Pain-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain : PAIN

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Pain-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain

Plinsinga, Melanie Louisea,b,*; Vuvan, Vianaa; Maclachlan, Liama,c; Klyne, Davidd; Graven-Nielsen, Thomase; Vicenzino, Billa; Hodges, Pauld; Bjarke Vaegter, Henrikf,g

Author Information

aSchool of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

bMenzies Health Institute Queensland, Griffith University, Nathan, Australia

cThe Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia

dNHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

eDepartment of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark

fPain Research Group, Pain Center, Odense University Hospital, Odense, Denmark

gDepartment of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

*Corresponding author. Address: Menzies Health Institute Queensland, Griffith University, Nathan Campus, QLD 4111, Australia. Tel.: +61 7 3735 8082. E-mail address: [email protected] (M. L. Plinsinga).

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 (www.painjournalonline.com).

M. L. Plinsinga and V. Vulvan contributed equally to this article.

PAIN 164(7):p 1593-1599, July 2023. | DOI: 10.1097/j.pain.0000000000002864

Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.

© 2023 International Association for the Study of Pain

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