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

Mark P. Jensen 1 , Ester Solé 2 , 3 , 4 , Elena Castarlenas 2 , 3 , 4 , Mélanie Racine 5 , Rubén Roy 2 , 3 , 4 , Jordi Miró 2 , 3 , 4 , and Douglas Cane 6
  • 1 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
  • 2 Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
  • 3 Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
  • 4 Institut d’Investigació Sanityària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
  • 5 Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
  • 6 Pain Management Unit, Nova Scotia Health Authority, Halifax, NS, Canada
Mark P. Jensen, Ester Solé
  • Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
  • Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
  • Institut d’Investigació Sanityària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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, Elena Castarlenas
  • Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
  • Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
  • Institut d’Investigació Sanityària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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, Mélanie Racine
  • Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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, Rubén Roy
  • Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
  • Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
  • Institut d’Investigació Sanityària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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, Jordi Miró
  • Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
  • Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
  • Institut d’Investigació Sanityària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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and Douglas Cane

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Implications

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.

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