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The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling

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Abstract

Background

Previous research on the fear-avoidance model (FAM) of chronic pain suggests that the personality traits of neuroticism and negative affect (NA) influence pain catastrophizing. However, the mechanisms of their influence on pain catastrophizing remain unclear.

Purpose

This study examined four possible models of relationships between neuroticism, NA, and pain catastrophizing within the FAM framework using structural equation modeling.

Method

A total of 401 patients with chronic musculoskeletal pain completed measures of neuroticism, NA, three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety), and adjustment outcomes (pain-related disability and depression).

Results

Regression analyses refuted the possibility that neuroticism and NA moderated each other’s effect on pain catastrophic thoughts (p > 0.05). Results of structural equation modeling (SEM) evidenced superior data-model fit for the collapsed models in which neuroticism and NA were two secondary traits underlying a latent construct, negative emotion (disability: comparative fit index (CFI) = 0.93; depression: CFI = 0.91).

Conclusion

The results offer preliminary evidence that patients presenting with more neurotic symptom and heightened NA probably elicit more catastrophic thoughts about pain.

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Acknowledgments

This project was supported by Hong Kong Research Grants Council’s General Research Fund (Project no. 150810) awarded to the first author (WS 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.

Declaration

This study conformed to the Helsinki Declaration concerning human rights and informed consent, and it also followed correct procedures concerning treatment of humans and animals in research.

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Authors and Affiliations

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

    W. S. Wong & H. M. J. Lam

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

    P. P. Chen

  3. Department of Anesthesiology and Operating Services, Queen Elizabeth Hospital, Kowloon, Hong Kong, China

    Y. F. Chow & S. Wong

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

    H. S. Lim

  5. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    M. P. Jensen

  6. Health Behaviours Research Group, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong, China

    R. Fielding

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  1. W. S. Wong
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  2. H. M. J. Lam
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  3. P. P. Chen
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  4. Y. F. Chow
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  5. S. Wong
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Correspondence to W. S. Wong.

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Wong, W.S., Lam, H.M.J., Chen, P.P. et al. The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling. Int.J. Behav. Med. 22, 118–131 (2015). https://doi.org/10.1007/s12529-014-9413-7

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