Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity

  • R. Kathryn McHughEmail author
  • Elizabeth T. Kneeland
  • Robert R. Edwards
  • Robert Jamison
  • Roger D. Weiss


Exposure to stress is associated with poor outcomes in people with chronic pain. Dispositional variables, such as pain catastrophizing and distress intolerance, may impact reactivity to stressors. Importantly, these variables can be modified with treatment. The aim of this study was to investigate whether pain catastrophizing and distress intolerance were associated with tolerance of a pain stressor or a psychosocial stressor, and heightened negative affect following these stressors. A sample of 50 adults with chronic pain completed self-report measures and pain and psychosocial stress inductions. Results indicated that pain catastrophizing was associated with heightened anxiety during pain induction. Distress intolerance was associated with negative affect following a psychosocial stressor, and with poorer tolerance of the psychosocial stressor. Pain catastrophizing and distress intolerance are related factors, however, they exhibit distinct associations with amplification of pain and psychosocial stress reactivity. These variables may be important treatment targets in people with chronic pain.


Chronic pain Pain catastrophizing Distress intolerance Stress reactivity Opioids 



This study was funded by the National Institute on Drug Abuse (Grant Numbers DA034102 and DA035297).

Compliance with ethical standards

Conflict of interest

Dr. Weiss has been a consultant to Indivior, Alkermes, Braeburn Pharmaceuticals, GW Pharmaceuticals, US World Meds, Janssen Pharmaceuticals and Daiichi Sankyo. Drs. McHugh, Kneeland, Edwards and Jamison report no potential conflicts of interest relevant to this manuscript.

Human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Bornovalova, M. A., Gratz, K. L., Daughters, S. B., Hunt, E. D., & Lejuez, C. W. (2012). Initial RCT of a distress tolerance treatment for individuals with substance use disorders. Drug and Alcohol Dependence, 122, 70–76. CrossRefGoogle Scholar
  2. Cruz-Almeida, Y., & Fillingim, R. B. (2014). Can quantitative sensory testing move us closer to mechanism-based pain management? Pain Medicine, 15, 61–72. CrossRefGoogle Scholar
  3. Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in etiology and maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143–163). New York, NY, US: Guilford Press.Google Scholar
  4. Edwards, R. R., Dolman, A. J., Michna, E., Katz, J. N., Nedeljkovic, S. S., Janfaza, D., et al. (2016a). Changes in pain sensitivity and pain modulation during oral opioid treatment: The impact of negative affect. Pain Medicine, 17, 1882–1891.CrossRefGoogle Scholar
  5. Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016b). The role of psychosocial processes in the development and maintenance of chronic pain. Journal of Pain, 17, 70–92. CrossRefGoogle Scholar
  6. Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics, 76, 226–233.CrossRefGoogle Scholar
  7. Harrington, N. (2005a). It’s too difficult! Frustration intolerance beliefs and procrastination. Personality and Individual Differences, 39, 873–883.CrossRefGoogle Scholar
  8. Harrington, N. (2005b). The Frustration Discomfort Scale: Development and psychometric properties. Clinical Psychology and Psychotherapy., 12, 374–387.CrossRefGoogle Scholar
  9. Hübscher, M., Moloney, N., Leaver, A., Rebbeck, T., McAuley, J. H., & Refshauge, K. M. (2013). Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis. Pain, 154, 1497–1504. CrossRefGoogle Scholar
  10. Kahler, C. W., McHugh, R. K., Metrik, J., Spillane, N. S., & Rohsenow, D. J. (2012). Breath holding duration and self-reported smoking abstinence intolerance as predictors of smoking lapse behavior in a laboratory analog task. Nicotine & Tobacco Research, 15, 1151–1154. CrossRefGoogle Scholar
  11. Kjøgx, H., Kasch, H., Zachariae, R., Svensson, P., Jensen, T. S., & Vase, L. (2016). Experimental manipulations of pain catastrophizing influence pain levels in patients with chronic pain and healthy volunteers. Pain, 157, 1287–1296. CrossRefGoogle Scholar
  12. Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136, 576–600. CrossRefGoogle Scholar
  13. Linton, S. J. (2000). A review of psychological risk factors in back and neck pain. Spine, 25, 1148–1156.CrossRefGoogle Scholar
  14. Marcuzzi, A., Dean, C. M., Wrigley, P. J., & Hush, J. M. (2015). Early changes in somatosensory function in spinal pain: A systematic review and meta-analysis. Pain, 156, 203–214. CrossRefGoogle Scholar
  15. Martel, M. O., Dolman, A. J., Edwards, R. R., Jamison, R. N., & Wasan, A. D. (2014). The association between negative affect and prescription opioid misuse in patients with chronic pain: The mediating role of opioid craving. The Journal of Pain, 15, 90–100. CrossRefGoogle Scholar
  16. Martel, M. O., Wasan, A. D., Jamison, R. N., & Edwards, R. R. (2013). Catastrophic thinking and increased risk for prescription opioid misuse in patients with chronic pain. Drug and Alcohol Dependence, 132, 335–341. CrossRefGoogle Scholar
  17. McHugh, R. K., Kertz, S. J., Weiss, R. B., Baskin-Sommers, A. R., Hearon, B. A., & Björgvinsson, T. (2014). Changes in distress intolerance and treatment outcome in a partial hospital setting. Behavior Therapy, 45, 232–240. CrossRefGoogle Scholar
  18. McHugh, R. K., & Otto, M. W. (2011). Domain-general and domain-specific strategies for the assessment of distress intolerance. Psychology of Addictive Behaviors, 25, 745–749. CrossRefGoogle Scholar
  19. McHugh, R. K., & Otto, M. W. (2012a). Refining the measurement of distress intolerance. Behavior Therapy, 43, 641–651. CrossRefGoogle Scholar
  20. McHugh, R. K., & Otto, M. W. (2012b). Profiles of distress intolerance in a substance-dependent sample. The American Journal of Drug and Alcohol Abuse, 38, 161–165. CrossRefGoogle Scholar
  21. McHugh, R. K., Weiss, R. D., Cornelius, M., Martel, M. O., Jamison, R. N., & Edwards, R. R. (2016). Distress intolerance and prescription opioid misuse among patients with chronic pain. The Journal of Pain, 17, 806–814. CrossRefGoogle Scholar
  22. Meints, S. M., Wang, V., & Edwards, R. R. (2018). Sex and race differences in pain sensitization among patients with chronic low back pain. Journal of Pain, 19, 1461–1470. CrossRefGoogle Scholar
  23. Nock, M. K., & Mendes, W. B. (2008). Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76, 28–38. CrossRefGoogle Scholar
  24. Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index- revised manual. Worthington, OH: International Diagnostic Systems Publishing Corporation.Google Scholar
  25. Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23, 183–192.CrossRefGoogle Scholar
  26. Schmidt, N. B., Richey, J. A., & Fitzpatrick, K. K. (2006). Discomfort intolerance: Development of a construct and measure relevant to panic disorder. Journal of Anxiety Disorders, 20, 263–280.CrossRefGoogle Scholar
  27. Severeijns, R., Vlaeyen, J. W., van den Hout, M. A., & Weber, W. E. (2001). Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical Journal of Pain, 17, 165–172.CrossRefGoogle Scholar
  28. Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83–102.CrossRefGoogle Scholar
  29. Sirota, A. D., Rohsenow, D. J., MacKinnon, S. V., Martin, R. A., Eaton, C. A., Kaplan, G. B., et al. (2010). Intolerance for Smoking Abstinence Questionnaire: Psychometric properties and relationship to tobacco dependence and abstinence. Addictive Behaviors, 35, 686–693. CrossRefGoogle Scholar
  30. Strong, D. R., Lejeuz, C. W., Daughters, S., Marinello, M., Kahler, C. W., & Brown, R. A. (2003). The computerized mirror tracing task, version 1 (Unpublished manual).Google Scholar
  31. Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRefGoogle Scholar
  32. Taub, C. J., Sturgeon, J. A., Johnson, K. A., Mackey, S. C., & Darnall, B. D. (2017). Effects of a pain catastrophizing induction on sensory testing in women with chronic low back pain: A pilot study. Pain Research and Management. Google Scholar
  33. Terry, E. L., Thompson, K. A., & Rhudy, J. L. (2015). Experimental reduction of pain catastrophizing modulates pain report but not spinal nociception as verified by mediation analyses. Pain, 156, 1477–1488. CrossRefGoogle Scholar
  34. Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: Similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157, 2434–2444.CrossRefGoogle Scholar
  35. Vachon-Presseau, E., Martel, M. O., Roy, M., Caron, E., Albouy, G., Marin, M. F., et al. (2013). Acute stress contributes to individual differences in pain and pain-related brain activity in healthy and chronic pain patients. Journal of Neuroscience, 33, 6826–6833. CrossRefGoogle Scholar
  36. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.CrossRefGoogle Scholar
  37. Zvolensky, M. J., Vujanovic, A. A., Bernstein, A., & Leyro, T. (2010). Distress tolerance: Theory, measurement, and relations to psychopathology. Current Directions in Psychological Science, 19, 406–410.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • R. Kathryn McHugh
    • 1
    • 2
    Email author
  • Elizabeth T. Kneeland
    • 1
    • 2
  • Robert R. Edwards
    • 3
    • 4
  • Robert Jamison
    • 3
    • 4
  • Roger D. Weiss
    • 1
    • 2
  1. 1.Division of Alcohol and Drug AbuseMcLean HospitalBelmontUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Pain Management CenterBrigham and Women’s HospitalBostonUSA
  4. 4.Department of AnesthesiologyHarvard Medical SchoolBostonUSA

Personalised recommendations