The relationship among emotion regulation and pain catastrophizing in chronic pain patients

Objectives: Pain catastrophizing (PC) is a cognitive/emotional response to and in anticipation of pain, which may be maladaptive, further exacerbating pain and the difficulty in emotion regulation (ER). There is a lack of research on the interplay between PC and ER and its impact on pain. Our aim was to investigate whether ER exacerbated the pain experience through PC.

Materials and methods: Adults with chronic pain of > 3 months' duration (n = 150) with non-cancer pain and taking opioid medication were recruited from a large medical center in Pennsylvania. A battery of questionaries was conducted to gather data on demographics, substance use, mental health histories, and health and pain outcomes. Measures used included Difficulties in Emotion Regulation Scale 18 Item, Pain Catastrophizing Scale (PCS), Brief Pain Inventory-Short Form (BPI-SF), and Hospital Anxiety and Depression Scale (HADS). A structural equation model with latent variables was conducted to examine our aim.

Results: Both pain interference and severity were significantly positively associated with several psychosocial variables, such as anxiety, depression, ER constructs, PC and distress intolerance. The associations between subscales and pain interference were larger than those with pain severity. PC fully mediated the paths from ER to pain experiences.

Discussion: Our results highlight the importance of several cognitive and emotional constructs: Non-acceptance of negative emotions, lack of emotional awareness, magnification of pain experience, and a sense of helplessness. Further, by showing the indirect effects from PC in affecting ER and pain, we posit that ER, mediated by PC, may serve a critical role in influencing the pain experience in chronic pain patients.