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The influence of pain catastrophizing on emotional modulation of nociceptive reactions (ECON)
Emily J. Bartley, MS1, Amy E. Williams, MA2, and Jamie L. Rhudy, PhD2. (1) Department of Psychology, University of Tulsa, 600 S. College Ave., Tulsa, OK 74104, (2) Department of Psychology, The University of Tulsa, 600 South College, Tulsa, OK 74104
Pain catastrophizing is associated with enhanced pain and pain-related outcomes. Although the exact mechanisms for the catastrophizing-pain relationship are unknown, it does not appear to result from tonic activation of descending mechanisms that alter afferent nociception at spinal levels. Indeed, catastrophizing does not correlate with nociceptive flexion reflex (NFR) threshold – a spinal nociceptive reflex. Alternatively, catastrophizing may alter ascending nociception and pain indirectly through emotional processes. Research suggests that positive emotions inhibit nociception, whereas negative emotions enhance it. Therefore, catastrophizing could enhance pain by exacerbating negative emotional responses, inhibiting positive emotional responses, or both. However, catastrophizing could also enhance pain by altering the influence of emotion on pain without necessarily altering emotional responses themselves (by influencing mechanisms of negative affect-induced facilitation or positive affect-induced inhibition). To examine these issues, we combined data from two similar studies (N=53). Pictures intended to elicit varying emotional valence (unpleasant, neutral, pleasant) were presented in random order during which noxious electric stimulations were delivered to the sural nerve. Four nociceptive reactions to the stimulations were assessed (nociceptive flexion reflex magnitude, skin conductance response, heart rate acceleration, subjective pain), standardized within-individuals, and averaged by picture valence. For the present analyses, catastrophizing was entered as a covariate into custom MANOVA models that included a Catastrophizing x Picture Valence interaction. The first two models determined whether catastrophizing moderated participants' emotional reactions to picture stimuli; thus, the models predicted affective valence (Model 1) and arousal (Model 2) ratings of pictures. Model 3 determined whether catastrophizing moderated the influence of emotion on nociceptive reactions; thus, the model predicted a multivariate combination of the 4 nociceptive reactions. The Catastrophizing x Picture Valence interaction was not significant in any model. This suggests catastrophizing does not influence pain by indirectly altering emotional reactivity or the manner in which emotion influences nociceptive reactivity.
