This study examined the relationship between several cognitive-affective factors of the fear-avoidance model of pain, the big five model of personality, and functional impairment in fibromyalgia (FM). Seventy-four FM patients completed the NEO Five-Factor Inventory, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale-20, the Pain Vigilance and Awareness Questionnaire, and the Impairment and Functioning Inventory. Results indicated that the cognitive-affective factors of pain are differentially associated with personality traits. Neuroticism and conscientiousness were significant predictors of pain catastrophizing, and neuroticism, openness, and agreeableness were significant predictors of pain anxiety. Personality traits did not contribute significantly to vigilance to pain. The effect of neuroticism upon pain anxiety was mediated by pain catastrophizing, and neuroticism showed a trend to moderate the relationship between impairment and pain anxiety. Results support the fear-avoidance model of pain. Implications of the findings for the understanding and management of FM are discussed.
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Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. rev.). Washington, DC: APA (Spanish translation: Barcelona, Masson, 2002).
Anderberg, U. A., Forsgren, T., Ekselius, L., Marteinsdottir, I., & Hallman, J. (1999). Personality traits on the basis of the temperament and character inventory in female fibromyalgia syndrome patients. Nordic Journal of Psychiatry, 53, 353–359.
Asghari, A., & Nicholas, M. K. (2006). Personality and pain-related beliefs/coping strategies: A prospective study. Clinical Journal of Pain, 22, 10–18.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychology research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Bazzichi, L., Rossi, A., Massimetti, G., Giannaccini, G., Giuliano, T., De Feo, F., et al. (2007). Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clinical Experimental Rheumatology, 25, 225–230.
Branco, J. C., Bannwarth, B., Failde, I., Abello, C. J., Blotman, F., Spaeth, M., et al. (2010). Prevalence of fibromyalgia: A survey in five European countries. Seminars in Arthritis and Rheumatism, 39, 448–453.
Brosschot, J. F., & Aarsse, H. R. (2001). Restricted emotional processing and somatic attributions in fibromyalgia. International Journal of Psychiatry and Medicine, 31, 127–146.
Buckelew, S. P., Murray, S. E., Hewett, J. E., Johnson, J., & Huyser, B. (1995). Self-efficacy, pain and physical activity among fibromyalgia subjects. Arthritis and Rheumatism, 8, 43–50.
Burckhardt, C. S., Jones, K. D., & Clark, S. R. (1998). Soft tissue problems associated with rheumatic disease. Lippincott’s Primary Care Practice, 2, 20–29.
Carver, C. S., & Scheier, M. F. (2000). Perspectives on personality (4th ed.). Needham Heights, MA: Simon & Schuster.
Cook, A. J., Brawer, P. A., & Vowles, K. E. (2006). The fear-avoidance model of chronic pain: Validation and age analysis using structural equation modeling. Pain, 121, 195–206.
Costa, P. T., & McCrae, R. R. (1992). NEO-PI-R, Revised NEO Personality Inventory and NEO Five-Factor Inventory (NEO-FFI). Psychological Assessment Resources, Inc. Odessa, FL, (Spanish version: Madrid, TEA Ediciones, 2002).
Cox, B. J., Kuch, K., Parker, J. D., Shulman, I. D., & Evans, R. J. (1994). Alexithymia in somatoform disorder patients with chronic pain. Journal of Psychosomatic Research, 38, 523–527.
Crombez, G., Eccleston, C., Van den Broeck, A., Goubert, L., & Van Houdenhove, B. (2004). Hypervigilance to pain in fibromyalgia: The mediating role of pain intensity and catastrophic thinking about pain. Clinical Journal of Pain, 20, 98–102.
Dadabhoy, D., Crofford, L. J., Spaeth, M., Russell, I. J., & Clauw, D. J. (2008). Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome. Arthritis Research and Therapy, 10:211. doi:10.1186/ar2443.
De Gucht, V., Fischler, B., & Heiser, W. (2004). Neuroticism, alexithymia, negative affect, and positive affect as determinants of medically unexplained symptoms. Personality and Individual Differences, 36, 1655–1667.
García-Campayo, J., Pascual, A., Alda, M., & González-Ramírez, M. T. (2007). Coping with fibromyalgia: Usefulness of the Chronic Pain Coping Inventory-42. Pain, 132, S68–S76.
Gerritsen, L., Geerlings, M. I., Bremmer, M. A., Beekman, A. T. F., Deeg, D. J. H., Penninx, B. W. J. H., et al. (2009). Personality characteristics and hypothalamic-pituitary-adrenal axis regulation in older persons. American Journal of Geriatric Psychiatry, 17, 1077–1084.
Glombiewski, J. A., Sawyer, A. T., Gutermann, J., Koenig, K., Rief, W., & Hofmann, S. G. (2010). Psychological treatments for fibromyalgia: A meta-analysis. Pain, 151, 280–295.
Goubert, L., Crombez, G., & Van Damme, S. (2004). The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: A structural equations approach. Pain, 107, 234–241.
Hassett, A. I., Cone, J., Patella, S. J., & Sigal, L. H. (2000). The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. Arthritis and Rheumatism, 43, 2493–2500.
Herrero, A. M., Ramírez-Maestre, C., & González, V. (2008). Personality, cognitive appraisal and adjustment in chronic pain patients. Spanish Journal of Psychology, 11, 531–542.
Jerram, K. L., & Coleman, P. G. (1999). The big five personality traits and reporting of health problems and health behaviour in old age. British Journal of Health Psychology, 4, 181–192.
Johnson, M. (2003). The vulnerability status of neuroticism: Over-reporting or genuine complaints? Personality and Individual Differences, 35, 877–887.
Jose, P. E. (2003). MedGraph-I: A programme to graphically depict mediation among three variables: The internet version, version 2.0. Victoria University of Wellington, Wellington, New Zealand. Retrieved from http://www.victoria.ac.nz/staff/paul-jose-files/medgraph/medgraph.php.
Jose, P. E. (2008). ModGraph-I: A programme to compute cell means for the graphical display of moderational analyses: The internet version, Version 2.0. Victoria University of Wellington, Wellington, New Zealand. Retrieved from: http://www.victoria.ac.nz/psyc/staff/paul-jose-files/modgraph/modgraph.php.
Kristensen, A. S., Mortensen, E. L., & Mors, O. (2009). The association between bodily anxiety symptom dimensions and the scales of the revised NEO Personality Inventory and the Temperament and Character Inventory. Comprehensive Psychiatry, 50, 38–47.
Lachaine, J., Beauchemin, C., & Landry, P.-A. (2010). Clinical and economic characteristics of patients with fibromyalgia syndrome. Clinical Journal of Pain, 26, 284–290.
Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64, 241–256.
Lauver, S. C., & Johnson, J. L. (1997). The role of neuroticism and social support in older adults with chronic pain behavior. Personality and Individual Differences, 23, 165–167.
Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., et al. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis and Rheumatism, 58, 26–35.
Lázaro, C., Caseras, X., Whizar-Lugo, V. M., Wenk, R., Baldioceda, F., Bernal, R., et al. (2001). Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries. Clinical Journal of Pain, 17, 365–374.
Lazarus, R. S., & Folkman, S. (1984). Stress appraisal and coping. New York: Springer.
Lee, J. E. (2009). The psychology of pain: The influence of personality on experimentally-induced pain perception. Dissertation Abstracts International: Section B: The Sciences and Engineering, 70, 1348.
Lee, E.-J., Wu, M.-Y., Lee, G. K., Cheing, G., & Chan, F. (2008). Catastrophizing as a cognitive vulnerability factor related to depression in workers’ compensation patients with chronic musculoskeletal pain. Journal of Clinical Psychology in Medical Settings, 15, 182–192.
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30, 77–94.
Lohnberg, J. A. (2007). A review of outcome studies on cognitive-behavioural therapy for reducing fear-avoidance beliefs among individuals with chronic pain. Journal of Clinical Psychology in Medical Settings, 14, 113–122.
Malt, E. A., Olafsson, S., Lund, A., & Ursin, H. (2002). Factors explaining variance in perceived pain in women with fibromyalgia. BMC Musculoskeletal Disorders, 3, 12. doi:10.1186/1471-2474-3-12.
Manga, D., Ramos, F., & Morán, C. (2004). The Spanish norms of the NEO five-factor inventory: New data and analyses for its improvement. International Journal of Psychology and Psychological Therapy, 4, 639–648.
Marques, A. P., Assumpção, A., Matsutani, L. A., Pereira, C. A. B., & Lage, L. (2008). Pain in fibromyalgia and discriminative power of the instruments: Visual analog scale, dolorimetry and the McGill Pain Questionnaire. Acta Reumatologica Portuguesa, 33, 345–351.
Masedo, A. I., & Esteve, R. (2000). Some empirical evidence regarding the validity of the Spanish version of the McGill Pain Questionnaire (MPQ-SV). Pain, 85, 451–456.
Mcallister, M. J. (2000). The unvanquished: Prevalence of moral masochistic personality characteristics in persons with fibromyalgia. Dissertation Abstracts International Section B: The Sciences and Engineering, 61, 540.
McCracken, L. M. (1997). ‘Attention’ to pain in persons with chronic pain: A behavioural approach. Behaviour Therapy, 28, 271–284.
McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): Preliminary development and validity. Pain Research and Management, 7, 45–50.
Melzack, R. (1987). The short form McGill Pain Questionnaire. Pain, 30, 191–197.
Miró, E., Lupiáñez, J., Hita, E., Martínez, M. P., Sánchez, A. I., & Buela-Casal, G. (2011). Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints. Psychology and Health, 26, 765–780.
Muris, P., Meesters, C., Van den Hout, A., Wessels, S., Franken, I., & Rassin, E. (2007). Personality and temperament correlates of pain catastrophizing in young adolescents. Child Psychiatry and Human Development, 38, 171–181.
Neumann, L., & Buskila, D. (2003). Epidemiology of fibromyalgia. Current Pain and Headache Reports, 7, 362–368.
Nicassio, P. M., Schuman, C., Radojevic, V., & Weisman, M. H. (1999). Helplessness as a mediator of health status in fibromyalgia. Cognitive, Therapy and Research, 23, 181–196.
Nishikai, M., Tomomatsu, S., Hankins, R. W., Takagi, S., Miyachi, K., Kosaka, S., et al. (2001). Autoantibodies to a 68/48 kDa protein in chronic fatigue syndrome and primary fibromyalgia: A possible marker for hypersomnia and cognitive disorders. Rheumatology, 40, 806–810.
Nitch, S. R., & Boone, K. B. (2004). Normal personality correlates of chronic pain subgroups. Journal of Clinical Psychology in Medical Settings, 11, 203–209.
Osman, A., Barrios, F. X., Gutierrez, P. M., Kopper, B. A., Merrifield, T., & Grittman, L. (2000). The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. Journal of Behavioral Medicine, 23, 351–365.
Paine, P., Kishor, J., Worthen, S. F., Gregory, L. J., & Aziz, Q. (2009). Exploring relationships for visceral and somatic pain with autonomic control and personality. Pain, 144, 236–244.
Pamuk, O. N., & Cakir, N. (2007). The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms. Clinical Rheumatology, 26, 55–59.
Pérez-Pareja, J., Sesé, A., González-Ordi, H., & Palmer, A. (2010). Fibromyalgia and chronic pain: Are there discriminating patterns by using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)? International Journal of Clinical and Health Psychology, 10, 41–56.
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9, 745–758.
Ramírez-Maestre, C., Esteve, R., & López, A. E. (2008). Cognitive appraisal and coping in chronic pain patients. European Journal of Pain, 12, 749–756.
Ramírez-Maestre, C., López-Martínez, A. E., & Esteve-Zaragoza, R. (2004). Personality characteristics as differential variables of the pain experience. Journal of Behavioral Medicine, 27, 147–165.
Ramírez-Maestre, C., & Valdivia, Y. (2003). Evaluación del funcionamiento diario en pacientes con dolor crónico [Evaluation of daily functioning in patients with chronic pain]. Psicología Conductual, 11, 283–291.
Roelofs, J., McCracken, L., Peters, M. L., Crombez, G., van Breukelen, G., & Vlaeyen, J. W. S. (2004). Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients. Journal of Behavioral Medicine, 27, 167–183.
Roelofs, J., Peters, M. L., McCracken, L., & Vlaeyen, J. W. S. (2003). The Pain Vigilance and Awareness Questionnaire (PVAQ): Further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain, 101, 299–306.
Ross, R. L., Jones, K. D., Bennett, R. M., Ward, R. L., Druker, B. J., & Wood, L. J. (2010). Preliminary evidence of increased pain and elevated cytokines in fibromyalgia patients with defective growth hormone response to exercise. Open Immunology Journal, 3, 9–18.
Sánchez, A. I., Martínez, M. P., Miró, E., & Medina, A. (2011). Predictors of the pain perception and self-efficacy for pain control in patients with fibromyalgia. Spanish Journal of Psychology, 14, 366–373.
Sayar, K., Gulec, H., & Topbas, M. (2004). Alexithymia and anger in patients with fibromyalgia. Clinical Rheumatology, 23, 441–448.
Schneider, M. J. (1995). Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: A need for clarity in terminology and differential diagnosis. Journal of Manipulative and Physiological Therapeutics, 18, 398–406.
Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17, 52–64.
Thorn, B. E., Clements, K. L., Ward, L. C., Dixon, K. E., Kersh, B. C., Boothby, J. L., et al. (2004). Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain. Clinical Journal of Pain, 20, 275–282.
Trygg, T., Lundberg, G., Rosenlund, E., Timpka, T., & Bjorn, G. (2002). Personality characteristics of women with fibromyalgia and of women with chronic neck, shoulder, or low back complaints in terms of Minnesota Multiphasic Personality Inventory and defense mechanisms technique modified. Journal of Musculoskeletal Pain, 10, 33–55.
Turk, D. C., Robinson, J. P., & Burwinkle, T. (2004). Prevalence of fear of pain and activity in patients with fibromyalgia syndrome. Journal of Pain, 5, 483–490.
Turner, J. A., & Aaron, L. A. (2001). Pain-related catastrophizing: What is it? Clinical Journal of Pain, 17, 65–71.
Vearing, A., & Mak, A. S. (2007). Big five personality and effort-reward imbalance factors in employee’s depressive symptoms. Personality and Individual Differences, 43, 1744–1755.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.
Watson, D., & Casillas, A. (2003). Neuroticism: Adaptive and maladaptive features. In E. C. Chang & L. J. Sanna (Eds.), Virtue, vice, and personality: The complexity of behavior (pp. 145–161). Washington, DC: American Psychological Association.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62, 600–610.
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennet, R. M., Bombardier, C., Goldenberg, D. L., et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism, 33, 160–172.
This study is part of a broader research project financially supported by the Spanish ministry of science and innovation (research project PSI2009-13765PSIC). The authors wish to thank AGRAFIM (Association of People Affected with FM in Granada, Spain) for its cooperation in the study.
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Martínez, M.P., Sánchez, A.I., Miró, E. et al. The Relationship Between the Fear-Avoidance Model of Pain and Personality Traits in Fibromyalgia Patients. J Clin Psychol Med Settings 18, 380–391 (2011). https://doi.org/10.1007/s10880-011-9263-2
- Pain catastrophizing
- Pain anxiety
- Vigilance to pain