Positive traits linked to less pain through lower pain catastrophizing

Abstract

The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test-Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0 °C) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = −.41, p < .01) and MPQ-SF scores (r = −.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = −.44, p < .01) and MPQ-SF scores (r = −.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing.

Introduction

Pain affects more than 76 million people in the United States, or about 26% of the population. Annual estimates of healthcare costs for those suffering with chronic pain exceed $6000 per person (Centers for Disease Control & Prevention, 2006). Moreover, chronic pain is a continual burden affecting both physical and mental functioning. Negative consequences of chronic pain can include long hours of rehabilitation, loss of work and income, and hospitalization (Centers for Disease Control & Prevention, 2006).

Pain is a complex phenomenon influenced by biological, psychological, and social factors. The control gate theory of pain is a popular psychological explanation that suggests that perception and interpretation are important in understanding pain (Siegele, 1974). When individuals assess pain, their characteristic ways of thinking (i.e., cognitive sets), and their feelings are significant determinants of their subsequent pain response. For instance, anxiety can intensify the experience of pain, whereas, positive affect can attenuate pain (Siegele, 1974). The present study focused on the psychological experience of pain and addressed the influence of positive psychological traits and negative cognitive sets; specifically, how hope, optimism and pain catastrophizing affected pain outcomes.

Pain catastrophizing is an exaggerated negative response to actual or anticipated pain. It is the tendency to ruminate, magnify, or feel helplessness about pain experience (Sullivan, Bishop, & Pivik, 1995). Previous studies have found that pain catastrophizers report more pain in clinical and experimental settings (France et al., 2002, Rhudy et al., 2009). Further, pain catastrophizers generally report significantly more pain-related thoughts, and experience more emotional distress, and greater pain intensity than non-catastrophizers (Moldovan, Onac, Vantu, Szentagotai, & Onac, 2009).

Negative personality traits, or response patterns and their association with pain have historically been the primary focus of clinical research (Pearce & Porter, 1983). Neuroticism, a negative psychological trait that can produce nervousness, moodiness, and sensitivity to negative stimuli, has been shown to influence pain report (Charles, Gatz, Kato, & Pedersen, 2008), and higher neuroticism can provoke more negative affect in emotion-inducing situations (Larsen & Ketelaar, 1989). Other recent research suggests that pain catastrophizing mediates the relationship between self-handicapping and pain. Self-handicapping is a defense mechanism whereby individuals generate hurdles prior to a performance that affects their attributions after the performance. Individuals who self-handicap tend to pain catastrophize and report higher pain (Uysal & Lu, 2010).

Within the past decade, there has been a shift from studying negative traits and emotions to also examining the important role of positive traits and emotions (Fredrickson, 2001, Lyubomirsky et al., 2005, Seligman and Csikszentmihalyi, 2000). Emerging evidence suggests that levels of hope, a positive psychological construct, and optimism, described as a generalized expectancy of positive outcomes are linked with lower pain reports (Berg et al., 2008, Geers et al., 2008, Snyder et al., 2005). In addition, positive emotions and psychological resilience are associated with less pain catastrophizing (Ong, Zautra, & Reid, 2010).

Optimism and hope are positive traits that both have links to adaptive outcomes (Scheier and Carver, 1985, Scheier and Carver, 1987). Despite their similarities, the two constructs differ in important ways. Optimism is a dispositional trait conceived as an explanatory style whereby individuals focus their cognitions on distancing themselves from negative outcomes (Scheier & Carver, 1985). Conversely, hope is a construct conceived as dispositional (Snyder et al., 1991), state (Snyder et al., 1996), or goal-specific (Feldman, Rand, & Kahle-Wrobleski, 2009). Importantly, compared to optimism, hope has been shown to better describe an individual’s emphasis on positive, goal-directed cognitions (Snyder, 2002).

Previous research suggests that hope and optimism are strongly associated but not identical, with correlations ranging from .51 to .55 (Magaletta and Oliver, 1999, Rand, 2009). In addition, statistical modeling has differentiated hope and optimism as distinct but related constructs. Bryant and Cvengros (2004) found that when analyzing hope and optimism, a goodness-of-fit model with separate second-order factors had greater explanatory power than a model analyzing the constructs as a single global factor. Moreover, hope and optimism had divergent patterns of association with coping and self-efficacy. They suggest that researchers interested in future physical and emotional outcomes should examine the constructs separately.

There is a need to examine the relationships among positive psychological traits, pain, and negative reactions to pain (i.e., pain catastrophizing). Therefore, in the present study, we aimed to describe the mechanism through which positive traits and pain perception are linked. We tested the hypothesis that pain catastrophizing mediates the relationship between the positive traits, hope and optimism, and pain perception.