Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

  • Brandy Wolff
  • John W. Burns
  • Phillip J. Quartana
  • Kenneth Lofland
  • Stephen Bruehl
  • Ok Y. Chung


Catastrophizing about pain is related to elevated pain severity and poor adjustment among chronic pain patients, but few physiological mechanisms by which pain catastrophizing maintains and exacerbates pain have been explored. We hypothesized that resting levels of lower paraspinal muscle tension and/or lower paraspinal and cardiovascular reactivity to emotional arousal may: (a) mediate links between pain catastrophizing and chronic pain intensity; (b) moderate these links such that only patients described by certain combinations of pain catastrophizing and physiological indexes would report pronounced chronic pain. Chronic low back pain patients (N = 97) participated in anger recall and sadness recall interviews while lower paraspinal and trapezius EMG and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded. Mediation models were not supported. However, pain catastrophizing significantly interacted with resting lower paraspinal muscle tension to predict pain severity such that high catastrophizers with high resting lower paraspinal tension reported the greatest pain. Pain catastrophizing also interacted with SBP, DBP and HR reactivity to affect pain such that high catastrophizers who showed low cardiovascular reactivity to the interviews reported the greatest pain. Results support a multi-variable profile approach to identifying pain catastrophizers at greatest risk for pain severity by virtue of resting muscle tension and cardiovascular stress function.


Pain catastrophizing Chronic pain severity Lower paraspinal muscle tension Cardiovascular reactivity Profile approach 


  1. Arena, J. G., Sherman, R. A., Bruno, G. M., & Young, T. R. (1991). Electromyographic recordings of low back pain subjects and non-pain control is six different positions: Effects of pain levels. Pain, 45, 23–28.PubMedCrossRefGoogle Scholar
  2. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  3. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedGoogle Scholar
  4. Bragdon, E. E., Light, K. C., Costello, N. L., Sigurdsson, A., Bunting, S., Bhalang, K., & Maixner, W. (2002). Group differences in pain modulation: Pain-free women compared to pain-free men and to women with TMD. Pain, 96, 227–237.PubMedCrossRefGoogle Scholar
  5. Bruehl, S., Carlson, C. R., & McCubbin, J. A. (1992). The relationship between pain sensitivity and blood pressure in normotensives. Pain, 48, 463–467.PubMedCrossRefGoogle Scholar
  6. Bruehl, S., & Chung, O. Y. (2004). Interactions between the cardiovascular and pain regulatory systems: An updated review of mechanisms and possible alterations in chronic pain. Neuroscience and Biobehavioral Reviews, 28, 395–414.PubMedCrossRefGoogle Scholar
  7. Bruehl, S., Chung, O. Y., Ward, P., Johnson, B., & McCubbin, J. A. (2002). The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: The effects of opioid blockade. Pain, 100, 191–201.PubMedCrossRefGoogle Scholar
  8. Bruehl, S., McCubbin, J. A., & Wilson, J. F. (1994). Coping styles, opioid blockade, and cardiovascular response to stress. Journal of Behavioral Medicine, 17, 25–40.PubMedCrossRefGoogle Scholar
  9. Burns, J. W. (1995). Interactive effects of traits, states, and gender on cardiovascular reactivity during different situations. Journal of Behavioral Medicine, 18, 279–303.PubMedCrossRefGoogle Scholar
  10. Burns, J. W. (2006a). The role of attentional strategies in moderating links between acute pain induction and subsequent emotional stress: Evidence for symptom specific reactivity among chronic pain patients versus healthy nonpatients. Emotion, 6, 180–192.PubMedCrossRefGoogle Scholar
  11. Burns, J. W. (2006b). Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients. Emotion, 6, 309–319.PubMedCrossRefGoogle Scholar
  12. Burns, J. W., Bruehl, S., & Quartana, P. J. (2006). Anger management style and hostility among patients with chronic pain: Effects on symptom-specific physiological reactivity during anger- and sadness-recall interviews. Psychosomatic Medicine, 68, 786–793.PubMedCrossRefGoogle Scholar
  13. Burns, J. W., Kubilus, A., & Bruehl, S. (2003). Emotion induction moderates effects of anger. Management style on acute pain sensitivity. Pain, 106, 109–118.PubMedCrossRefGoogle Scholar
  14. Burns, J. W., Wiegner, S., & Derleth, M. (1997). Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models. Health Psychology, 16, 319–326.PubMedCrossRefGoogle Scholar
  15. Dimsdale, J. E., Stern, M. J., & Dillon, E. (1988). The stress interview as a tool for examining physiological reactivity. Psychosomatic Medicine, 50, 64–71.PubMedGoogle Scholar
  16. Edwards, L., McIntyre, D., Carroll, D., Ring, C., France, C. R., & Martin, U. (2003). Effects of artificial and natural baroreceptor stimulation on nociceptive responding and pain. Psychophysiolgy, 40, 762–769.CrossRefGoogle Scholar
  17. Edwards, L., Ring, C., McIntyre, D., & Carroll, D. (2001). Modulation of the human nociceptive flexion reflex across the cardiac cycle. Psychophysiology, 38, 712–718.PubMedCrossRefGoogle Scholar
  18. Edwards, R. R., & Fillingim, R. B. (2005). Styles of pain coping predict cardiovascular functioning following a cold pressor test. Pain Research and Management, 10, 219–222.PubMedGoogle Scholar
  19. Feldman, P. J., Cohen, S., Lepore, S. J., Matthews, K. A., Kamarck, T. W., Marsland, A. L. (1999). Negative emotions and acute physiological responses to stress. Annals of Behavioral Medicine, 21, 216–222.PubMedCrossRefGoogle Scholar
  20. Fields, H. L. (1987). Pain. New York: Raven.Google Scholar
  21. Flor, H., Birbaumer, N., Schugens, M. M., & Lutzenberger, W. (1992). Symptom- specific psychophysiological responses in chronic pain patients. Psychophysiology, 29, 452–460.PubMedCrossRefGoogle Scholar
  22. Flor, H., Birbaumer, N., Schulte, W., & Roos, R. (1991). Stress-related electromyographic responses in patients with chronic temporomandibular pain. Pain, 46, 145–152.PubMedCrossRefGoogle Scholar
  23. Flor, H., Turk, D. C., & Birbaumer, N. (1985). Assessment of stress-related psychophysiological reactions in chronic back pain patients. Journal of Consulting and Clinical Psychology, 53, 354–364.PubMedCrossRefGoogle Scholar
  24. Fridlund, A. J., & Cacioppo, J. T. (1986). Guidelines for human electromyographic research. Psychophysiology, 23, 567–589.PubMedCrossRefGoogle Scholar
  25. George, S. Z., Wallace, M. R., Wright, T. W., Moser, M. W., Greenfield, W. H. 3rd, Sack, B. K., Herbstman, D. M., & Fillingim, R. B. (in press) Evidence for a biopsychosocial influence on shoulder pain: Pain catastrophizing and catechol-O-methyltransferase (COMT) diplotype predict clinical pain ratings.Google Scholar
  26. Ghione, S. (1996). Hypertension-associated hypalgesia: Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences. Hypertension, 28, 494–504.PubMedGoogle Scholar
  27. Hirsh, A. T., George, S. Z., & Riley, J. L. (2007). An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire. European Journal of Pain, 11, 75–81.PubMedCrossRefGoogle Scholar
  28. Kamarck, T. W., Shiffman, S. M., Smithline, L., Goodie, J. L., Paty, J. A., Gnys, M., & Jong, J. Y. (1998). Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: Daily life consequences of recurring stress in a multiethnic adult sample. Health Psychology, 17, 17–29.PubMedCrossRefGoogle Scholar
  29. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The west Haven-Yale multidimensional pain inventory (WHYMPI). Pain, 23, 345–356.PubMedCrossRefGoogle Scholar
  30. Lundberg, U., Dohns, I. E., Melin, B., Sandsjo, L., Palmeund, G., Kadefors, R., Ekstron, M., & Parr, D. (1999). Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. Journal of Occupational Health Psychology, 4, 245–255.PubMedCrossRefGoogle Scholar
  31. Lundberg, U., Kadefors, R., Melin, B., Palmeund, G., Hassmen, P., Engstrom, M., & Dohns, I. E. (1994). Psychophysiological stress and EMG activity of the trapezius muscle. International Journal of Behavioral Medicine, 1, 354–370.PubMedCrossRefGoogle Scholar
  32. Mense, S. (1993). Nociception from skeletal muscle in relation to clinical muscle pain. Pain, 54, 241–289.PubMedCrossRefGoogle Scholar
  33. Michael, E. S., & Burns, J. W. (2004). Catastrophizing and pain sensitivity among chronic pain patients: Moderating effects of sensory and affect focus. Annals of Behavioral Medicine, 27, 185–194.PubMedCrossRefGoogle Scholar
  34. Neumann, S. A., & Waldstein, S. R. (2001). Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender. Journal of Psychosomatic Research, 50, 245–253.PubMedCrossRefGoogle Scholar
  35. Prkachin, K. M., Williams-Avery, R. M., Zwaal, C., & Mills, D. E. (1999). Cardiovascular changes during induced emotion: An application of Lang’s theory of emotional imagery. Journal of Psychosomatic Research, 47, 255–267.PubMedCrossRefGoogle Scholar
  36. Rau, H., & Elbert, T. (2001). Psychophysiology of arterial baroreceptors and the etiology of hypertension. Biological Psychiatry, 57, 179–201.CrossRefGoogle Scholar
  37. Seminowicz, D. A., & Davis, K. D. (2006). Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain, 120, 297–306.PubMedCrossRefGoogle Scholar
  38. Sjegaard, G., Lundberg, U., & Kudefors, R. (2000). The role of muscle activity and mental load in the development of pain and degenerative processes of the muscle cell level during computer work. European Journal of Applied Physiology, 83, 99–105.CrossRefGoogle Scholar
  39. Spanos, N. P., Radtke-Bodorik, L., Ferguson, J. D., & Jones, B. (1979). The effects of hypnotic susceptibility suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain. Journal of Abnormal Psychology, 3, 282–292.CrossRefGoogle Scholar
  40. Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRefGoogle Scholar
  41. Sullivan, M. J. L., & D’Eon, J. L. (1990). Relation between catastrophizing and depression in chronic pain patients. Journal of Abnormal Psychology, 99, 260–264.PubMedCrossRefGoogle Scholar
  42. Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17, 52–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Brandy Wolff
    • 1
  • John W. Burns
    • 1
  • Phillip J. Quartana
    • 1
  • Kenneth Lofland
    • 2
  • Stephen Bruehl
    • 3
  • Ok Y. Chung
    • 3
  1. 1.Department of PsychologyRosalind Franklin University of Medicine and ScienceNorth ChicagoUSA
  2. 2.Pain & Rehabilitation Clinic of ChicagoChicagoUSA
  3. 3.Vanderbilt University School of MedicineNashvilleUSA

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