Changes in Situation-Specific Pain Catastrophizing Precede Changes in Pain Report During Capsaicin Pain: A Cross-Lagged Panel Analysis Among Healthy, Pain-Free Participants

Considerable evidence has linked catastrophizing to pain responses, and recent experimental pain research has suggested that situational catastrophizing, measured during or immediately after laboratory pain procedures, is strongly related to pain ratings of standardized noxious stimuli. However, given that most experimental pain protocols involve "static" assessments of pain ratings and catastrophizing at a single time point, the direction by which these factors may affect each other remains unclear. Does catastrophizing influences one's subsequent pain responses or do individual differences in the perceived severity of pain lead to differential rates of catastrophizing? Little is known regarding the course of these variables. Using a cross-lagged panel analysis, we evaluated whether changes in situation-specific catastrophizing preceded changes in laboratory-induced pain responses, or vice versa, during tonic capsaicin pain stimulation. Topical application of a 10% capsaicin cream was applied to the dorsal aspect of the nondominant hand of 38 healthy participants. Situation-specific catastrophizing and pain ratings were obtained at Early (0 to 15 minutes), Mid (15 to 30 minutes), and Final (30 to 35 minutes) periods during capsaicin pain. Analyses revealed that Early-to-Mid changes in catastrophizing ratings prospectively accounted for unique variance in subsequent Mid-to-Final changes in pain ratings, whereas Early-to-Mid changes in pain ratings did not account for unique variance in Mid-to-Final changes in catastrophizing ratings. That is, participants who showed the largest initial increases in catastrophizing reported the greatest subsequent increases in pain. Controlling for the reported change in stress did not affect this pattern of results. These findings provide empirical evidence that a situation-specific catastrophizing process might precede and contribute to subsequent increases in pain experience. Limitations of the present study and possible future research directions are discussed. Perspective: The present study adds to a growing literature on prospective associations between catastrophizing and pain. These results provide initial evidence, in healthy individuals, that changes in catastrophizing may precede changes in pain response. (C) 2010 by the American Pain Society