Skip to main content

Advertisement

Log in

The relevance of health anxiety to chronic pain: Research findings and recommendations for assessment and treatment

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Health anxiety is a dimensional construct that is characterized by extreme concern about one’s health at one end of the continuum and lack of concern about health on the other. Research evidence is consistent with the notion that high levels of health anxiety among patients with pain represent a poor prognostic indicator. Moreover, the experience of chronic pain can serve to increase health anxiety levels. This article concludes with a series of practical recommendations to assist practitioners in the assessment and management of patients with health anxiety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Asmundson JG, Taylor S, Cox B: Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. New York: Wiley; 2001. This book is a comprehensive resource on health anxiety and hypochondriasis.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  3. Salkovskis PM, Warwick HMC: Morbid preoccupation, health anxiety and reassurance: a cognitive-behavioral approach to hypochondriasis. Behav Res Ther 1986, 24:597–602.

    Article  PubMed  CAS  Google Scholar 

  4. Warwick HM, Salkovskis P: Hypochondriasis. Behav Res Ther 1990, 28:105–117.

    Article  PubMed  CAS  Google Scholar 

  5. Kellner R, Abbott P, Winslow WW, Pathak D: Fears, beliefs, and attitudes in DSM-III hypochondriasis. J Nerv Ment Dis 1987, 175:20–25.

    Article  PubMed  CAS  Google Scholar 

  6. Hitchcock PB, Mathews A: Interpretation of bodily symptoms in hypochondriasis. Behav Res Ther 1992, 30:223–234.

    Article  PubMed  CAS  Google Scholar 

  7. Aigner M, Bach M: Clinical utility of DSM-IV pain disorder. Compr Psychiatry 1999, 40:353–357.

    Article  PubMed  CAS  Google Scholar 

  8. Gatchel RJ, Polatin PB, Mayer TG, Garcy PD: Psychopathology and the rehabilitation of patients with chronic low back pain disability. Arch Phys Med Rehab 1994, 75:666–670.

    Article  CAS  Google Scholar 

  9. Kinney RK, Gatchel RJ, Polatin PB, et al.: Prevalence of psychopathology in acute and chronic low back pain patients. J Occup Rehabil 1993, 3:95–103.

    Article  Google Scholar 

  10. Polatin PB, Kinney RK, Gatchel RJ, et al.: Psychiatric illness and chronic low-back pain: the mind and the spine—which goes first? Spine 1993, 18:66–71.

    Article  PubMed  CAS  Google Scholar 

  11. Hadjistavropoulos HD, Hadjistavropoulos T, Quine A: Health anxiety moderates the effects of distraction versus attention to pain. Behav Res Ther 2000, 38:425–438. In this paper, strong evidence is found for the impact of health anxiety on physical treatment and the differential effects of psychologic coping strategies on patients with and without health anxiety.

    Article  PubMed  CAS  Google Scholar 

  12. Looper KL, Kirmayer LJ: Hypochondriacal concerns in a community population. Psychol Med 2001, 31:577–584. This paper provides an interesting overview of the extent of hypochondriacal concerns in a community sample, which is likely of particular relevance for family physicians.

    Article  PubMed  CAS  Google Scholar 

  13. Robbins JM, Kirmayer LJ, Kapusta MA: Illness worry and disability in the fibromyalgia syndrome. Int J Psychiatry Med 1990, 20:49–63.

    Article  PubMed  CAS  Google Scholar 

  14. Barnes D, Gatchel RJ, Mayer TG, Barnett J: Changes in MMPI profile levels of chronic low back pain patients following successful treatment. J Spinal Disord 1990, 3:353–355.

    PubMed  CAS  Google Scholar 

  15. Waddell G, Pilowsky I, Bond MR: Clinical assessment and interpretation of abnormal illness behavior in low back pain. Pain 1989, 39:41–53.

    Article  PubMed  CAS  Google Scholar 

  16. Gramling SE, Clawson EP, McDonald MK: Perceptual and cognitive abnormality model of hypochondriasis: amplification and physiologic reactivity in women. Psychosom Med 1996, 58:423–431.

    PubMed  CAS  Google Scholar 

  17. Jennings JR: Bodily changes during attending. In Psychophysiology: Systems, Processes, and Applications. Edited by Coles M, Donchin E, Porges SW. New York: Guilford Press; 1986:268–289.

    Google Scholar 

  18. Kettell J, Jones R, Lydeard S: Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. Br J Gen Pract 1992, 42:459–461.

    PubMed  CAS  Google Scholar 

  19. Main CJ, Waddell G: Psychometric construction and validity of the Pilowsky Illness Behavior Questionnaire in British patients with chronic low back pain. Pain 1987, 28:13–25.

    Article  PubMed  CAS  Google Scholar 

  20. Pilowsky I, Smith QP, Katsikitis M: Illness behavior and general practice utilization: a prospective study. J Psychosom Res 1987, 31:177–183.

    Article  PubMed  CAS  Google Scholar 

  21. Hellzén Ingemarsson A, Nordholm L, Sivik T: Risk of longterm disability among patients with back pain. Scand J Rehabil Med 1997, 29:205–212.

    Google Scholar 

  22. McCreary C, Colman A: Medication usage, emotional disturbance and pain behavior in chronic low back pain patients. J Clin Psychol 1984, 40:15–19.

    Article  PubMed  CAS  Google Scholar 

  23. Turner JA, Calsyn DA, Fordyce WE, Ready LB: Drug utilization patterns in chronic pain patients. Pain 1982, 12:357–363.

    Article  PubMed  CAS  Google Scholar 

  24. Barsky AJ, Ettner SL, Horsky J, Bates DW: Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care 2001, 39:705–715. This paper extensively discusses resource use among patients with health anxiety.

    Article  PubMed  CAS  Google Scholar 

  25. Hadjistavropoulos HD: Cognitive and behavioral responses to illness information in health anxiety. Unpublished doctoral dissertation, University of British Columbia, Vancouver, British Columbia 1995

    Google Scholar 

  26. Hadjistavropoulos HD, Asmundson GJG, Quine A, LaChapelle D: The role of health anxiety among chronic pain patients in determining response to therapy. Pain Res Manag (in press).

  27. Novy DM, Collins HS, Nelson DV, et al.: Waddell signs: distributional properties and correlates. Arch Phys Med Rehabil 1998, 79:820–822.

    Article  PubMed  CAS  Google Scholar 

  28. Block AR, Vanharanta H, Ohnmeiss DD, Guyer RD: Discographic pain report: influence of psychological factors. Spine 1996, 21:334–338.

    Article  PubMed  CAS  Google Scholar 

  29. Hadjistavropoulos HD, Craig KD, Hadjistavropoulos T: Cognitive and behavioral responses to illness information: the role of health anxiety. Behav Res Ther 1998, 36:149–164.

    Article  PubMed  CAS  Google Scholar 

  30. Pauli P, Schwenzer M, Brody S, et al.: Hypochondriacal attitudes, pain sensitivity, and attentional bias. J Psychosom Res 1993, 37:745–752.

    Article  PubMed  CAS  Google Scholar 

  31. Hadjistavropoulos HD, Owens KMB, Hadjistavropoulos T, Asmundson GJG: Hypochondriasis and health anxiety among pain patients. In Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Edited by Asmundson GJG, Taylor S, Cox B. New York: Wiley; 2001:298–323. This chapter discusses the relation of pain with hypochondriasis and health anxiety in considerable detail.

    Google Scholar 

  32. Dzioba RB, Doxey NC: A prospective investigation into the orthopedic and psychological predictors of outcome of first lumbar surgery following industrial injury. Spine 1984, 9:614–623.

    Article  PubMed  CAS  Google Scholar 

  33. Herron L, Turner J, Weiner P: A comparison of the Millon Clinical Multiaxial Inventory and the Minnesota Multiphasic Personality Inventory as predictors of successful treatment by lumbar laminectomy. Clin Orthop 1986, 203:232–238.

    PubMed  Google Scholar 

  34. Pilowsky I, Barrow CG: A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, ‘psychogenic’ pain. Pain 1990, 40:3–19.

    Article  PubMed  CAS  Google Scholar 

  35. McCreary C, Turner J, Dawson E: The MMPI as a predictor of response to conservative treatment for low back pain. J Clin Psychol 1979, 35:278–284.

    Article  PubMed  CAS  Google Scholar 

  36. Moore ME, Berk SN, Nypaver A: Chronic pain: inpatient treatment with small group effects. Arch Phys Med Rehabil 1984, 65:356–361.

    PubMed  CAS  Google Scholar 

  37. Turner JA, Robinson J, McCreary CP: Chronic low back pain: Predicting response to nonsurgical treatment. Arch Phys Med Rehabil 1983, 64:560–563.

    PubMed  CAS  Google Scholar 

  38. Pilowsky I, Spence ND: Manual for the Illness Behavior Questionnaire (IBQ). Adelaide, Australia: University of Adelaide; 1983.

    Google Scholar 

  39. Hathaway SR, McKinley JC: Minnesota Multiphasic Personality Inventory Manual. New York: Psychological Corporation; 1983.

    Google Scholar 

  40. Hathaway SR, McKinley JC: Minnesota Multiphasic Personality Inventory II Manual. New York: Psychological Corporation; 1989.

    Google Scholar 

  41. Salkovskis PM, Rimes KA, Warwick HM, Clark DM: The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 2002, 32:843–853. This paper describes the development and validation of a promising new inventory for measuring the full range of health anxiety from mild concern to hypochondriasis. A very short version of the scale also was developed and, with future research, may prove to be useful for the busy clinician.

    Article  PubMed  CAS  Google Scholar 

  42. Hadjistavropoulos HD, Asmundson GJG: Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behav Res Ther 1998, 36:1185–1195.

    Article  PubMed  CAS  Google Scholar 

  43. Stewart HS, Watt MC: Assessment of health anxiety. In Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Edited by Asmundson GJG, Taylor S, Cox B. New York: Wiley, 2001:298–323. This chapter provides comprehensive information on the assessment of health anxiety, including details regarding questionnaires and interviews and an extensive summary of reliability and validity of available measures.

    Google Scholar 

  44. Bouman TK, Visser S: Cognitive and behavioral treatment of hypochondriasis. Psychother Psychosom 1998, 67:214–221.

    Article  PubMed  CAS  Google Scholar 

  45. Enns MW, Kjernisted K, Lander M: Pharmacological management of hypochondriasis and related disorders. In Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Edited by Asmundson GJG, Taylor S, Cox B. New York: Wiley; 2001:298–323. This article discusses pharmacologic alternatives that have been used in the treatment of extreme health anxiety.

    Google Scholar 

  46. Furer P, Walker JR, Freeston MH: Integrated approach to cognitive-behavioral therapy for intense illness worries. In Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Edited by Asmundson GJG, Taylor S, Cox B. New York: Wiley; 2001:132–160. This chapter provides a thorough review of the cognitive-behavioral approach to health anxiety, including the review of a treatment protocol and available evidence.

    Google Scholar 

  47. Rachman S: Anxiety. East Sussex, UK: Psychology Press, Ltd; 1998.

    Google Scholar 

  48. Looper KJ, Kirmayer LJ: Behavioral medicine approaches to somatoform disorders. J Consult Clin Psychol 2002, 70:810–827. Randomized, controlled studies are reviewed that support the efficacy of individual cognitive-behavioral therapy for the treatment of hypochondriasis and medically unexplained symptoms.

    Article  PubMed  Google Scholar 

  49. Walker JR, Vincent N, Furer P, et al.: Treatment preference in hypochondriasis. J Behav Ther Exp Psychiatry 1999, 30:251–258. This paper describes a research study showing that patients who were once informed of the major advantages and disadvantages of pharmacologic versus cognitive behavioral treatment show a strong preference for psychologic intervention.

    Article  PubMed  CAS  Google Scholar 

  50. Hadjistavropoulos HD, LaChapelle D: Extent and nature of anxiety experienced during physical examination of chronic low back pain. Behav Res Ther 2000, 38:13–29. This paper describes the anxiety that is experienced by patients during physical examination including cognitive, behavioral, and emotional correlates.

    Article  PubMed  CAS  Google Scholar 

  51. Barsky AJ, Geringer E, Wool CA: A cognitive-educational treatment for hypochondriasis. Gen Hosp Psychiatry 1988, 10:322–327.

    Article  PubMed  CAS  Google Scholar 

  52. Marquis MS, Davies AR, Ware JE: Patient satisfaction and change in medical care provider: a longitudinal study. Med Care 1983, 21:821–829.

    Article  PubMed  CAS  Google Scholar 

  53. Pascoe GC: Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann 1983, 6:185–210.

    Article  PubMed  CAS  Google Scholar 

  54. Thomas JW, Penchansky R: Relating satisfaction with access to utilization of services. Med Care 1984, 22:553–568.

    Article  PubMed  CAS  Google Scholar 

  55. Salkovskis PM: Somatic problems. In Cognitive Behavior Therapy for Psychiatric Problems: A Practical Guide. Edited by Hawton K, Salkovskis PM, Kirk JW, Clark DM. Oxford: Oxford University Press; 1989:235–276.

    Google Scholar 

  56. Warwick H: Provision of appropriate and effective reassurance. Int Rev Psychiatry 1992, 4:76–80.

    Google Scholar 

  57. van Dulmen AM, Fennis JFM, Mokkink HGA, et al.: Doctordependent changes in complaint-related cognitions and anxiety during medical consultations in functional abdominal complaints. Psychol Med 1995, 25:1011–1018.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hadjistavropoulos, H.D., Hadjistavropoulos, T. The relevance of health anxiety to chronic pain: Research findings and recommendations for assessment and treatment. Current Science Inc 7, 98–104 (2003). https://doi.org/10.1007/s11916-003-0019-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-003-0019-z

Keywords

Navigation