title: Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety.
abstract: OBJECTIVE
  Anxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA), is associated with pain-related anxiety.
  
  
  METHODS
  One hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI) of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20). Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS). The Beck Depression Inventory (BDI) was used to control for the influence of depression on the personality measurement.
  
  
  RESULTS
  The HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales.
  
  
  CONCLUSIONS
  Harm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.
authors.affiliation: Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. peter.knaster@dr.com
authors.forename: Peter
authors.initials: P
authors.lastname: Knaster
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Estlander
authors.forename: Hasse
authors.initials: H
authors.lastname: Karlsson
authors.forename: Jaakko
authors.initials: J
authors.lastname: Kaprio
authors.forename: Eija
authors.initials: E
authors.lastname: Kalso
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D001008:Anxiety Disorders / Q000175:diagnosis*; D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013694:Temperament