Pain anxiety differentially mediates the association of pain intensity with function depending on level of intolerance of uncertainty
Abstract
Uncertainty about symptom duration, cause, prognosis and treatment is common in patients who seek medical care, yet individual ability to manage this uncertainty varies. Intolerance of uncertainty is considered an important factor in the etiology and persistence of negative emotions- in particular, depression and anxiety. We explored the contribution of intolerance of uncertainty to anxiety due to pain and physical function in patients seeking care at an orthopedic medical practice. Participants (N = 105, mean age of 51 ± 17, 63% male) were administered PROMIS Physical Function v1.2 Upper Extremity CAT, Numerical Rating Scale (NRS), Pain Anxiety Symptoms Scale-short form (PASS-20), and the Intolerance of Uncertainty Scale-short version (IUS-12). Results showed that the mediating role of pain anxiety is contingent upon the level of intolerance of uncertainty. Specifically, a minimum level of intolerance of uncertainty is required for the development of pain anxiety and its effect on function, and as intolerance of uncertainty rises from low to medium to high levels, the effect of pain on function goes from being independent of the anxiety to being more and more carried by and through anxiety about pain. These findings support the contention that intolerance of uncertainty plays a crucial role in the relationship between pain, pain anxiety, and physical function. Intolerance of uncertainty appears to be a trans-diagnostic target for coping skills training.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Mediation is frequently examined in cross-sectional studies in which hypotheses are driven by theoretical information.
“However, mediation is frequently examined in cross-sectional studies [13, 33] in which hypotheses are driven by theoretical information, similar to this study.”
From What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients? (2019) · cites this paper as [13]
A study of patients consulting orthopaedic surgeons found that intolerance of uncertainty is important in the relationship among pain, pain anxiety, and physical function.
“A study of patients consulting orthopaedic surgeons found that intolerance of uncertainty is important in the relationship among pain, pain anxiety, and physical function [13].”
From What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients? (2019) · cites this paper as [13]
Cites
Required sample size to detect the mediated effect
Fritz, M. S., & MacKinnon, D. P. (2007) · Psychological Science · doi:10.1111/j.1467-9280.2007.01882.x · Cited by 4,810 · see citing works
Fearing the unknown: A short version of the Intolerance of Uncertainty Scale
Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.03.014 · Cited by 2,288 · see citing works
Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective
Grupe, D. W., & Nitschke, J. B. (2013) · Nature Reviews Neuroscience · doi:10.1038/nrn3524 · Cited by 2,007 · see citing works
Outline of a fear-avoidance model of exaggerated pain perception--I.
Lethem, J., Slade, P. D., Troup, J. D. G., & Bentley, G. (1983) · Behaviour Research and Therapy · doi:10.1016/0005-7967(83)90009-8 · Cited by 1,327 · see citing works
Generalized anxiety disorder: A preliminary test of a conceptual model
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)00070-3 · Cited by 1,072 · see citing works
Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. G. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.01.011 · Cited by 775 · see citing works
Carleton, R. N. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.82 · Cited by 599 · see citing works
Intolerance of uncertainty and worry: investigating specificity in a nonclinical sample
Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001) · Cognitive Therapy and Research · doi:10.1023/a:1005553414688 · Cited by 538 · see citing works
Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry
Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00133-3 · Cited by 524 · see citing works
Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21965 · Cited by 495 · see citing works
Intolerance of uncertainty in obsessive-compulsive disorder
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(02)00182-2 · Cited by 494 · see citing works
Barlow, D. H., Ellard, K. K., Sauer-Zavala, S., Bullis, J. R., & Carl, J. R. (2014) · Perspectives on Psychological Science · doi:10.1177/1745691614544528 · Cited by 491 · see citing works
Intolerance of uncertainty and social anxiety
Boelen, P. A., & Reijntjes, A. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.04.007 · Cited by 436 · see citing works
Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2005.01.002 · Cited by 399 · see citing works
Treatment of Gad: Targeting Intolerance of Uncertainty in Two Types of Worry
Dugas, M. J., & Ladouceur, R. (2000) · Behavior Modification · doi:10.1177/0145445500245002 · Cited by 334 · see citing works
Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma
Vranceanu, A.-M., Bachoura, A., Weening, A., Vrahas, M., Smith, R. M., & Ring, D. (2014) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.l.00479 · Cited by 315 · see citing works
Self-citationAnxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears?
Nicholas Carleton, R., Sharpe, D., & Asmundson, G. J. G. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.04.006 · Cited by 293 · see citing works
Carleton, R. N., Collimore, K. C., & Asmundson, G. J. G. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.10.007 · Cited by 268 · see citing works
A Transdiagnostic Examination of Intolerance of Uncertainty Across Anxiety and Depressive Disorders
Mahoney, A. E. J., & McEvoy, P. M. (2012) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.622130 · Cited by 237 · see citing works
Understanding Adolescent Worry: The Application of a Cognitive Model
Laugesen, N., Dugas, M. J., & Bukowski, W. M. (2003) · Journal of Abnormal Child Psychology · doi:10.1023/a:1021721332181 · Cited by 224 · see citing works
Einstein, D. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12077 · Cited by 223 · see citing works
McEvoy, P. M., & Erceg-Hurn, D. M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.002 · Cited by 155 · see citing works
Can the components of a cognitive model predict the severity of generalized anxiety disorder
Dugas, M. J., Savard, P., Gaudet, A., Turcotte, J., Laugesen, N., Robichaud, M., Francis, K., & Koerner, N. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.07.002 · Cited by 142 · see citing works
Uncertainty and psychological adjustment in patients with lung cancer
Kurita, K., Garon, E. B., Stanton, A. L., & Meyerowitz, B. E. (2013) · Psycho-Oncology · doi:10.1002/pon.3155 · Cited by 132 · see citing works
Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks
Carleton, R. N., Fetzner, M. G., Hackl, J. L., & McEvoy, P. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.792100 · Cited by 126 · see citing works
A psychometric analysis of the Intolerance of Uncertainty Scale among four racial groups
Norton, P. J. (2005) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2004.08.002 · Cited by 118 · see citing works
Norr, A. M., Oglesby, M. E., Capron, D. W., Raines, A. M., Korte, K. J., & Schmidt, N. B. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.05.063 · Cited by 109 · see citing works
Oglesby, M. E., Boffa, J. W., Short, N. A., Raines, A. M., & Schmidt, N. B. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.01.005 · Cited by 109 · see citing works
Jacoby, R. J., Fabricant, L. E., Leonard, R. C., Riemann, B. C., & Abramowitz, J. S. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.07.008 · Cited by 102 · see citing works
McEvoy, P. M., & Mahoney, A. E. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.01.006 · Cited by 99 · see citing works
Fergus, T. A., & Bardeen, J. R. (2013) · Personality and Individual Differences · doi:10.1016/j.paid.2013.05.016 · Cited by 97 · see citing works
Acceptance-based behavioral therapy for GAD: effects on outcomes from three theoretical models.
Treanor, M., Erisman, S. M., Salters-Pedneault, K., Roemer, L., & Orsillo, S. M. (2011) · Depression and Anxiety · doi:10.1002/da.20766 · Cited by 79 · see citing works
Stress and worry: examining intolerance of uncertainty's moderating effect
Zlomke, K. R., & Jeter, K. M. (2014) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2013.835400 · Cited by 73 · see citing works
Cognitive Constructs and Social Anxiety Disorder: Beyond Fearing Negative Evaluation
Teale Sapach, M. J. N., Carleton, R. N., Mulvogue, M. K., Weeks, J. W., & Heimberg, R. G. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.961539 · Cited by 65 · see citing works
OCD and intolerance of uncertainty: treatment issues.
Grayson, J. B. (2010) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.24.1.3 · Cited by 43 · see citing works
Fetzner, M. G., Asmundson, G. J. G., Carey, C., Thibodeau, M. A., Brandt, C., Zvolensky, M. J., & Carleton, R. N. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.929170 · Cited by 38 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Blackburn, J., Fischerauer, S. F., Talaei-Khoei, M., Chen, N. C., Oh, L. S., & Vranceanu, A.-M. (2019) · Clinical Orthopaedics & Related Research · doi:10.1097/corr.0000000000000888 · Cited by 42 · see citing works
Self-citation
- Authors
- Fischerauer, S. F., Talaei-Khoei, M., Vissers, F. L., Chen, N., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Vranceanu, Ana-Maria
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 97
- Pages
- 30-37
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2767235681
- Cited by
- 35
- References
- 36
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 1 · 2020: 8 · 2019: 4 · 2018: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- intolerance of uncertainty, pain-related anxiety, pain intensity, physical function, mediation, orthopedic patients, upper limb function, coping skills training
- MeSH terms
- Adult, Aged, Anxiety, Anxiety Disorders, Cross-Sectional Studies, Humans, Middle Aged, Pain, Uncertainty, Pain Perception
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
