to be significantly more pain sensitive than pain approachers, characterized by high BAS, fight and positive pain attitudes. Moderate effects (d = 0.56 to d = 0.70) were demonstrated in subjective and objective measures and across pain modalities.

CONCLUSIONS

The present study expands the scientific knowledge on factors influencing pain responsiveness. Future research is needed to confirm implications for chronic pain prevention and therapy, particularly concerning pain avoiders.

SIGNIFICANCE

We have identified two clusters of participants, pain avoiders and pain approachers, that not only present differential patterns of revised reinforcement theory traits and general attitudes towards pain but also differ in their pain responsiveness. Pain avoiders appeared more pain sensitive compared to pain approachers, both in objective and subjective measurements, with implications for the improvement of chronic pain prevention and therapy.

Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious Youth

A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.

Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study

Background

Despite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited.

Methods

This observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State‐Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain‐free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes‐, neuropathy‐ and pain‐related), the socio‐economic and the cognitive factors (catastrophizing).

Results

The study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety.

Conclusions

In addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals.

Significance

In large cohorts of well‐defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.

More Insight on the Role of Personality Traits and Sensitivity to Experimental Pain

Purpose

The present study aimed to assess the influence of personality traits on the variability of sensitivity to pain in two distinct groups of healthy subjects with low versus high sensitivity to pain (LSP vs HSP, respectively).

Methods

Healthy subjects (n=156) were allocated to two groups according to their tolerability to cold stimulation (cold pressor test, CPT, 1°C). Group LSP (n=76) reached the cut-off time of 180±0 sec, and a size matched group of HSP (n=80) tolerated the CPT for an average of 10.5±3.4 sec only. Subjects from both groups completed the self-reported pain sensitivity questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Neuroticism Extraversion Openness - Five Factor Inventory (NEO-FFI).

Results

In comparison to the LSP group, HSP individuals had higher scores of PSQ (p<0.001), catastrophizing (p=0.001), and extraversion (p=0.01). By adjusting for age and gender, mediation analyses revealed that catastrophizing mediated the relationship between neuroticism and pain sensitivity, both in the allocation of subjects to a certain group of sensitivity to pain (LSP or HSP, B=0.02 95% CI: 0.006–0.040) and in the PSQ score (B=0.01 95% CI: 0.001–0.023).

Conclusion

These results, which were demonstrated by two different prisms (CPT and PSQ), point to the potential of the five-factor inventory and pain catastrophizing scale as tools for identifying specific personality traits associated with a high sensitivity to pain.

Longitudinal Impact of Parental Catastrophizing on Child Functional Disability in Pediatric Amplified Pain

Objective

Children with amplified musculoskeletal pain (AMPS) experience significant functional disability, with impairment in their ability to participate in age-appropriate activities of daily living. Parental factors play an important role in a child’s pain symptoms and treatment outcomes, with parental pain catastrophizing and protective behaviors linked to several maladaptive outcomes for children. Aims of the current study were to examine how parental pain catastrophizing, child pain catastrophizing, and parental protective behaviors longitudinally impacted functional disability for children with AMPS.

Methods

Archival data were examined from parent-child dyads presenting to a tertiary pain clinic for treatment of AMPS. Over 1 year, parents completed measures assessing the level of pain catastrophizing, common behavioral responses to child pain, and child functional disability. Children completed measures of pain catastrophizing and functional disability. Measures were collected at initial evaluation, 6-months, and 12-months. Latent growth models (LGM) were conducted to examine how to study variables longitudinally impacted the rate of change in child functional disability.

Results

Examining a comprehensive LGM of study variables, parental catastrophizing emerged as the sole contributing factor to slower improvement in functional disability.

Conclusions

The strong influence of parental pain catastrophizing on functional disability may relate to parents limiting behaviors that promote adaptive coping in children with pain. As such, parents who catastrophize may benefit from specific interventions to increase their use of adaptive behavioral responses, such as redirecting children to complete functional activities and encouraging the use of positive coping skills for pain-related distress.

Understanding Pain Catastrophizing: Putting Pieces Together

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.

Stressful Events and Temperament Change during Early and Middle Adolescence: The TRAILS Study

This project investigates how stressful events are related to deviations from normative temperament development during adolescence. Temperament traits were assessed at ages 11 and 16 years. Life–event data was captured using an interview (total n = 1197). Normative changes were found in all traits. A linear trend was found between the experience of stressful events and temperament development. Adolescents exposed to stressful events showed smaller decreases in fear and shyness, stronger decreases in effortful control and affiliation and smaller increases in high intensity pleasure. Exposure to stressful events was related to increases in frustration instead of decreases. Our results show that whereas normative development is mostly in the direction of maturation, adolescents who experienced stressful events showed less maturation of their temperament. Copyright © 2011 John Wiley & Sons, Ltd.

The effect of pediatric patient temperament on postoperative outcomes

BACKGROUND

Research has improved practitioner awareness of the impact of individual characteristics on responses to painful procedures. However, there is little data relating preexisting temperament profiles and postsurgical/anesthesia outcomes in pediatric patients. In particular, it is not clear how best to identify which patients are at risk of poor postsurgical outcomes.

AIM

In this prospective study, we examined relationships between preoperative measures of child temperament and postoperative pain/behavioral outcomes of children undergoing tonsillectomy/adenoidectomy surgeries. We sought to determine which temperament profiles were predictive of poor outcomes.

METHODS

After IRB approval and informed consent, validated temperament surveys were administered to the parents of a cohort of children undergoing tonsillectomy/adenoidectomy surgery. These data were combined with preoperative, intraoperative, and postoperative outcome measures collected from the electronic medical record utilizing a large integrated anesthesia outcome database. The dataset was further augmented with surveys addressing remote postoperative behaviors. Analysis of the temperament data yielded four groups (positive, negative, excitable, and inhibitory). The probability of high perioperative pain, agitation, emesis, and postoperative behavior changes based on cluster membership was then assessed.

RESULTS

A total of 260 patients undergoing tonsillectomy and/or adenoidectomy surgeries were enrolled in the study. ANOVA and chi-squared analyses indicated no statistically significant age, gender, or anesthesia technique differences across the four temperament clusters. Temperament cluster membership was not related to emesis, agitation, or behavioral changes. However, it was found to be predictive of high postoperative pain. Members of the excitable cluster (high positive and negative emotionality) were more likely to report high pain than those in positive cluster (high positive, low negative emotionality) (OR 7.97, 95% CI: 1.62-39.26; P < 0.05). Comparisons among other clusters were not significant.

CONCLUSION

Our data indicate that preoperative temperament characteristics may differentially influence pediatric postoperative pain experience in children. Specifically, children with high levels of positive and negative emotionality may exhibit more postsurgical pain behaviors.

The behavioural inhibition system, behavioural activation system and experiential avoidance as explanatory variables of comorbid chronic pain and posttraumatic stress symptoms

Background: The variables that underlie comorbid chronic pain and posttraumatic stress symptoms (PTSS) are not yet clearly established. Objective: The aim of the present study was to analyse the role of the behavioural inhibition system (BIS), behavioural approach system (BAS) and experiential avoidance (EA) in pain adjustment (i.e. pain intensity, daily functioning and pain-related impairment) in patients with chronic pain and PTSS. Methods: A battery of instruments was administered to 388 chronic pain patients. The sample was divided into those with PTSS (n = 194) and those without PTSS (n =194). Results: Significant differences were found between groups in the BIS, EA, impairment and daily functioning. No differences were found between groups in the BAS. Structural equation modelling showed that the BIS and EA were associated with worse adjustment in the 194 patients with both chronic pain and PTSS. The BAS was associated with a lower level of pain and greater daily functioning. Conclusion: The findings provide evidence that BIS and BAS activation and EA play a role in adjustment to chronic pain in patients with concurrent PTSS. These results may help guide the development of psychological treatments for patients with both conditions.

Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ²/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.

Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain

BACKGROUND AND AIMS

Trait behavioral inhibition represents a tendency to react with negative emotions - primarily worry - to cues which signal potential threats. This tendency has been hypothesized by a two-factor model of chronic pain to have direct effects on psychological and physical function in individuals with chronic pain, as well as to influence the associations between pain-related maladaptive cognitions and function. Our aim was to test these hypothesized associations in a sample of individuals who were being screened for possible interdisciplinary chronic pain treatment.

METHODS

Eighty-eight patients referred to an interdisciplinary chronic pain management program were administered measures of average pain intensity, trait behavioral inhibition, kinesiophobia, pain catastrophizing, depressive symptoms, and pain interference. We then performed two linear regression analyses to evaluate the direct effects of trait behavioral inhibition on depressive symptoms and pain interference and the extent to which behavioral inhibition moderated the associations between kinesiophobia and pain catastrophizing, and the criterion variables.

RESULTS

In partial support of the study hypotheses, the results showed significant (and independent) direct effects of trait behavioral inhibition on depressive symptoms, and behavioral inhibition moderated the association between kinesiophobia and depression, such that there were stronger associations between kinesiophobia and depressive symptoms in those with higher dispositional sensitivity to fear-inducing stimuli. However, neither direct nor moderating effects of behavioral inhibition emerged in the prediction of pain interference.

CONCLUSIONS

If replicated in additional studies, the findings would indicate that chronic pain treatments which target both reductions in maladaptive cognitions (to decrease the direct negative effects of these on depressive symptoms) and the individual's tendency to respond to pain with worry (as a way to buffer the potential effects of maladaptive cognitions on depressive symptoms) might be more effective than treatments that targeted only one of these factors.

IMPLICATIONS

Additional research is needed to further evaluate the direct and moderating effects of pain-related behavioral inhibition on function, as well as the extent to which treatments which target behavioral inhibition responses provide benefits to individuals with chronic pain.

Lower inhibitory control interacts with greater pain catastrophizing to predict greater pain intensity in women with migraine and overweight/obesity

BACKGROUND

Pain catastrophizing (PC) is associated with more severe and disabling migraine attacks. However, factors that moderate this relationship are unknown. Failure of inhibitory control (IC), or the ability to suppress automatic or inappropriate responses, may be one such factor given previous research showing a relationship between higher PC and lower IC in non-migraine samples, and research showing reduced IC in migraine. Therefore, we examined whether lower IC interacts with increased PC to predict greater migraine severity as measured by pain intensity, attack frequency, and duration.

METHODS

Women (n = 105) aged 18-50 years old (M = 38.0 ± 1.2) with overweight/obesity and migraine who were seeking behavioral treatment for weight loss and migraine reduction completed a 28-day smartphone-based headache diary assessing migraine headache severity. Participants then completed a modified computerized Stroop task as a measure of IC and self-report measures of PC (Pain Catastrophizing Scale [PCS]), anxiety, and depression. Linear regression was used to examine independent and joint associations of PC and IC with indices of migraine severity after controlling for age, body mass index (BMI) depression, and anxiety.

RESULTS

Participants on average had BMI of 35.1 ± 6.5 kg/m²and reported 5.3 ± 2.6 migraine attacks (8.3 ± 4.4 migraine days) over 28 days that produced moderate pain intensity (5.9 ± 1.4 out of 10) with duration of 20.0 ± 14.2 h. After adjusting for covariates, higher PCS total (β = .241, SE = .14, p = .03) and magnification subscale (β = .311, SE = .51, p < .01) scores were significant independent correlates of longer attack duration. IC interacted with total PCS (β = 1.106, SE = .001, p = .03) rumination (β = 1.098, SE = .001, p = .04), and helplessness (β = 1.026, SE = .001, p = .04) subscale scores to predict headache pain intensity, such that the association between PC and pain intensity became more positive at lower levels of IC.

CONCLUSIONS

Results showed that lower IC interacted with higher PC, both overall and specific subcomponents, to predict higher pain intensity during migraine attacks. Future studies are needed to determine whether interventions to improve IC could lead to less painful migraine attacks via improvements in PC.

Pain perception and EEG dynamics: does hypnotizability account for the efficacy of the suggestions of analgesia?

We report novel findings concerning the role of hypnotizability, suggestions of analgesia and the activity of the Behavioral Inhibition/Activation System (BIS/BAS) in the modulation of the subjective experience of pain and of the associated EEG dynamics. The EEG of high (highs) and low hypnotizable participants (lows) who completed the BIS/BAS questionnaire was recorded during basal conditions, tonic nociceptive stimulation without (PAIN) and with suggestions for analgesia (AN). Participants scored the perceived pain intensity at the end of PAIN and AN. The EEG midline dynamics was characterized by indices indicating the signal predictability (Determinism) and complexity (Entropy) obtained through the Recurrence Quantification Analysis. The reduced pain intensity reported by highs during AN was partially accounted for by the activity of the Behavioral Activation System. The decreased midline cortical Determinism observed during nociceptive stimulation in both groups independently of suggestions remained significantly reduced only in lows after controlling for the activity of the Behavioral Activation System. Finally, controlling for the activity of the Behavioral Inhibition System abolished stimulation, suggestions and hypnotizability-related differences. Results indicate that the BIS/BAS activity may be more important than hypnotizability itself in pain modulation and in the associated EEG dynamics.

Safety climate, hardiness, and musculoskeletal complaints: a mediated moderation model

This study explores the mechanisms linking the psychosocial characteristics of the workplace with employees' work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees' reports of musculoskeletal discomforts. Results from an employee sample supported that when employees' perceived safety was considered a priority, they experienced less frustration and reported fewer work-related upper body musculoskeletal symptoms. Psychological hardiness, a personality trait that is indicative of individuals' resilience and success in managing stressful circumstances, moderated these relationships. Interestingly, employees with high hardiness were more affected by poor safety climate.

The association between catastrophizing and craving in patients with chronic pain prescribed opioid therapy: a preliminary analysis

BACKGROUND

A growing number of studies have shown that opioid craving (i.e., the perceived need or desire to consume opioids) is one of the strongest determinants of prescription opioid misuse in patients with chronic pain prescribed opioid therapy. To date, however, the factors that are associated with craving in patients with pain remain largely unexplored. Based on previous research, there is reason to believe that catastrophizing might be associated with heightened opioid craving.

OBJECTIVES

To test the hypothesis that catastrophizing would be associated with heightened craving in patients with chronic pain prescribed long-term opioid therapy.

DESIGN AND SUBJECTS, AND METHODS

In this cross-sectional study, 109 patients with chronic pain were asked to provide self-reports of catastrophizing and craving. Patients also provided self-reports of pain intensity and depressive symptoms.

RESULTS

We found that higher levels of catastrophizing were associated with higher levels of craving. Importantly, results of a regression analysis revealed that the association between catastrophizing and craving remained significant even after controlling for a host of demographic (i.e., age, sex), psychological (i.e., depressive symptoms), medical (i.e., pain intensity, pain duration), and medication regimen (i.e., opioid doses) variables.

CONCLUSIONS

Our preliminary findings provide valuable new insights into the determinants of craving in patients with pain. The finding that catastrophizing was associated with craving even after controlling for a host of demographic, psychological, medical, and medication regimen variables is particularly striking, and raises questions concerning the factors that underlie the association between catastrophizing and craving in patients prescribed opioid therapy.

Behavioral approach system activity and self-reported somatic symptoms in fibromyalgia: an exploratory study

The first objective was to investigate the behavioural activity in the systems of Gray's theory; these are the Behavioural Inhibition System (BIS) and Behavioural Approach System (BAS), in fibromyalgia (FM) patients. The second aim was to assess in FM patients whether there is an association between BIS or BAS with self-reported somatic symptoms. Twenty FM patients and 20 healthy controls completed questionnaire measures of BIS and BAS activity (Sensitivity to Punishment and Sensitivity to Reward Questionnaire), self-reported somatic symptoms (Somatic Symptoms Scale Revised), positive and negative affect (Positive and Negative Affect Schedule) and health status (EuroQoL Visual Analogue Scale). The results showed that FM patients had lower Sensitivity to Reward (SR) scores than controls. The SR score correlated with different somatic symptoms groups. The partial correlation (controlling for other variables measured) showed that the SR score correlated specifically with musculoskeletal symptoms. Furthermore, in regression analysis, SR score significantly predicted musculoskeletal symptoms, after controlling for other variables measured in this study. Our findings suggest that FM patients show BAS hypoactivity. This BAS activity in FM is similar to patients with depression, where a lower BAS functioning has also been found. The BAS activity predicts the musculoskeletal self-reported symptoms in FM better than other measures included in this study. Although this is a preliminary study, it suggests the importance of BAS activity in FM.

Management of chronic pain with chronic opioid therapy in patients with substance use disorders

Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.

The German Pain Catastrophizing Scale for Children (PCS-C) - psychometric analysis and evaluation of the construct

Objective: The Pain Catastrophizing Scale, adapted for children (PCS-C) by Crombez et al. (2003), was translated into German (SKS-D) and evaluated regarding its factorial structure, its reliability and validity. The association of catastrophizing with various pain characteristics and disability measures was examined as well as its association to neighboring constructs.

Method: The paper-and-pencil version of the SKS-D was used in two different samples of children and adolescents. Analyses were conducted on a subgroup of participants from an epidemiological sample [n=898; age: M=12.9 (SD=1.4)] who had experienced monthly headaches in the 6-months period before and a clinical sample [n=60; age: M=12.6 (SD=0.8)] seeking treatment for recurrent headaches.

Results: Exploratory factor analysis (PCA) suggested a one-factor model in contrast to the 3-factor model suggested by Crombez et al. (2003). The unidimensional scale showed distinct homogeneity and satisfying reliability. The clinical sample showed significantly higher scores than the epidemiological group. Also girls scored higher than boys. The catastrophizing explained a considerable amount of variance in pain and disability parameters in both samples thus underlining its validity.

The psychological variables internalising, anxiety sensitivity and somatosensory amplification showed significant small to moderate associations with pain catastrophizing and also with pain and disability. After controlling for the above mentioned psychological variables, catastrophizing still yielded an independent contribution to the explanation of variance in pain and disability parameters.

Conclusions: The PCS-C in its German form is a valid and reliable instrument for assessing catastrophizing in children with recurrent pain, in particular headache, in the age of 10–16 years. Pain catastrophizing is suggested to be assessed especially in pediatric pain patients as it is a significant moderator of pain and disability. In children with a distinct tendency to catastrophize cognitive restructuring should become a target of pediatric pain therapy, as a reduction of catastrophizing cognitions may indirectly help to ameliorate pain and disability.

Interactive contributions of self-regulation deficits and social motivation to psychopathology: unraveling divergent pathways to aggressive behavior and depressive symptoms

Poor self-regulation has been implicated as a significant risk factor for the development of multiple forms of psychopathology. This research examined the proposition that self-regulation deficits differentially predict aggressive behavior and depressive symptoms, depending on children's social approach versus avoidance motivation. A prospective, multiple-informant approach was used to test this hypothesis in 419 children (M age = 8.92, SD = 0.36). Parents rated children's inhibitory control. Children completed measures of social approach-avoidance motivation and depressive symptoms. Teachers rated children's aggressive behavior. As anticipated, poor inhibitory control predicted aggressive behavior in boys with high but not low approach motivation and low but not high avoidance motivation, whereas poor inhibitory control predicted depressive symptoms in girls with high but not low avoidance motivation. This research supports several complementary theoretical models of psychopathology and provides insight into the differential contributions of poor self-regulation to maladaptive developmental outcomes. The findings suggest the need for targeted intervention programs that consider heterogeneity among children with self-regulatory deficits.

A Neuropsychological Model of Mentally Tough Behavior

Four studies were conducted with two primary objectives: (a) to conceptualize and measure mental toughness from a behavioral perspective and (b) to apply relevant personality theory to the examination of between-person differences in mentally tough behavior. Studies 1 (N = 305 participants from a range of different sports) and 2 (N = 110 high-level cricketers) focused on the development of an informant-rated mental toughness questionnaire that assessed individual differences in ability to maintain or enhance performance under pressure from a wide range of stressors. Studies 3 (N = 214) and 4 (N = 196) examined the relationship between reinforcement sensitivities and mentally tough behavior in high-level cricketers. The highest levels of mental toughness reported by coaches occurred when cricketers were sensitive to punishment and insensitive to reward. Study 4 suggested that such players are predisposed to identify threatening stimuli early, which gives them the best possible opportunity to prepare an effective response to the pressurized environments they encounter. The findings show that high-level cricketers who are punishment sensitive, but not reward sensitive, detect threat early and can maintain goal-directed behavior under pressure from a range of different stressors.

Pediatric fear-avoidance model of chronic pain: foundation, application and future directions

The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child⁄adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child⁄adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.

Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety

OBJECTIVE

Anxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA), is associated with pain-related anxiety.

METHODS

One hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI) of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20). Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS). The Beck Depression Inventory (BDI) was used to control for the influence of depression on the personality measurement.

RESULTS

The HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales.

CONCLUSION

Harm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.

Noncardiac chest pain in children and adolescents: a biopsychosocial conceptualization

Pediatric NCCP may be characterized by recurrent pain accompanied by emotional distress and functional impairment. This paper reviews and critiques literature on pediatric noncardiac chest pain (NCCP) and introduces a theoretical conceptualization to guide future study of NCCP in children and adolescents. A developmentally informed biopsychosocial conceptualization of NCCP etiology is proposed based on a synthesis of empirical evidence and clinical observations of pediatric NCCP within the context of relevant findings from the broader pediatric pain and anxiety literature. Multiple factors from biological, psychological, social, familial, and developmental domains are potentially relevant to the etiology of this ailment. This article concludes with directions for future research and clinical implications.

Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal x emotion regulation model

We examined whether people who tend to catastrophize about pain and who also attempt to regulate negative thoughts and feelings through suppression may represent a distinct subgroup of individuals highly susceptible to pain and distress. Ninety-seven healthy normal participants underwent a 4-min ischemic pain task followed by a 2-min recovery period. Self-reported pain and distress was recorded during the task and every 20 s during recovery. Participants completed the Pain Catastrophizing Scale and the White Bear Suppression Inventory. Repeated measures multiple regression analysis (using General Linear Model procedures) revealed significant 3-way interactions such that participants scoring high on the rumination and/or helplessness subscales of the Pain Catastrophizing Scale and who scored high on the predisposition to suppress unwanted thoughts and feelings reported the greatest pain and distress during recovery. Results suggest that pain catastrophizers who attempt to regulate their substantial pain intensity and distress with maladaptive emotion regulation strategies, such as suppression, may be especially prone to experience prolonged recovery from episodes of acute pain. Thus, emotion regulation factors may represent critical variables needed to understand the full impact of catastrophic appraisals on long-term adjustment to pain.

Hippocampal volume is positively associated with behavioural inhibition (BIS) in a large community-based sample of mid-life adults: the PATH through life study

The fields of personality research and neuropsychology have developed with very little overlap. Gray and McNaughton were among the first to recognize that personality traits must have neurobiological correlates and developed models relating personality factors to brain structures. Of particular note was their description of associations between conditioning, inhibition and activation of behaviours, and specific neural structures such as the hippocampus, amygdala and the prefrontal cortex. The aim of this study was to determine whether personality constructs representing the behavioural inhibition and activation systems (BIS/BAS) were associated with volumetric measures of the hippocampus and amygdala in humans. Amygdalar and hippocampal volumes were measured in 430 brain scans of cognitively intact community-based volunteers. Linear associations between brain volumes and the BIS/BAS measures were assessed using multiple regression, controlling for age, sex, education, intra-cranial and total brain volume. Results showed that hippocampal volumes were positively associated with BIS sensitivity and to a lesser extent with BAS sensitivity. No association was found between amygdalar volume and either the BIS or BAS. These findings add support to the model of Gray and McNaughton, which proposes a role of the hippocampus in the regulation of defensive/approach behaviours and trait anxiety but suggest an absence of associations between amygdala volume and BIS/BAS measures.