The net suppression effect of pain catastrophic cognition on anxiety sensitivity

Abstract

Introduction

The existing literature on chronic pain points to the effects anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear; however, the nature of the relationships remains unclear. The three dispositional factors may affect one another in the prediction of pain adjustment outcomes. The addition of one disposition may increase the association between another disposition and outcomes, a consequence known as suppressor effects in statistical terms.

Objective

This study examined the possible statistical suppressor effects of anxiety sensitivity, pain hypervigilance and pain catastrophizing in predicting pain-related fear and adjustment outcomes (disability and depression).

Methods

Chinese patients with chronic musculoskeletal pain (n = 401) completed a battery of assessments on pain intensity, depression, anxiety sensitivity, pain vigilance, pain catastrophizing, and pain-related fear. Multiple regression analyses assessed the mediating/moderating role of pain hypervigilance. Structural equation modeling (SEM) was used to evaluate suppression effects.

Results

Our results evidenced pain hypervigilance mediated the effects of anxiety sensitivity (Model 1: Sobel z = 4.86) and pain catastrophizing (Model 3: Sobel z = 5.08) on pain-related fear. Net suppression effect of pain catastrophizing on anxiety sensitivity was found in SEM where both anxiety sensitivity and pain catastrophizing were included in the same full model to predict disability (Model 9: CFI = 0.95) and depression (Model 10: CFI = 0.93) (all P < 0.001) (see Figs. 3 and 4, Figs. 1 and 2).

Conclusions

Our findings evidenced that pain hypervigilance mediated the relationship of two dispositional factors, pain catastrophic cognition and anxiety sensitivity, with pain-related fear. The net suppression effects of pain catastrophizing suggest that anxiety sensitivity enhanced the effect of pain catastrophic cognition on pain hypervigilance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Fig. 3 Multivariate regression analyses of the relationships between pain hypervigilance, anxiety sensitivity, pain-related fear.

Fig. 4 Results of SEM testing the relationships between anxiety sensitivity, pain catastrophizing, and pain hypervigilance for two pain adjustment outcomes.

Fig. 1 Simple models testing the mediating role of pain hypervigilance in the link between anxiety sensitivity and pain-related fear (Models 7 and 8) predicting disability and depression. Anxiety Sensitivity was indexed by the Anxiety Sensitivity Index (ASI). PC: ASI Physiological Concerns subscale; CC: ASI Physiological Concerns subscale; SC: ASI Social Concerns subscale. Pain catastrophizing was indexed by the Pain Catastrophizing scale (PCS). RUM: PCS Rumination subscale; MAGN: PCS Magnification subscale; HELP: PCS Helplessness subscale. Pain hypervigilance was indexed by the Pain Vigilance and Awareness Questionnaire (PVAQ). AWAR: PVAQ Passive Awareness subscale; VIG: PVAQ Active Vigilance subscale. Pain-related fear was indexed by the Tampa Scale for Kinesiophobia (TSK). AA: TSK Activity Avoidance subscale; SF: TSK Somatic Focus. Disability was indexed by the Chronic Pain Grade Disability score. Depression was indexed by the Depression subscale of the Hospital Anxiety and Depression scale. S–B_X ²: Satorra and Bentler scaled Chi² statistic; CFI: comparative fit index; RMSEA: root mean square error of approximation; SRMR: standardized root mean square residual. ^***P < 0.001.

Fig. 2 Full models testing pain hypervigilance as a mediator in the link of both anxiety sensitivity and pain catastrophizing with pain-related fear which predicts disability (Model 9) and depression. Anxiety Sensitivity was indexed by the Anxiety Sensitivity Index (ASI). PC: ASI Physiological Concerns subscale; CC: ASI Physiological Concerns subscale; SC: ASI Social Concerns subscale. Pain catastrophizing was indexed by the Pain Catastrophizing scale (PCS). RUM: PCS Rumination subscale; MAGN: PCS Magnification subscale; HELP: PCS Helplessness subscale. Pain hypervigilance was indexed by the Pain Vigilance and Awareness Questionnaire (PVAQ). AWAR: PVAQ Passive Awareness subscale; VIG: PVAQ Active Vigilance subscale. Pain-related fear was indexed by the Tampa Scale for Kinesiophobia (TSK). AA: TSK Activity Avoidance subscale; SF: TSK Somatic Focus. Disability was indexed by the Chronic Pain Grade Disability score. Depression was indexed by the Depression subscale of the Hospital Anxiety and Depression scale. S–B_X ²: Satorra and Bentler scaled Chi² statistic; CFI: comparative fit index; RMSEA: root mean square error of approximation; SRMR: standardized root mean square residual. ^***P < 0.001.