Catastrophizing and experimental pain sensitivity: Only in vivo reports of catastrophic cognitions correlate with pain responses

Studies of the influence of psychosocial variables on the experience of pain are being revolutionized by recent methodological advances in in vivo assessment techniques (eg, ecological momentary assessment).(5,7) However, although such methodologies have found frequent application in clinical settings (ie, using a portable electronic device such as a palmtop computer, patients with pain report on their current pain and mood at various time points throughout the day; see Litcher-Kelly et al(6)), laboratory-based studies of pain have rarely utilized such in vivo assessment procedures to study the effect of psychological processes on responses to noxious stimuli. Typically, questionnaires are administered prior to conducting experimental pain testing, and participants' scores on the questionnaire are then examined in relation to subsequent laboratory-derived measures of pain responses such as pain threshold or pain tolerance.(3) A recently published study(1) using a cold pressor task (CPT) to assess pain tolerance examined the construct of catastrophizing, which has garnered substantial attention as an important correlate of pain and pain-related disability. One crucial distinction between prior studies and Dixon et al's work(1) is that these authors measured catastrophizing in a standard manner (ie, by administering, prior to pain testing, the Pain Catastrophizing Scale [PCS], which requires subjects to recall the frequency of catastrophizing cognitions during past episodes of pain), and then measured catastrophizing on an in vivo basis (using PCS-derived questions) during the CPT. At least 2 important findings emerged from this investigation: (1) in vivo catastrophizing during CPT was only moderately correlated with standard PCS scores (r =.46); and (2) only in vivo catastrophizing, not standard PCs scores, correlated with cold pain ratings and pain tolerance. In light of these results, we reanalyzed data from a recent CPT study of healthy older and younger adults.(2,4) Briefly, participants underwent a series of 4 consecutive CPTs for the purposes of studying age differences in endogenous analgesic responses. The catastrophizing subscale of the Coping Strategies Questionnaire (CSQ) was administered pre-CPT, and participants reported afterwards on their cognitions during CPT (ie, in vivo cata-strophizing). We assessed the association of 3 variables with cold pain responses: the total score on the CSQ catastrophizing subscale, the rating on an in vivo item inquiring about the frequency of a particular catastrophic cognition during the CPT (ie, I felt that if the pain got any worse, I wouldn't be able to tolerate it), and the rating on a CSQ item corresponding roughly to the previous in vivo item (ie, I feel I can't stand it anymore). The in vivo catastrophizing item correlated only weakly with the corresponding CSQ item (r =.23, P =.03), and its correlation with the CSQ catastrophizing subscale was not significant (r =.16, P =.14). Moreover, as evidenced in Table 1, only the in vivo item was related to CPT pain responses (computed as the average for all 4 CPT trials). These findings parallel those of Dixon et all to a remarkable degree and suggest that in vivo reports of catastrophizing during experimental pain testing provide information distinct from that obtained using standard catastrophizing questionnaires. Given that associations between catastrophizing and pain responses appear to vary as a function of the method and timing of catastrophizing's assessment, future laboratory-based studies are likely to benefit from in vivo assessment of catastrophizing during the experience of pain.