Catastrophizing predicts changes in thermal pain responses after resolution of acute dental pain.
Substantial research suggests that coping strategies, especially catastrophizing, play an important role in shaping adjustment to chronic pain. Although laboratory and clinical studies both suggest that catastrophizing enhances pain, the interaction of catastrophizing and clinical pain on pain sensitivity has received little attention. The present study evaluated the extent to which catastrophizing influenced laboratory thermal pain responses during and after the resolution of acute dental pain. Thermal pain threshold and tolerance, as well as self-reported catastrophizing, were determined in 46 dental patients (15 men and 31 women) experiencing pain as a result of acute pulpitis. All subjects participated in 2 experimental sessions; the first took place immediately before endodontic treatment for relief of pulpal pain, and the second session occurred when patients were pain free, approximately 1 to 2 weeks later. Thermal pain thresholds increased on resolution of acute dental pain, whereas levels of catastrophizing did not change from pretreatment to post-treatment. Catastrophizing was unrelated to thermal pain responses in the presence of acute dental pain (ie, during the first session). Once patients were pain free, catastrophizing showed significant inverse associations with measures of thermal pain threshold and tolerance. In addition, catastrophizing was a robust predictor of changes in thermal pain responses across sessions, with higher baseline catastrophizing predicting reductions or relatively smaller increases in pain threshold and tolerance after successful treatment of acute pain. These data suggest that catastrophizing is prospectively associated with enhanced sensitivity to and reduced tolerance for thermal pain. The use of catastrophizing as a coping strategy might interfere with the resolution of sensitization after cessation of an acutely painful condition, or it might be associated with magnified experimental pain responses across time.


CONCLUSIONS
The findings of the present study suggest that, in some instances, different ethnic groups and genders may use the same descriptors to report different levels of pain. In the context of clinical pain assessment, it may be important to consider the possibility that descriptions of painful sensations reflect, in part, demographic characteristics.
Edwards
Robert R
RR
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA. redwar10@jhmi.edu
Fillingim
Roger B
RB
Maixner
William
W
Sigurdsson
Asgeir
A
Haythornthwaite
Jennifer
J
D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006998:Hypochondriasis / Q000523:psychology*; D008297:Male; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D017288:Pain Threshold; D011671:Pulpitis / Q000150:complications; D014098:Toothache / Q000523:psychology*