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Experimental manipulations of pain catastrophizing influence pain levels in patients with chronic pain and healthy volunteers

Kjøgx, Heidi; Kasch, Helge; Zachariae, Robert; Svensson, Peter; Jensen, Troels S.; Vase, Lene

doi: 10.1097/j.pain.0000000000000519
Research Paper
Editor's Choice

Pain catastrophizing (PC) has been related to pain levels in both patients experiencing acute or chronic pain and in healthy volunteers exposed to experimental pain. Still, it is unclear whether high levels of pain catastrophizing lead to high levels of pain or vice versa. We therefore tested whether levels of pain catastrophizing could be increased and decreased in the same participant through hypnotic suggestions and whether the altered level of situation-specific pain catastrophizing was related to increased and decreased pain levels, respectively. Using the spontaneous pain of 22 patients with chronic tension-type headache and experimentally induced pain in 22 healthy volunteers, participants were tested in 3 randomized sessions where they received 3 types of hypnotic suggestions: Negative (based on the 13 items in the Pain Catastrophizing Scale), Positive (coping-oriented reversion of the Pain Catastrophizing Scale), and Neutral (neutral sentence) hypnotic suggestions. The hypnotic suggestions significantly increased and decreased situation-specific PC in both patients and healthy volunteers (P < 0.001). Also, the levels of pain intensity and pain unpleasantness were significantly altered in both patients and healthy volunteers (P < 0.001). Furthermore, regression analyses showed that changes in pain catastrophizing predicted changes in pain in patients (R2 = 0.204-0.304; P < 0.045) and in healthy volunteers (R2 = 0.328-0.252; P < 0.018). This is the first study to successfully manipulate PC in positive and negative directions in both patients with chronic pain and healthy volunteers and to show that these manipulations significantly influence pain levels. These findings may have important theoretical and clinical implications.

Supplemental Digital Content is Available in the Text.Hypnotic suggestions of increased and decreased pain catastrophizing influenced the subsequent pain ratings in patients with chronic pain and healthy volunteers.

aDepartment of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark

bDanish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark

cResearch Department, Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark

dDepartment of Oncology, Aarhus University Hospital, Aarhus, Denmark

eSection of Orofacial Pain and Jaw Function, School of Dentistry, Aarhus University, Aarhus, Denmark

fDepartment of Dental Medicine, Karolinska Institutet, Huddinge, Sweden

Corresponding author. Address: Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 9, Building 1350, DK-8000 Aarhus C, Denmark. Tel.: +45 87165828; fax: +45 87150201. E-mail address: (L. Vase).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received June 02, 2015

Received in revised form November 24, 2015

Accepted December 22, 2015

© 2016 International Association for the Study of Pain
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