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The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: a preliminary, cross-sectional analysis

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Abstract

Purpose

In the fear-avoidance model (FAM) of chronic pain, pain-related fear is one of the most prominent predictors of negative adjustment outcomes. While existing data point to the effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear, the nature of their multivariate relationships remains unclear. This study explored the possible mediating role of pain hypervigilance in the relationship of anxiety sensitivity and pain catastrophizing with pain-related fear, and their effects on quality of life (QoL) outcomes within the FAM framework.

Methods

A sample of 401 Chinese patients with chronic musculoskeletal pain completed the standardized measures assessing the FAM components and QoL. Structural equation modeling (SEM) was used to evaluate six hypothesized models.

Results

Results of SEM showed adequate data-model fit [comparative fit indexes (CFIs) ranging from 0.92 to 0.94] on models which specified pain hypervigilance as mediator of anxiety sensitivity and pain catastrophizing with pain-related fear on two QoL outcomes (QoL-Physical and QoL-Mental). Results consistent with net suppression effects of pain catastrophizing on anxiety sensitivity were found in SEM when both anxiety sensitivity and pain catastrophizing were included in the same full model to predict QoL-Physical (CFI = 0.95; Sobel z = 8.06, p < 0.001) and QoL-Mental (CFI = 0.93; Sobel z = 8.31, p < 0.001).

Conclusions

These cross-sectional analyses gave results consistent with pain hypervigilance, mediating the relationship of pain catastrophic cognition and anxiety sensitivity with pain-related fear. The net suppression effects of pain catastrophizing point to anxiety sensitivity, enhancing the effect of pain catastrophic cognition on pain hypervigilance. These findings elucidate how the interdependence of dispositional factors might influence pain adjustment and functioning.

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Acknowledgement

This project was supported by Hong Kong Research Grants Council’s General Research Fund (Project #: 150810) awarded to the first author (W.S. Wong). The authors would like to acknowledge support from the Pain Unit of three public hospitals in Hong Kong: the Alice Ho Mui Ling Nethersole Hospital, the Queen Elizabeth Hospital, and the United Christian Hospital. We also thank all patients for their participation in the project.

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Authors and Affiliations

  1. Department of Psychological Studies, Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, Hong Kong SAR

    W. S. Wong & H. M. J. Lam

  2. Department of Anesthesiology and Operating Services, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR

    Y. F. Chow & Steven Wong

  3. Department of Anesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR

    P. P. Chen

  4. Department of Anesthesiology, Pain Medicine and Operating Services, United Christian Hospital, Kowloon, Hong Kong SAR

    H. S. Lim

  5. School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR

    R. Fielding

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  1. W. S. Wong
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Correspondence to W. S. Wong.

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Wong, W.S., Lam, H.M.J., Chow, Y.F. et al. The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: a preliminary, cross-sectional analysis. Qual Life Res 23, 2333–2341 (2014). https://doi.org/10.1007/s11136-014-0683-y

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