Anxiety sensitivity and fear of pain in patients with recurring headaches

Clinical Research and Development Program, Regina Health District, Regina, Sask., Canada.
Behaviour Research and Therapy (Impact Factor: 3.85). 09/1999; 37(8):703-13. DOI: 10.1016/S0005-7967(98)00172-7
Source: PubMed


Anxiety sensitivity (AS) plays an important role in the cognitive, affective and behavioral profiles of patients with chronic pain related to musculoskeletal injury. However, investigators have not considered whether these findings extend to patients with other classes of chronic pain. The primary purpose of this investigation was to address this issue in 72 patients with recurring headaches who completed a self-report questionnaire inventory during a treatment visit to an outpatient neurology clinic. The mean ASI score for the group (mean = 24; SD = 11) was relatively high. When patients were classified on the basis of ASI scores, 20 (28%) met criteria for high, 41 (57%) for medium and 11 (15%) for low AS. Multivariate analysis of variance confirmed that these groups differed on specific aspects of their cognitive, affective, and behavioral profiles. High AS patients reported greater depression, trait anxiety, pain-related escape/avoidance behavior and fearful appraisals of pain than did patients with medium or low AS. High AS patients also indicated greater cognitive disruption in response to pain than did patients with low AS. Groups did not differ in headache severity, physiological reactivity, change in lifestyle, anger, nor did they differ in use of over-the-counter or prescribed analgesics. Multiple regression analysis identified AS, pain-related cognitive disruption, and sensory pain experience as significant predictors of fear of pain. Lifestyle changes attributed to headache were, on the other hand, predicted by headache severity, physiological and cognitive anxiety and escape/avoidance behavior. These results provide further evidence of the important association between AS and fear responses of patients with chronic pain syndromes. Implications and future directions are discussed.

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    • "Anxiety sensitivity (AS), which refers to distress related to the potential sensations and consequences associated with anxiety (Asmundson and Taylor, 1996), including heightened interoceptive awareness, may be a precursor to the development of pain-related fear where physiological cues are interpreted as precursors to aversive pain-related outcomes. AS has consistently been associated with a greater fear of pain (FOP) in adult headache (Asmundson et al., 1999), chronic musculoskeletal pain populations and nonclinical samples (Asmundson et al., 1999; Greenberg and Burns, 2003; Ocanez et al., 2010), linking these overlapping but distinct constructs. Due to this robust association in adult headache populations and the absence of a similarly comprehensive paediatric model, paediatric headache presents as an appropriate genesis point for the development of this link in paediatric chronic pain. "
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    ABSTRACT: Background Recent research suggests that anxiety sensitivity (AS) may be a critical factor in the maintenance of chronic pain. Converging lines of evidence also propose a relationship between AS and fear of pain (FOP) that may result from interoceptive fear conditioning in interoceptively biased individuals. While some AS and FOP research has been carried out in adults, literature exploring this relationship is sparse in clinical paediatric populations.Methods This study investigated the hypotheses that FOP mediates the relationships between AS and disability as well as AS and somatization in children and adolescents with chronic headache pain. Mediation models were investigated using bootstrap regression analyses.ResultsResults indicate that the AS-disability relationship is mediated by FOP, whereas AS seems to contribute both directly and indirectly to somatization.Conclusion These results provide evidence for the pivotal role of AS in the paediatric chronic pain model. The findings of this study further emphasize the application of the fear-avoidance model in children and provide new evidence for the critical role of AS in a paediatric headache population.
    European journal of pain (London, England) 02/2015; 19(2). DOI:10.1002/ejp.542 · 2.93 Impact Factor
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    • "Separately, the writers found that AS Index scores dropped off to the normal levels through antidepressant medication treatment. There was evidence regarding the fact that AS played a role in the relationship between pain symptoms and depression (Asmundson et al. 1999). "
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    ABSTRACT: Anxiety sensitivity refers to the extent of beliefs that anxiety symptoms or arousal can have harmful consequences. There is growing evidence for anxiety sensitivity as a risk factor for anxiety disorders. Anxiety sensitivity is elevated in panic disorder as well as other anxiety disorders. It is thought to contribute to the maintenance and severity of anxiety symptoms. Studies have shown that anxiety sensitivity more specifically predicts the future occurrence of panic attacks. The Anxiety Sensitivity Index (ASI), which measures the construct of anxiety sensitivity, has three subscales, namely, the ASI-Physical subscale, ASI-Social subscale and ASI-Mental Incapacitation Concerns subscale. The dimension reflecting "fear of physical sensations" of anxiety sensitivity is the most predictive one of panic attacks and panic disorder. Research on the ASI has demonstrated that persons diagnosed with post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, and social anxiety disorder all had ASI scores higher than normal controls. Depression was speculated to hold a positive correlation to high anxiety sensitivity scores. The relationships between anxiety sensitivity, alcohol and substance use disorders are still unknown. There is evidence that anxiety sensitivity is related with "drinking used as a way of coping". Since anxiety sensitivity is a cognitive construct, it should be taken into consideration when evaluating patients with anxiety and psychotherapeutic formulations.
    Turk psikiyatri dergisi = Turkish journal of psychiatry 01/2011; 22(3):187-93. · 0.43 Impact Factor
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    • "The most likely reason for this discrepancy is that the present study was conducted with a non-clinical sample. In fact, the mean AS Total score in the present non-clinical sample of headache sufferers was lower than that observed in Asmundson et al.'s (1999) clinical headache sample. Future research could replicate this study in a clinical population of patients who may be experiencing more severe and chronic pain, such as those attending a headache clinic. "
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    ABSTRACT: General catastrophic thinking styles about uncomfortable bodily sensations may predispose the development of common health pathologies, such as persistent headache. The purpose of this research was to explore the relationships between the Pain Catastrophizing (PC) Scale and Anxiety Sensitivity (AS) Index, which measure tendencies to catastrophize pain- and anxiety-related somatic sensations, respectively. A non-clinical sample completed the PC Scale, AS Index, and health outcome questionnaires regarding headache (n = 1018). Results revealed that: (i) AS and PC are empirically separate constructs; (ii) the overlap between PC and AS lies within the domain of fearing physical catastrophe; (iii) AS independently predicts weekly headache, headache pain intensity, and the number of a wide range of physical symptoms associated with headache; and (iv) PC independently predicts the presence of weekly headache. Limitations and implications of this research, as well as recommendations for future research directions are discussed.
    Cognitive Behaviour Therapy 02/2006; 35(4):226-35. DOI:10.1080/16506070600898397
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