Anxiety sensitivity and fear of pain in patients with recurring headaches.
ABSTRACT 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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ABSTRACT: Previous research has shown positive relationships between dysfunctional cognitive styles and different aspects of pain (eg, pain frequency). One goal of our longitudinal study was to investigate potential risk factors for the incidence of headache (HA) and back pain (BP).Journal of Pain Research 01/2014; DOI:10.2147/JPR.S64334.
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ABSTRACT: Recent experimental data show that associative learning processes are involved not only in the acquisition but also the spreading of pain-related fear. Clinical studies suggest involvement of positive affect in resilience against chronic pain. Surprisingly, the role of positive affect in associative learning in general and in fear generalization in particular has received scant attention. In a voluntary movement paradigm, in which one arm movement (CS+) was followed by a painful stimulus and another was not (CS-), we tested generalization of fear to five novel but related generalization movements (GSs; within-subjects) after either a positive affect induction or a control exercise (Group = between-subjects) in healthy participants (N = 50). The GSs' similarity with the original CS+ movement and CS- movement varied. Fear learning was assessed via verbal ratings. Results indicated that there was an interaction between the increase in positive affect and the linear generalization gradient. Stronger increases in positive affect were associated with steeper generalization curves due to relatively lower pain-US expectancy and less fear to stimuli more similar to the CS-. There was no Group by Stimulus interaction. Results thus suggest that positive affect may enhance safety learning through promoting generalization from known safe movements to novel yet related movements. Improved safety learning may be a central mechanism underlying the association between positive affect and increased resilience against chronic pain.Perspective: We investigated to which extent positive affect influences the generalization (i.e., spreading) of pain-related fear to situations similar to the original, pain-eliciting situation. Results suggest that increasing positive affect in the acute pain stage may limit the spreading of pain-related fear, thereby potentially inhibiting transgression to chronic pain conditions.The journal of pain: official journal of the American Pain Society 12/2014; DOI:10.1016/j.jpain.2014.12.003 · 4.22 Impact Factor