title: Pain catastrophizing in patients with noncardiac chest pain: relationships with pain, anxiety, and disability.
abstract: OBJECTIVE
  To examine the contributions of chest pain, anxiety, and pain catastrophizing to disability in 97 patients with noncardiac chest pain (NCCP) and to test whether chest pain and anxiety were related indirectly to greater disability via pain catastrophizing.
  
  
  METHODS
  Participants completed daily diaries measuring chest pain for 7 days before completing measures of pain catastrophizing, trait anxiety, and disability. Linear path model analyses examined the contributions of chest pain, trait anxiety, and catastrophizing to physical disability, psychosocial disability, and disability in work, home, and recreational activities.
  
  
  RESULTS
  Path models accounted for a significant amount of the variability in disability scales (R(2) = 0.35 to 0.52). Chest pain and anxiety accounted for 46% of the variance in pain catastrophizing. Both chest pain (beta = 0.18, Sobel test Z = 2.58, p < .01) and trait anxiety (beta = 0.14, Sobel test Z = 2.11, p < .05) demonstrated significant indirect relationships with physical disability via pain catastrophizing. Chest pain demonstrated a significant indirect relationship with psychosocial disability via pain catastrophizing (beta = 0.12, Sobel test Z = 1.96, p = .05). After controlling for the effects of chest pain and anxiety, pain catastrophizing was no longer related to disability in work, home, and recreational activities.
  
  
  CONCLUSIONS
  Chest pain and anxiety were directly related to greater disability and indirectly related to physical and psychosocial disability via pain catastrophizing. Efforts to improve functioning in patients with NCCP should consider addressing pain catastrophizing.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27708, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Shelby
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Somers
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Susan G
authors.initials: SG
authors.lastname: Silva
authors.forename: Daphne C
authors.initials: DC
authors.lastname: McKee
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Waters
authors.forename: Indira
authors.initials: I
authors.lastname: Varia
authors.forename: Yelena B
authors.initials: YB
authors.lastname: Riordan
authors.forename: Verena M
authors.initials: VM
authors.lastname: Knowles
authors.forename: Michael
authors.initials: M
authors.lastname: Blazing
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Paige
authors.initials: P
authors.lastname: Johnson
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D001294:Attitude to Health; D002637:Chest Pain / Q000175:diagnosis* / Q000523:psychology; D017281:Cost of Illness; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010555:Personality Inventory / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012917:Social Adjustment; D011795:Surveys and Questionnaires