Compelling evidence exists that non-Hispanic blacks (NHB) engage in pain catastrophizing (negatively evaluate one’s ability to cope with pain) more often than non-Hispanic whites (NHW). Functional neuroimaging studies revealed that individuals with high levels of trait pain catastrophizing show increased cerebral responses to pain in several pain-related brain regions (e.g., insula, primary somatosensory cortex [S1]), but associations between brain structure and catastrophizing remain largely unexplored. The current investigation was conducted at the University of Florida and the University of Alabama at Birmingham. Participants were 129 community-dwelling adults with or at risk of knee osteoarthritis (OA). Participants completed the pain catastrophizing subscale of the Coping Strategies Questionnaire-Revised and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain intensity subscale. Magnetic Resonance Imaging data were obtained. MANOVA and Chi-Square analyses assessed sociodemographic/clinical differences stratified by ethnicity/race. Multivariate regression analyses with insula and somatosensory cortical thickness entered as dependent variables with catastrophizing and the interaction between catastrophizing and ethnicity/race as the independent variables. Covariates include education, body mass index, study site, and WOMAC pain (ethnicity/race was an additional covariate in non-stratified analyses). There were significant interactions between ethnicity/race, pain catastrophizing, and brain structure. Higher pain catastrophizing was associated with thinner S1 bilaterally (ps < .05) in NHW, but not NHB participants with or at risk for knee OA. These results suggest that pain catastrophizing might have differing effects on pain-related central pathways and may contribute to ethnic/race group differences in individuals with or at risk for knee OA.
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Allen, K., Oddone, E., Coffman, C., Keefe, F., Lindquist, J., & Bosworth, H. (2010). Racial differences in osteoarthritis pain and function: Potential explanatory factors. Osteoarthritis and Cartilage, 18(2), 160–167.
Allen, K. D. (2010). Racial and ethnic disparities in osteoarthritis phenotypes. Current Opinion in Rheumatology, 22(5), 528–532.
Anderson, K. O., Green, C. R., & Payne, R. (2009). Racial and ethnic disparities in pain: Causes and consequences of unequal care. The Journal of Pain, 10(12), 1187–1204.
Apkarian, A. V., Bushnell, M. C., & Schweinhardt, P. (2013). Representation of pain in the brain. In M. S. B, Koltzenburg M, I. Tracey, & D. C. Turk (Eds.), Textbook of Pain (6 ed., pp. 111–128). London: Churchill Livingstone: Elsevier Saunders.
Apkarian, A. V., Sosa, Y., Sonty, S., Levy, R. M., Harden, R. N., Parrish, T. B., & Gitelman, D. R. (2004). Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience, 24(46), 10410–10415.
Apkarian, V., Bushnell, M. C., Treede, R.-D., & Zubieta, J.-K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9(4), 463–484.
Auvray, M., Myin, E., & Spence, C. (2010). The sensory-discriminative and affective-motivational aspects of pain. Neuroscience & Biobehavioral Reviews, 34(2), 214–223.
Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology, 15(12), 1833–1840.
Bierke, S., & Petersen, W. (2017). Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: A prospective study. Archives of Orthopaedic and Trauma Surgery, 137(12), 1735–1742.
Bishop, S. R., & Warr, D. (2003). Coping, catastrophizing and chronic pain in breast cancer. Journal of Behavioral Medicine, 26(3), 265–281.
Burchard, E. G., Ziv, E., Coyle, N., Gomez, S. L., Tang, H., Karter, A. J., Mountain, J. L., Pérez-Stable, E. J., Sheppard, D., & Risch, N. (2003). The importance of race and ethnic background in biomedical research and clinical practice. New England Journal of Medicine, 348(12), 1170–1175.
Campbell, C. M., Buenaver, L. F., Finan, P., Bounds, S. C., Redding, M., McCauley, L., Robinson, M., Edwards, R. R., & Smith, M. T. (2015). Sleep, pain catastrophizing, and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care & Research, 67(10), 1387–1396.
Cleveland, W. S., & Devlin, S. J. (1988). Locally weighted regression: An approach to regression analysis by local fitting. Journal of the American Statistical Association, 83(403), 596–610.
Craig, A. D., & Craig, A. (2009). How do you feel--now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1).
Cruz-Almeida, Y., Sibille, K. T., Goodin, B. R., Petrov, M. E., Bartley, E. J., Riley, J. L., et al. (2014). Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis & Rheumatology, 66(7), 1800–1810.
Dominick, K. L., & Baker, T. A. (2003). Racial and ethnic differences in osteoarthritis: Prevalence, outcomes, and medical care. Ethnicity & Disease, 14(4), 558–566.
Edwards, C. L., Fillingim, R. B., & Keefe, F. (2001). Race, ethnicity and pain. Pain, 94(2), 133–137.
Edwards, R. R., Bingham 3rd, C. O., Bathon, J., & Haythornthwaite, J. A. (2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis and Rheumatism, 55(2), 325–332.
Edwards, R. R., & Fillingim, R. B. (1999). Ethnic differences in thermal pain responses. Psychosomatic Medicine, 61(3), 346–354.
Fairhurst, M., Wiech, K., Dunckley, P., & Tracey, I. (2007). Anticipatory brainstem activity predicts neural processing of pain in humans. Pain, 128(1), 101–110.
Fischl, B. (2012). FreeSurfer. NeuroImage, 62(2), 774–781.
Fischl, B., & Dale, A. M. (2000). Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proceedings of the National Academy of Sciences, 97(20), 11050–11055.
Fischl, B., Salat, D. H., Busa, E., Albert, M., Dieterich, M., Haselgrove, C., et al. (2002). Whole brain segmentation: Automated labeling of neuroanatomical structures in the human brain. Neuron, 33(3), 341–355.
Fischl, B., Salat, D. H., Van Der Kouwe, A. J., Makris, N., Ségonne, F., Quinn, B. T., & Dale, A. M. (2004a). Sequence-independent segmentation of magnetic resonance images. NeuroImage, 23, S69–S84.
Fischl, B., Van Der Kouwe, A., Destrieux, C., Halgren, E., Ségonne, F., Salat, D. H., et al. (2004b). Automatically parcellating the human cerebral cortex. Cerebral Cortex, 14(1), 11–22.
Geisser, M. E., Robinson, M. E., Keefe, F. J., & Weiner, M. L. (1994). Catastrophizing, depression and the sensory, affective and evaluative aspects of chronic pain. Pain, 59(1), 79–83.
Gracely, R. H., Geisser, M. E., Giesecke, T., Grant, M. A., Petzke, F., Williams, D. A., & Clauw, D. J. (2004). Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain, 127(4), 835–843.
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., et al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277–294.
Gwilym, S. E., Filippini, N., Douaud, G., Carr, A. J., & Tracey, I. (2010). Thalamic atrophy associated with painful osteoarthritis of the hip is reversible after arthroplasty: A longitudinal voxel-based morphometric study. Arthritis and Rheumatism, 62(10), 2930–2940.
Han, X., Jovicich, J., Salat, D., van der Kouwe, A., Quinn, B., Czanner, S., et al. (2006). Reliability of MRI-derived measurements of human cerebral cortical thickness: The effects of field strength, scanner upgrade and manufacturer. NeuroImage, 32(1), 180–194.
Hastie, B. A., Riley 3rd, J. L., & Fillingim, R. B. (2004). Ethnic differences in pain coping: Factor structure of the coping strategies questionnaire and coping strategies questionnaire-revised. Journal of Pain, 5(6), 304–316.
Iacobucci, D., Schneider, M. J., Popovich, D. L., & Bakamitsos, G. A. (2016). Mean centering helps alleviate “micro” but not “macro” multicollinearity. Behavior Research Methods, 48(4), 1308–1317.
Jacoby, W. G. (2000). Loess: a nonparametric, graphical tool for depicting relationships between variables. Electoral Studies, 19(4), 577–613.
Jekel, J. F., Katz, D. L., Elmore, J. G., & Wild, D. (2007). Epidemiology, biostatistics and preventive medicine: Elsevier health sciences.
Jensen, M. P., Keefe, F. J., Lefebvre, J. C., Romano, J. M., & Turner, J. A. (2003). One-and two-item measures of pain beliefs and coping strategies. Pain, 104(3), 453–469.
Kim, H., Kim, J., Loggia, M. L., Cahalan, C., Garcia, R. G., Vangel, M. G., Wasan, A. D., Edwards, R. R., & Napadow, V. (2015). Fibromyalgia is characterized by altered frontal and cerebellar structural covariance brain networks. NeuroImage: Clinical, 7, 667–677.
Klein, A., & Tourville, J. (2012). 101 labeled brain images and a consistent human cortical labeling protocol. Frontiers in Neuroscience, 6, 171.
Knudsen, L., Petersen, G. L., Nørskov, K. N., Vase, L., Finnerup, N., Jensen, T. S., & Svensson, P. (2011). Review of neuroimaging studies related to pain modulation. Scandinavian Journal of Pain, 2(3), 108–120.
Kraus, V. B., Blanco, F. J., Englund, M., Karsdal, M. A., & Lohmander, L. S. (2015). Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis and Cartilage, 23(8), 1233–1241.
Kuperberg, G. R., Broome, M. R., McGuire, P. K., David, A. S., Eddy, M., Ozawa, F., et al. (2003). Regionally localized thinning of the cerebral cortex in schizophrenia. Archives of General Psychiatry, 60(9), 878–888.
Lazaridou, A., Kim, J., Cahalan, C. M., Loggia, M. L., Franceschelli, O., Berna, C., et al. (2017). Effects of cognitive-behavioral therapy (CBT) on brain connectivity supporting catastrophizing in fibromyalgia. The Clinical Journal of Pain, 33(3), 215–221.
Martin, M. Y., Bradley, L. A., Alexander, R. W., Alarcón, G. S., Triana-Alexander, M., Aaron, L. A., & Alberts, K. R. (1996). Coping strategies predict disability in patients with primary fibromyalgia. Pain, 68(1), 45–53.
Meints, S. M., Miller, M. M., & Hirsh, A. T. (2016). Differences in pain coping between black and white Americans: A meta-analysis. The Journal of Pain, 17(6), 642–653.
Meints, S. M., Stout, M., Abplanalp, S., & Hirsh, A. T. (2017). Pain-related rumination, but not magnification or helplessness, mediates race and sex differences in experimental pain. The Journal of Pain, 18(3), 332–339.
Melzack, R., & Casey, K. L. (1968). Sensory, motivational, and central control determinants of pain. A new conceptual model. In D. R. Kenshalo (Ed.), The skin senses (pp. 423–443). Springfield, IL: Charles C. Thomas.
Peyron, R., Laurent, B., & García-Larrea, L. (2000). Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiologie Clinique = Clinical Neurophysiology, 30(5), 263–288.
Rahim-Williams, B., Riley, J. L., Williams, A. K., & Fillingim, R. B. (2012). A quantitative review of ethnic group differences in experimental pain response: Do biology, psychology, and culture matter? Pain Medicine, 13(4), 522–540.
Reuter, M., Schmansky, N. J., Rosas, H. D., & Fischl, B. (2012). Within-subject template estimation for unbiased longitudinal image analysis. NeuroImage, 61(4), 1402–1418.
Rodriguez-Raecke, R., Niemeier, A., Ihle, K., Ruether, W., & May, A. (2009). Brain gray matter decrease in chronic pain is the consequence and not the cause of pain. Journal of Neuroscience, 29(44), 13746–13750.
Rosas, H., Liu, A., Hersch, S., Glessner, M., Ferrante, R., Salat, D., et al. (2002). Regional and progressive thinning of the cortical ribbon in Huntington’s disease. Neurology, 58(5), 695–701.
Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain, 17(1), 33–44.
Roux, C. H., Saraux, A., Mazieres, B., Pouchot, J., Morvan, J., Fautrel, B., et al. (2008). Screening for hip and knee osteoarthritis in the general population: Predictive value of a questionnaire and prevalence estimates. Annals of the Rheumatic Diseases, 67(10), 1406–1411.
Salat, D. H., Buckner, R. L., Snyder, A. Z., Greve, D. N., Desikan, R. S., Busa, E., et al. (2004). Thinning of the cerebral cortex in aging. Cerebral Cortex, 14(7), 721–730.
Seminowicz, D. A., Shpaner, M., Keaser, M. L., Krauthamer, G. M., Mantegna, J., Dumas, J. A., Newhouse, P. A., Filippi, C. G., Keefe, F. J., & Naylor, M. R. (2013). Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. The Journal of Pain, 14(12), 1573–1584.
Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality (complete samples). Biometrika, 52(3/4), 591–611.
Shavers, V. L., Bakos, A., & Sheppard, V. B. (2010). Race, ethnicity, and pain among the US adult population. Journal of Health Care for the Poor and Underserved, 21(1), 177–220.
Sheffield, D., Biles, P. L., Orom, H., Maixner, W., & Sheps, D. S. (2000). Race and sex differences in cutaneous pain perception. Psychosomatic Medicine, 62(4), 517–523.
Shelby, R. A., Somers, T. J., Keefe, F. J., Pells, J. J., Dixon, K. E., & Blumenthal, J. A. (2008). Domain specific self-efficacy mediates the impact of pain catastrophizing on pain and disability in overweight and obese osteoarthritis patients. The Journal of Pain, 9(10), 912–919.
Somers, T. J., Keefe, F. J., Pells, J. J., Dixon, K. E., Waters, S. J., Riordan, P. A., et al. (2009). Pain catastrophizing and pain-related fear in osteoarthritis patients: Relationships to pain and disability. Journal of Pain and Symptom Management, 37(5), 863–872.
Theiler, R., Spielberger, J., Bischoff, H., Bellamy, N., Huber, J., & Kroesen, S. (2002). Clinical evaluation of the WOMAC 3.0 OA index in numeric rating scale format using a computerized touch screen version. Osteoarthritis and Cartilage, 10(6), 479–481.
Treede, R. D., Kenshalo, D. R., Gracely, R. H., & Jones, A. K. (1999). The cortical representation of pain. Pain, 79(2–3), 105–111.
Vaughn, I. A., Terry, E. L., Bartley, E. J., Schaefer, N., & Fillingim, R. B. (2019). Racial-ethnic differences in osteoarthritis pain and disability: A meta-analysis. The Journal of Pain, 20(6), 629–644.
Vickers, A. J. (2005). Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC Medical Research Methodology, 5(1), 35.
Vina, E., Ran, D., Ashbeck, E., & Kwoh, C. (2018). Natural history of pain and disability among African–Americans and whites with or at risk for knee osteoarthritis: A longitudinal study. Osteoarthritis and Cartilage, 26(4), 471–479.
Vlaeyen, J. W. S., Timmermans, C., Rodriguez, L.-M., Crombez, G., van Horne, W., Ayers, G. M., Albert, A., & Wellens, H. J. J. (2004). Catastrophic thinking about pain increases discomfort during internal atrial cardioversion. Journal of Psychosomatic Research, 56(1), 139–144.
Wade, J. B., Riddle, D. L., Price, D. D., & Dumenci, L. (2011). Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain. PAIN®, 152(2), 314–319.
The authors would like to thank the research team that made this work possible: Ralisa Pop and Eric Weber.
This study was funded and supported by NIH Grants R37AG033906 (R.B.F.), T32AG049673 and K22NS102334 (E.L.T.), R01AG054370 (K.T.S.), CTSA Grants UL1TR001427 (UF) and UL1TR001417 (UAB) from the NIH Center for Advancing Translational Sciences. Support was also provided by UF McKnight Brain Institute Career Enhancement Award (E.L.T.).
Conflict of interest
All authors declare that there are no conflicts of interest with this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at the University of Florida and University of Alabama at Birmingham 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.
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Terry, E.L., Tanner, J.J., Cardoso, J.S. et al. Associations of pain catastrophizing with pain-related brain structure in individuals with or at risk for knee osteoarthritis: Sociodemographic considerations. Brain Imaging and Behavior (2020). https://doi.org/10.1007/s11682-020-00372-w
- Pain Catastrophizing
- Knee osteoarthritis
- Knee pain
- Cortical thickness