Sensitivity to Pain Traumatization: A Higher‐Order Factor Underlying Pain‐Related Anxiety, Pain Catastrophizing and Anxiety Sensitivity among Patients Scheduled for Major Surgery
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BACKGROUND: The present article addresses two related developments in the psychology of pain, and integrates them into a coherent framework to better understand the relationship between pain and trauma. The first is an emerging conceptualization regarding the nature of the hierarchical organization of major pain‐related anxiety constructs. The second is the theoretical rationale and empirical evidence linking pain and symptoms of post‐traumatic stress disorder. OBJECTIVES: To explore the underlying hierarchical factor structure of commonly used pain‐related anxiety measures including the Pain Anxiety Symptoms Scale (PASS‐20), the Pain Catastrophizing Scale (PCS), and the Anxiety Sensitivity Index (ASI); and to relate this structure to post‐traumatic stress disorder in patients scheduled for major surgery. METHODS: Measures were completed by 444 patients scheduled to undergo major surgery. Exploratory factor analysis and subsequent higher‐order analysis using the Schmid‐Leiman transformation were conducted to investigate the underlying factor structure of the ASI, the PCS and the PASS‐20. RESULTS: Twenty items from the ASI, the PASS‐20 and the PCS loaded exclusively on one higher‐order factor. The authors suggest the term ‘sensitivity to pain traumatization’ (SPT) for the underlying construct based in part on the strong, significant positive correlation between SPT scores and scores on the Post‐traumatic Stress Disorder Checklist – Civilian Version. Finally, the total SPT score was significantly higher for patients with a history of pain than for those without a history of pain, both before surgery and one year after surgery. SPT describes the propensity to develop anxiety‐related somatic, cognitive, emotional and behavioural responses to pain that resemble features of a traumatic stress reaction. Together, the results of the present study provide preliminary evidence for the construct validity of SPT.
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Posttraumatic stress symptoms predict the development of chronic postsurgical pain.
“Negative cognitive–affective states including perioperative depression,42,43 anxiety,25,32,35,43,44 pain catastrophizing,18,44 and posttraumatic stress symptoms45 also predict the development of CPSP.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [45]
The paper’s PCL-C measure assesses PTSD symptoms (PTSD Checklist – Civilian Version). In “Testing the construct validity of SPT” (page not provided), presurgery PCL-C scores did not differ significantly between patients with persistent pain and those without it at one year (P=0.15). The paper reports this distinction for sensitivity to pain traumatization (SPT), not for PTSD symptoms. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMost patients are provided little more than pharmacotherapy for pain after surgery and are generally offered no intervention targeting the psychological vulnerability factors associated with a greater probability of pain chronicity, including pain catastrophizing, sensitivity to pain traumatization, anxiety and depressive symptoms.
“Most patients are provided little more than pharmacotherapy for pain after surgery and are generally offered no intervention targeting the psychological vulnerability factors that are associated with a greater probability of pain chronicity, including pain catastrophizing,8 sensitivity to pain traumatization,9 anxiety and depressive symptoms.10”
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Vogel, M., Krippl, M., Frenzel, L., Riediger, C., Frommer, J., Lohmann, C. H., & Illiger, S. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8050697 · Cited by 10 · see citing works
The Opioid-Tolerant Patient: Opioid Optimization
Gulur, P., & Nelli, A. (2020) · The Journal of Arthroplasty · doi:10.1016/j.arth.2020.01.001 · Cited by 8 · see citing works
Hypertensive Hypoalgesia in a Complex Chronic Disease Population
Ferguson, M. K., Slepian, P. M., France, C. R., Svendrovski, A., & Katz, J. D. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10173816 · Cited by 8 · see citing works
Self-citationAcute pain from the perspective of minor trauma patients treated at the emergency unit
Martin, A. R., Soares, J. R., Vieira, V. C. D. L., Marcon, S. S., & Barreto, M. D. S. (2015) · Revista gaúcha de enfermagem · doi:10.1590/1983-1447.2015.02.48728 · Cited by 8 · see citing works
Fear of pain as a predictor of concurrent and downstream PTSD symptoms
Barbano, A. C., Tull, M. T., Christ, N. M., Xie, H., Kaminski, B., & Wang, X. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102441 · Cited by 7 · see citing works
Prevention of the development and maintenance of paediatric chronic pain and disability
Pagé, M. G., Huguet, A., & Katz, J. D. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199642656.003.0005 · Cited by 7 · see citing works
Self-citationFashler, S. R., Pagé, M. G., Svendrovski, A., Flora, D. B., Slepian, P. M., Weinrib, A., Huang, A., Fiorellino, J., Clarke, H. A., & Katz, J. D. (2022) · Journal of Pain Research · doi:10.2147/jpr.s370497 · Cited by 7 · see citing works
Self-citationLapointe-Gagner, M., Jain, S., Alali, N., Elhaj, H., Poirier, A., Kaneva, P. A., Alhashemi, M., Lee, L., Agnihotram, R. V., Feldman, L. S., et al. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10307-3 · Cited by 6 · see citing works
Beveridge, J. K., Pavlova, M., Katz, J. D., & Noel, M. E. (2021) · Children · doi:10.3390/children8070537 · Cited by 6 · see citing works
Self-citationThe Neuromatrix in Behavioral Medicine
Melzack, R., & Katz, J. D. (2014) · doi:10.1002/9781118453940.ch35 · Cited by 6 · see citing works
Self-citationMaunder, L., Pavlova, M., Beveridge, J. K., Katz, J. D., Salomons, T. V., & Noel, M. E. (2022) · Children · doi:10.3390/children9040529 · Cited by 5 · see citing works
Self-citationMaunder, L., Marriott, E. C. S., Katz, J. D., & Salomons, T. V. (2022) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2022-0011 · Cited by 4 · see citing works
Self-citationAnalysis of the factors of pain chronicity in the postoperative period in abdominal surgery
Tyurina, E. А., Zagorulko, O. I., Medvedeva, L. A., Bedzhanyan, A. L., & Shestakov, A. L. (2022) · Clinical and Experimental Surgery Petrovsky journal · doi:10.33029/2308-1198-2022-10-1-108-113 · Cited by 4 · see citing works
Posttraumatic growth and pain acceptance: A profile analysis of chronic pain experience.
Ayache, R., & Goutaudier, N. (2021) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/cbs0000289 · Cited by 3 · see citing works
Assessment of Residual Pain and Dissatisfaction in Total Knee Arthroplasty
Musbahi, O., Collins, J. E., Yang, H. Y., Selzer, F., Chen, A. F., Lange, J. K., Losina, E., & Katz, J. N. (2023) · JBJS Open Access · doi:10.2106/jbjs.oa.23.00077 · Cited by 1 · see citing works
Self-citationAllgemeine Aspekte in präoperativen – intraoperativen – postoperativen Abschnitten
Kapfhammer, H. (2023) · Springer eBooks · doi:10.1007/978-3-662-68309-5_2 · Cited by 1 · see citing works
Postoperative Pain Treatments: Intensive Care, First Aid, Alternative Medicine, Acupuncture (Part 4)
Шаповалова, В. (2026) · SSP Modern Pharmacy and Medicine · doi:10.53933/tznr2436 · Cited by 1 · see citing works
Best Practices Education, Part II: Evidence for and Against Opioid Therapy
McAnally, H. B. (2017) · Springer eBooks · doi:10.1007/978-3-319-47497-7_7 · Cited by 1 · see citing works
Perioperative Care of the Orthopedic Patient with Chronic Pain
Rim, F., & Waldman, S. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-35570-8_21 · Cited by 1 · see citing works
Is Chronic Post-Surgical Pain Preventable?
Al-Mahrezi, A. M., & Shidhani, A. S. A. (2018) · IntechOpen eBooks · doi:10.5772/intechopen.79500 · Cited by 1 · see citing works
Pavlova, M., Beveridge, J. K., Soltani, S., Maunder, L., Salomons, T. V., Katz, J. D., & Noel, M. E. (2024) · Canadian Journal of Pain · doi:10.1080/24740527.2023.2298769 · Cited by 1 · see citing works
Self-citationThis won’t hurt a bit: Reflections on a career in chronic pain.
Katz, J. D. (2017) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000088
Self-citationPrevention of the development and maintenance of pediatric chronic pain and disability
Rosenbloom, B. N., Pagé, M. G., Huguet, A., & Katz, J. D. (2021) · doi:10.1093/med/9780198818762.003.0005
Self-citationPain Among an Inpatient Complex Chronic Care Population of Residents with and without Missing Limbs
Ferguson, M. K., Svendrovski, A., & Katz, J. D. (2021) · Journal of Pain Research · doi:10.2147/jpr.s319822
Self-citationClinique et psychopathologie de la douleur
(2020) · Dunod eBooks · doi:10.3917/dunod.bioy.2020.01.0203
Lung Cancer and Posttraumatic Stress Symptoms
Chung, P., Wu, S., Chen, H., Chen, V. C., & Lee, M. (2022) · Taiwanese Journal of Psychiatry · doi:10.4103/tpsy.tpsy_32_22
Tsur, N., Klebanov, B., Talmon, A., & Katz, C. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117796
Predictors of post-discharge pain outcomes after colorectal surgery: a prospective cohort study
de Cerqueira, J. V. M., Fermi, F., Shirzadi, S., Olleik, G., Lapointe-Gagner, M., Jain, S., Pook, M., Dmowski, K., Nguyen-Powanda, P., Kaneva, P., et al. (2025) · Surgical Endoscopy · doi:10.1007/s00464-025-12127-z
Facteurs psychosociaux influençant l’observance thérapeutique des adultes atteints de drépanocytose
Doglioni, D. O. (2021) · theses.fr (ABES) · doi:10.70675/9897b5b1z2953z487cza41aza3d226b9216f
- Authors
- Kleiman, V., Clarke, H., & Katz, J.
- Affiliations
- York University (CA)
- Mount Sinai Hospital (CA)
- Corresponding author
- Katz, Joel
- Venue
- Pain Research and Management
- Publisher
- Wiley
- Published
- 2011-01
- Volume
- 16
- Issue
- 3
- Pages
- 169-177
- ISSN
- 1203-6765 (ISSN-L)
- 1918-1523
- PMC
- PMC3198110
- OpenAlex
- W2294244675
- Cited by
- 74
- References
- 56
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 6 · 2018: 5 · 2017: 9 · 2016: 2 · 2015: 6 · 2014: 8 · 2013: 4 · 2012: 1
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Pain Research and Management (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- 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 › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- pain-related anxiety, pain catastrophizing, anxiety sensitivity, post-traumatic stress disorder, Pain Catastrophizing Scale, Anxiety Sensitivity Index, higher-order factor structure, major surgery, preoperative anxiety, construct validity, history of pain
- MeSH terms
- Adolescent, Adult, Anxiety, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Pain, Pain Measurement, Pain, Postoperative, Postoperative Pain, Surveys and Questionnaires, Retrospective Studies, Statistics as Topic, Stress Disorders, Post-Traumatic, Young Adult, Catastrophization
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