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PubMed2003

Acute oral pain intensity and pain threshold assessed by intensity matching to pain induced by electrical stimuli.

AIMS: To investigate a recently developed pain-intensity matching device (Painmatcher) in terms of reproducibility, pain intensity, and unpleasantness experienced by healthy individuals upon pain threshold assessment, as well as differences in pain threshold between genders and between healthy individuals and patients with acute oral pain, and the relation between pain-intensity assessments by the Painmatcher and a visual analog scale (VAS) in the patients. METHODS: Forty healthy individuals and 28 patients with acute oral pain participated. The Painmatcher produces an eventually noxious stimulus by increasing electrical impulses between 2 fingers. Pain thresholds were assessed twice in the healthy individuals and the provoked pain intensity and unpleasantness were recorded on a VAS. In the patients, pain threshold and ongoing pain were assessed with the Painmatcher and the ongoing pain was recorded on a VAS. RESULTS: Painmatcher scores for the 2 pain threshold assessments were equally correlated in the healthy individuals and patients. VAS scores for ongoing pain and pain caused by the Painmatcher when the ongoing pain intensity was assessed were positively correlated. In the healthy individuals, the degree of unpleasantness was higher than the pain intensity at the pain threshold. The patients had a lower pain threshold than the healthy individuals. CONCLUSION: This study indicates that patients with acute oral pain have lower Painmatcher pain thresholds than healthy individuals, suggesting a general decrease in nociceptive thresholds in these patients. The Painmatcher seems to be as valid as a VAS for acute oral pain assessment. The Painmatcher pain threshold is highly reproducible but associated with unpleasantness.

Acute Disease↗
PubMed1997

[Pain intensity, mood and pain-alleviating actions in pre-chronic low back pain patients].

INTRODUCTION: The present study examines the correlations between pain intensity, mood and pain-alleviating actions in pre-chronic low back pain patients. The three variables were obtained with the Ulm Pain Diary (Ulmer Schmerztagebuch, UST). METHODS: Thirty-eight patients with low back pain described pain intensity, effect of pain on mood and medication as well as other therapies over a 3-week period (21 days). The patients had a history of pain for between 6 weeks and 6 months. Clinical and orthopedic examinations revealed no relevant organic findings explaining the pain process. RESULTS: Pain occurred on 18.1 (of 21) days. Half of the patients (n=19) used medication or took other actions against their pain. Correlations between the three variables demonstrated that all three were significantly related. Partial correlations showed in addition to a high correlation between pain intensity and mood, that the frequency of pain-relieving actions was far less related to pain intensity than to mood. The group that took actions against their pain had a higher level of pain intensity than the no-action group. Furthermore, the effect of pain on mood was significantly greater in this group than in the no-action group. CONCLUSION: The findings indicate that pain intensity, mood and actions against pain are highly correlated. When pain intensity is statistically controlled, the influence of mood on taking medication or other actions against pain becomes more pronounced. It can be concluded that self-initiated actions against pain depend much more on mood than on pain intensity in pre-chronic low back pain patients.

English Abstract↗
PubMed2006

Preamputation pain and acute pain predict chronic pain after lower extremity amputation.

UNLABELLED: Although previous research suggests that preamputation pain is a risk factor for pain after amputation, little is known about the association between acute postsurgical pain and chronic amputation-related pain. The current prospective study examined the associations of preamputation pain and acute postamputation pain with chronic amputation-related pain. The sample consisted of patients with lower limb amputation (N = 57) who provided both preamputation and postamputation data during a 2-year study period. Preamputation pain intensity and duration were assessed before amputation; acute phantom limb pain (PLP) and residual limb pain (RLP) intensity were assessed on postsurgical days 4 and 5. Acute PLP intensity was the only significant independent predictor of chronic PLP intensity at 6 and 12 months after amputation, whereas preamputation pain intensity was the only significant predictor of chronic PLP intensity at 24 months. Similarly, acute RLP was found to be the best overall predictor of chronic RLP. Other variables (age, gender, level and etiology of amputation, amount of postsurgical pain medication, and duration of preamputation pain) were not associated with chronic pain. These results suggest that higher levels of pain either before or soon after amputation might help to identify individuals at greatest risk for chronic pain problems and most in need of early, intensive pain interventions. PERSPECTIVE: This study suggests that both preamputation pain and acute pain soon after amputation might be associated with bothersome chronic pain. The results support further research on acute pain mechanisms and the effectiveness of early interventions aimed at preventing or managing amputation-related pain.

Acute Disease↗
PubMed2006

Is pain the price of empathy? The perception of others' pain in patients with congenital insensitivity to pain.

Empathy is a complex form of psychological inference that enables us to understand the personal experience of another person through cognitive/evaluative and affective processes. Recent findings suggest that empathy for pain may involve a 'mirror-matching' simulation of the affective and sensory features of others' pain. Despite such evidence for a shared representation of self and other pain at the neural level, the possible influence of the observer's own sensitivity to pain upon his perception of others' pain has not been investigated yet. The aim of this study was to explore how patients with congenital insensitivity to pain (CIP), who are largely deprived of common stimulus-induced pain experiences, perceive the pain of others. Ratings of verbally presented imaginary painful situations showed that CIP patients' semantic knowledge regarding the pain of others did not differ from control subjects. Moreover, the propensity to infer pain from facial expressions was very similar between CIP patients and control subjects. On the other hand, when asked to rate pain-inducing events seen in video clips in the absence of visible or audible pain-related behaviour, CIP patients showed more variable and significantly lower pain ratings, as well as a reduction in aversive emotional responses, compared with control subjects. Interestingly, pain judgements, inferred either from facial pain expressions or from pain-inducing events, were strongly related to inter-individual differences in emotional empathy among CIP patients, while such correlation between pain judgement and empathy was not found in control subjects. The results suggest that a normal personal experience of pain is not necessarily required for perceiving and feeling empathy for others' pain. In the absence of functional somatic resonance mechanisms shaped by previous pain experiences, others' pain might be greatly underestimated, however, especially when emotional cues are lacking, unless the observer is endowed with sufficient empathic abilities to fully acknowledge the suffering experience of others in spite of his own insensitivity.

Adolescent↗
PubMed2001

[Comparison of severity of chronic pain in patients differing in pain diagnosis: an analysis by means of the Mainz Pain Staging System].

INTRODUCTION: Testing the validity of the Mainz Pain Staging System (MPSS) is often carried out by pain classification according to chronic stage. It is assumed that pain syndromes distribute equally over the chronic stages. This analysis was carried out to answer three questions: Do different pain syndromes vary in chronicity, do the four axes of the MPSS differ between pain syndromes, and are there any specific item responses with respect to a pain syndrome? METHODS: 406 patients with different pain diagnoses were included in this analysis. Patients were chosen from the PAIN-Documentation-System of the pain outpatients' department of the Medical University of Luebeck. The pain score according to MPSS had been assessed, and a diagnosis attributed according to the Multidimensional Classification of Pain (MASK). RESULTS: Pain diagnoses do differ in pain chronification. Patients with headache showing the lowest chronification, and patients with back pain describing the most severe chronification, formed the extreme patient groups. Further analysis using the axes of the MPSS demonstrate different sensitivity with respect to pain syndromes, i. e. intake of drugs being the least sensitive and aspects of time being the most sensitive axes. Statistical analysis using configural frequency analysis indicated a relation between pain syndromes and specific item responses. CONCLUSION: Using pain stages of the MPSS as an experimental factor in studies of pain, it is imperative either to control pain syndromes or to confine to a single pain syndrome, to avoid confusion between pain syndromes and severity of pain chronification.

Chronic Disease↗
PubMed2001

The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain.

There is no 'gold standard' to assess the adequacy of pain treatment in cancer patients. The purpose of the study is to explore the Amsterdam Pain Management Index, a newly designed measure to evaluate the adequacy of cancer pain treatment, and to compare it with eight frequently used outcome measures. The Amsterdam Pain Management Index compares patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity with a composite score of analgesics used, while correcting for what a patient considers as a tolerable level of pain. The eight frequently used outcome measure consisted of three Pain Intensity Markers, the Pain Relief Scale, the Patient Satisfaction Scale, and three Pain Management Indexes. In a randomized controlled trial, 313 cancer patients with a pain duration of at least 1 month were included and followed-up three times until 2 months postdischarge at home. The experimental group received a Pain Education Program, consisting of tailored pain information and instruction. Results showed that, except for the three Pain Management Indexes, the agreement between the measures was very low to moderate. The test of known-groups comparisons and equivalence between groups indicated that the Amsterdam Pain Management Index showed promising results. The Pain Intensity Markers and the Pain Relief Scale were limited in discriminating between groups, while the Patient Satisfaction Scale showed no differences between patient groups. Although it was possible for the Pain Management Indexes to distinguish between patient groups, the differences were not in the expected direction. The ability of the outcome measures to detect changes over time was clearly demonstrated by all outcome measures. Effects of the intervention were only found for the Amsterdam Pain Management Index and patients' Substantial Worst Pain score. Although support was provided for the use of the Amsterdam Pain Management Index, more research is warranted.

Aged↗
PubMed2000

Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation.

OBJECTIVES: To determine the characteristics of phantom limb sensation, phantom limb pain, and residual limb pain, and to evaluate pain-related disability associated with phantom limb pain. DESIGN: Retrospective, cross-sectional survey. Six or more months after lower limb amputation, participants (n = 255) completed an amputation pain questionnaire that included several standardized pain measures. SETTING: Community-based survey from clinical databases. PARTICIPANTS: A community-based sample of persons with lower limb amputations. MAIN OUTCOME MEASURES: Frequency, duration, intensity, and quality of phantom limb and residual limb pain, and pain-related disability as measured by the Chronic Pain Grade. RESULTS: Of the respondents, 79% reported phantom limb sensations, 72% reported phantom limb pain, and 74% reported residual limb pain. Many described their phantom limb and residual limb pain as episodic and not particularly bothersome. Most participants with phantom limb pain were classified into the two low pain-related disability categories: grade I, low disability/low pain intensity (47%) or grade II, low disability/high pain intensity (28%). Many participants reported having pain in other anatomic locations, including the back (52%). CONCLUSIONS: Phantom limb and residual limb pain are common after a lower limb amputation. For most, the pain is episodic and not particularly disabling. However, for a notable subset, the pain may be quite disabling. Pain after amputation should be viewed from a broad perspective that considers other anatomic sites as well as the impact of pain on functioning.

Adult↗
PubMed2006

Electronic momentary assessment in chronic pain I: psychological pain responses as predictors of pain intensity.

OBJECTIVES AND METHODS: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7,100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed in this regard. RESULTS: Psychological pain responses explained 40% of the total variance in pain intensity: almost 24% concerned pain variance that occurred between the CPD patients and 16% pertained to pain variance due to momentary differences within these patients. Separately tested fear-avoidance and cognitive responses each explained about 28% of the total pain variance, while spousal responses explained 9%. Catastrophizing emerged as the strongest pain predictor, followed by pain-related fear and bodily vigilance. Results did not differ with the duration of chronicity. DISCUSSION: Exaggerated negative interpretations of pain, and fear that movement will induce or increase pain strongly predicted CPD pain intensity. Spousal responses-assessed only when the spouse was with the patient who at that moment was in actual pain-may more strongly affect immobility due to pain than pain intensity per se (see part II of the study). The findings substantiate the importance of catastrophizing, fear and vigilance identified primarily in low back pain and extend this to other forms of chronic pain. The compelling evidence of momentary within-patients differences underscores that these must be accounted for in chronic pain research and practice.

Activities of Daily Living↗
PubMed2005

Assessment of pain quality in chronic neuropathic and nociceptive pain clinical trials with the Neuropathic Pain Scale.

UNLABELLED: Although a number of measures of pain qualities exist, little research has examined the potential for these measures to identify the unique effects of pain treatments on different pain qualities. We examined the utility of the Neuropathic Pain Scale (NPS) for assessing changes in pain qualities after open label lidocaine patch 5% in 3 samples of patients: patients with peripheral neuropathic pain, low back pain, and osteoarthritis. With one exception ("cold" pain in subjects with low back pain), each of the NPS items showed significant change after open label lidocaine patch. In addition, significantly larger changes were observed for the NPS items reflecting global pain intensity and pain unpleasantness and for items assessing sharp and deep pain than for items assessing cold, sensitive, and itchy pain. The pattern of changes in pain qualities did not differ across the 3 diagnostic groups, but it did differ from the patterns of changes in pain qualities associated with other analgesic treatments. The results support the potential utility of the NPS for assessing the patterns of changes in pain qualities that can be observed after pain treatment. PERSPECTIVE: Pain clinical trials that include measures of pain qualities, such as the NPS, might identify distinct patterns of treatment effects on those pain qualities. This research might be used to help clinicians target analgesics to match the specific qualities associated with a patient's pain and to better understand the mechanisms of analgesic effects in drug development programs.

Administration, Cutaneous↗
PubMed1993

Individual pain history and familial pain tolerance models: relationships to post-surgical pain.

OBJECTIVES: (a) To investigate the influence of previous pain experience and familial pain tolerance models on postsurgical pain; (b) to investigate the effect of personality traits on vicarious learning. DESIGN: Before surgery, the patients completed the Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests. They also underwent a semi-structured interview to collect information on familial pain tolerance models and their own pain history. Postthoracotomy pain was assessed by measuring its latency (h), intensity (VAS 0-10), and duration (days). SETTING: A unique protocol to minimize the use of pain killers and encourage the adoption of coping strategies to face postsurgical pain was in use in the Thoracic Department. PATIENTS: A total of 126 patients who were free from chronic pain and undergoing thoracic surgery entered the study. OUTCOME: Most patients recalled a history of surgical or medical pain and good pain tolerance models in their original family. An almost equal number denied pain or had good pain tolerance models in their present family. Only a few patients reported poor tolerance models. RESULTS: Patients who had previously been subjected to medical pain experienced a greater intensity of pain. In addition, those who had reported poor tolerance in the original family experienced both earlier and more severe pain. Some patients' personality traits were related to familial pain tolerance models. CONCLUSIONS: We conclude that knowledge of an individual's pain history and familial pain tolerance models can be useful in predicting and managing post-surgical pain.

Adolescent↗
PubMed2004

Usefulness of pain drawings in identifying real or imagined pain: accuracy of pain professionals, nonprofessionals, and a decision model.

UNLABELLED: The aim of this study was to determine the accuracy of pain specialists, nonprofessionals, and a decision model in judging whether a pain diagram was marked by a patient with chronic pain or by a healthy volunteer. Two hundred twenty-eight pain drawings were shown in random order to 10 pain medicine physicians, 10 pain medicine fellows, 10 nonphysician specialists, and 10 nonprofessionals. One half of the drawings (n = 114) had been produced by patients treated at a pain center and the other half (n = 114) by healthy individuals who were instructed to mark the diagrams as if they had a pain problem. The nonprofessionals were found to be 51.5% accurate, pain medicine fellows 52.7%, nonphysician specialists 54.3%, and pain medicine physicians 55.2 % accurate at distinguishing drawings by actual pain patients from drawings from volunteers without pain. A decision model was able to achieve 68.9% accuracy in determining which drawings were made by pain patients and which drawings were made by healthy individuals. The results suggest that subjective assessment of pain drawings alone is not useful in determining whether someone has real or imagined pain. A decision model that makes decisions on the basis of the number of highlighted squares on the pain diagram can identify real pain drawings with greater accuracy than humans. PERSPECTIVE: Pain drawings are clinically useful but have limitations. This study illustrates some of the benefits of computerized pain assessment and highlights the importance of not judging patients on the basis of one source of information.

Adolescent↗
PubMed2004

Laboratory pain perception and clinical pain in post-menopausal women and age-matched men with osteoarthritis: relationship to pain coping and hormonal status.

The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.

Adaptation, Psychological↗
PubMed1993

The effects of multidisciplinary pain management treatment on locus of control and pain beliefs in chronic non-terminal pain.

OBJECTIVE: To determine whether chronic pain patients' beliefs and attributions about pain control are amenable to change in a short-term inpatient multidisciplinary pain management program. DESIGN: Non-randomized consecutive sample with prospective, before-after treatment. SETTING: Pain-management, tertiary care center in a major U.S. city. PATIENTS: All adult patients (n = 50) who were treated in an inpatient multidisciplinary pain management center were contrasted with those of a control group of 46 adult patients who were treated in an outpatient pain center. OUTCOME MEASURES: Pain Locus of Control Scale, the Pain Beliefs and Perceptions Inventory, subjective pain intensity, and medication usage were measured before and after treatment. RESULTS: Statistically significant posttreatment changes were found for the treatment group, but not the control group. Patients who completed the inpatient pain management program reported significant decreases in subjective pain intensity despite discontinuation of narcotic analgesics. Patients in the treatment group showed an increased sense of personal control over their pain and substantial decreases in attributions of pain control to powerful others and chance. Patients in the treatment group also showed a significant reduction in their endorsement of the belief that their pain was a mysterious phenomenon. CONCLUSIONS: Chronic non-terminal pain patients' beliefs about pain and attributions of pain control are amenable to change in a short-term inpatient multidisciplinary pain management program. These results suggest that an intensive multidisciplinary program involving psychotherapy might be more effective in treating chronic pain patients similar to those in this study than outpatient treatment without psychotherapy.

Adult↗
PubMed2006

Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain.

Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain-related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease-related factors. Participants were 125 community-dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease-related variables (p<.001). These variables explained an additional 22% of the variance in pain-related interference (p<.001) and 43% of the variance in psychological functioning (p<.001), after adjusting for demographic and MS-related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.

Activities of Daily Living↗
PubMed2000

Sex-dependent effects of reported familial pain history on recent pain complaints and experimental pain responses.

Previous research has demonstrated that both sex and familial pain history can influence clinical pain, and sex is known to affect experimental pain responses. However, the potential interactive effects of sex and family history on pain-related symptoms and experimental pain have not been investigated. This experiment examined recent pain complaints and laboratory pain responses as a function of sex and reported family history of pain in 212 (122 female, 90 male) young adults. All subjects completed questionnaires regarding family history of pain, recent pain experiences, and psychological measures of hypervigilance. Then, warmth detection thresholds, heat pain thresholds and heat pain tolerances were determined. Results revealed sex-dependent influences of familial pain history on recent pain complaints and experimental pain responses. Specifically, a positive family history of pain was associated with increased reports of pain over the previous month and poorer general health as well as enhanced sensitivity to thermal stimuli among females but not males. Higher levels of hypervigilance accounted for some of the family history effects on recent pain complaints but not experimental pain measures. Potential mechanisms underlying these effects of family history among females are discussed.

Adult↗
PubMed2003

Does participation in a pain course based on the International Association for the Study of Pain's curricula guidelines change student knowledge about pain?

BACKGROUND: The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Analysis of Variance↗
PubMed1993

Prediction of pain in patients with chronic low back pain: effects of inaccurate prediction and pain-related anxiety.

This study investigated predictions of pain intensity, reports of pain and anxiety, frequency of pain-related anxiety symptoms, and range of motion, in 43 patients exposed to pain during a physical examination. All patients had primary complaints of low back pain. The pain stimuli used for this study included back and/or leg pain produced by repeatedly raising the extended leg of the patient to the point of pain tolerance. Generally, findings demonstrated that (a) predictions of pain were a function of discrepancies between previous predictions and experiences of pain, (b) patients reporting greater pain-related anxiety showed a tendency to overpredict new pain events, but corrected their predictions readily, (c) patients reporting less pain-related anxiety displayed a persistent tendency to underpredict pain, and (d) higher predictions of pain, independent of pain reports, related to less range of motion during a procedure that involved painful movement. Discussion focuses on differences between these results and those of previous studies and the implications of inaccurate prediction for continued pain and disability.

Adult↗
PubMed2007

Sex and pain-related psychological variables are associated with thermal pain sensitivity for patients with chronic low back pain.

UNLABELLED: Biologic and psychological associations with evoked pain sensitivity have been extensively studied in healthy subjects but not among subjects with clinical pain syndromes. This study involved patients with chronic low back pain and investigated whether: 1) sex differences existed for thermal pain sensitivity; and 2) sex, fear-avoidance beliefs, and/or pain catastrophizing influenced thermal pain sensitivity. Thirty-three consecutive patients enrolled in a pain rehabilitation program completed self-report questionnaires and underwent quantitative sensory testing with an established protocol for thermal stimuli. Women had elevated pain sensitivity for measures of tolerance and temporal summation but not for first pulse response. In the multivariate models predicting thermal pain sensitivity, sex was associated with tolerance, and fear-avoidance beliefs were associated with first pulse response. Sex and pain catastrophizing were associated with temporal summation of thermal pain. Future studies involving clinical samples are necessary to replicate these findings and to explore the involvement of cortical structures. PERSPECTIVE: This study suggests that sex, fear-avoidance beliefs, and pain catastrophizing were associated with thermal pain sensitivity for patients with chronic low back pain. These results corroborated sex differences in tolerance and temporal summation observed in the experimental pain literature for healthy subjects. These results also suggest the potential for these specific pain-related beliefs to be associated with a sensitized state because previous studies have demonstrated their association to clinical pain reports, and this study demonstrated associations with thermal pain sensitivity.

Adolescent↗