Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity?
Abstract
Rather than viewing anxiety among chronic pain patients as simply a component of negative affectivity, investigators have developed a model of "pain anxiety" in which patients develop fear and avoidance of activity linked to pain. We examined whether pain anxiety can be conceptualized as a specific phobia, or whether evidence supported the notion that pain anxiety is better understood as a manifestation of anxiety sensitivity in the context of chronic pain. Chronic musculoskeletal pain patients (N=70) underwent cold pressor and mental arithmetic tasks while cardiovascular, self-report, and behavior indexes were recorded. They completed measures of pain anxiety, anxiety sensitivity, fear of negative evaluation, depression and trait anxiety. Correlation analyses showed pain anxiety was related to pain-relevant responses during cold pressor, but it was also related to evaluation-relevant responses during cold pressor, and to pain- and evaluation-relevant responses (including subtraction accuracy) during mental arithmetic. Regression analyses showed that almost all effects of pain anxiety on task responses were accounted for by anxiety sensitivity. Fear of negative evaluation, in contrast, correlated only with evaluation-relevant responses, and mostly during mental arithmetic. These effects remained significant when depression, trait anxiety, or anxiety sensitivity were statistically controlled. Pain anxiety may be an expression of anxiety sensitivity rather than a circumscribed phobia; a distinction that could profitably guide treatment strategies.
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Pain-related fear and anxiety are associated with overprediction of daily pain, where patients expected more pain than their actual self-reported pain.
“Pain-related fear and anxiety have been associated with overprediction of daily pain, where patients expected to experience more pain than their actual self-reported pain [12,13].”
From Nocebo hyperalgesia and other expectancy-related factors in daily fibromyalgia pain: Combining experimental and electronic diary methods (2024) · cites this paper as [12]
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- Authors
- Greenberg, J., & Burns, J. W.
- Corresponding author
- Burns, John W
- ORCID
- Burns, John W
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2003-02
- Volume
- 41
- Issue
- 2
- Pages
- 223-240
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2036977942
- Cited by
- 87
- References
- 36
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2021: 4 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 9 · 2013: 3 · 2012: 6
- FWCI
- 9.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (NS37164, R29NS037164)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- pain-related anxiety, chronic pain, anxiety sensitivity, specific phobia, fear of negative evaluation, depression, trait anxiety, cold pressor task, mental arithmetic, cardiovascular response, musculoskeletal pain
- MeSH terms
- Adult, Anxiety Disorders, Avoidance Learning, Chronic Disease, Cold Temperature, Female, Humans, Male, Mental Processes, Middle Aged, Narcotics, Neuropsychological Tests, Pain, Regression Analysis
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