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Licensed Unlicensed Requires Authentication Published by De Gruyter October 1, 2017

Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain

Mark P. Jensen, Ester Solé, Elena Castarlenas, Mélanie Racine, Rubén Roy, Jordi Miró and Douglas Cane


Background and aims

Trait behavioral inhibition represents a tendency to react with negative emotions - primarily worry - to cues which signal potential threats. This tendency has been hypothesized by a two-factor model of chronic pain to have direct effects on psychological and physical function in individuals with chronic pain, as well as to influence the associations between pain-related maladaptive cognitions and function. Our aim was to test these hypothesized associations in a sample of individuals who were being screened for possible interdisciplinary chronic pain treatment.


Eighty-eight patients referred to an interdisciplinary chronic pain management program were administered measures of average pain intensity, trait behavioral inhibition, kinesiophobia, pain catastrophizing, depressive symptoms, and pain interference. We then performed two linear regression analyses to evaluate the direct effects of trait behavioral inhibition on depressive symptoms and pain interference and the extent to which behavioral inhibition moderated the associations between kinesiophobia and pain catastrophizing, and the criterion variables.


In partial support of the study hypotheses, the results showed significant (and independent) direct effects of trait behavioral inhibition on depressive symptoms, and behavioral inhibition moderated the association between kinesiophobia and depression, such that there were stronger associations between kinesiophobia and depressive symptoms in those with higher dispositional sensitivity to fear-inducing stimuli. However, neither direct nor moderating effects of behavioral inhibition emerged in the prediction of pain interference.


If replicated in additional studies, the findings would indicate that chronic pain treatments which target both reductions in maladaptive cognitions (to decrease the direct negative effects of these on depressive symptoms) and the individual’s tendency to respond to pain with worry (as a way to buffer the potential effects of maladaptive cognitions on depressive symptoms) might be more effective than treatments that targeted only one of these factors.


Additional research is needed to further evaluate the direct and moderating effects of pain-related behavioral inhibition on function, as well as the extent to which treatments which target behavioral inhibition responses provide benefits to individuals with chronic pain.

DOI of refers to article:

Department of Rehabilitation Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA98104, USA

  1. Financial support: Financial support for this project was provided by grants from the Spanish Ministry of Economy and Competitiveness (PSI2015-70966-P; PSI2016-82004-REDT), Obra Social de Caixabank and RecerCaixa awarded to JM.JM’s work is supported by the Institucio Catalana de Recerca i Estudis Avangats (ICREA-Academia), and Fundacion Grunenthal. RV’s work is supported by a Beatriu de Pinos Postdoctoral Fellowship (2014 BP-A 00009) granted by the Agency for Administration of University and Research Grants (AGAUR), grant R2B from Universitat Rovira i Virgili provided travel support. EC’s work is supported by grant PSI2014-60180-JIN of the Spanish Ministry of Economy and Competitiveness. SG is supported by a doctoral grant from MINECO. MR’s work is supported by The Earl Russell Chair in Pain Research, Western University, London, Ontario and by a bequest from the estate of Mrs. Beryl Ivey to Dr. Warren R. Nielson.

  2. Ethical issues: The participants provided their informed consent for their participation, and the procedures were reviewed and approved by the Research Ethics Board.

  3. Conflicts of interest: The authors have no conflicts of interest.


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Received: 2017-05-09
Revised: 2017-07-03
Accepted: 2017-07-04
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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