title: An Examination of Pain Catastrophizing and Endogenous Pain Modulatory Processes in Adults with Chronic Low Back Pain.
abstract: Research on chronic low back pain (cLBP) has focused heavily on structural abnormalities with emphasis on diagnostic imaging. However, for many cLBP patients, clinical pain and disability are not clearly associated with identifiable pathology of the spine or associated tissues. Therefore, alternative determinants such as psychological factors and dysfunctional pain modulatory processes have been suggested to be important.
  
  
  
  This observational study examined differences in pain catastrophizing and endogenous pain modulation between 25 cLBP patients and 25 pain-free controls. Associations among pain catastrophizing, endogenous pain modulatory processes, clinical pain reports, and disability were also examined in cLBP patients. Endogenous pain modulation was examined using temporal summation (TS) of mechanical and heat pain stimuli as well as conditioned pain modulation (CPM) with algometry (test stimulus) and the cold pressor task (conditioning stimulus).
  
  
  
  Findings demonstrated significantly greater pain catastrophizing as well as greater TS of mechanical and heat pain for cLBP patients compared with controls. CPM was not present in cLBP patients or controls. Among cLBP patients, pain catastrophizing was significantly associated with disability, while TS of mechanical pain was significantly associated with clinical pain severity and disability.
  
  
  
  This study suggests that endogenous pain modulatory processes are altered for cLBP patients, particularly TS of mechanical and heat stimuli. Pain catastrophizing and TS of mechanical pain may have important clinical relevance for cLBP, given associations with clinical pain and disability; however, future research is needed to replicate these findings.
authors.affiliation: Departments of *Psychology and.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Owens
authors.affiliation: Departments of *Psychology and.
authors.forename: Hailey W
authors.initials: HW
authors.lastname: Bulls
authors.affiliation: Departments of *Psychology and.
authors.forename: Zina
authors.initials: Z
authors.lastname: Trost
authors.affiliation: Departments of *Psychology and.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Terry
authors.affiliation: Departments of *Psychology and.
authors.forename: Ethan W
authors.initials: EW
authors.lastname: Gossett
authors.affiliation: Departments of *Psychology and.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Wesson-Sides
authors.affiliation: Departments of *Psychology and Anesthesiology and Perioperative Medicine, Division of Pain Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA bgoodin1@uab.edu.
authors.forename: Burel R
authors.initials: BR
authors.lastname: Goodin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000523:psychology*; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology / Q000523:psychology
keywords: Chronic Low Back Pain; Conditioned Pain Modulation; Disability; Pain Catastrophizing; Temporal Summation
references.citation: Pain. 1999 May;81(1-2):35-43
references.pmid: 10353491
references.citation: Spine (Phila Pa 1976). 1999 Oct 1;24(19):2035-41
references.pmid: 10528381
references.citation: Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952
references.pmid: 11074683
references.citation: N Engl J Med. 2001 Feb 1;344(5):363-70
references.pmid: 11172169
references.citation: Clin J Pain. 2001 Mar;17(1):52-64
references.pmid: 11289089
references.citation: Spine (Phila Pa 1976). 2002 Mar 1;27(5):E109-20
references.pmid: 11880847
references.citation: Ann Intern Med. 2002 Oct 1;137(7):586-97
references.pmid: 12353946
references.citation: J Consult Clin Psychol. 2003 Feb;71(1):81-91
references.pmid: 12602428
references.citation: Behav Res Ther. 2003 Oct;41(10):1163-82
references.pmid: 12971938
references.citation: Neurosci Lett. 2004 May 6;361(1-3):147-50
references.pmid: 15135915
references.citation: J Pain. 2005 May;6(5):338-9
references.pmid: 15890636
references.citation: Scand J Work Environ Health. 2005 Jun;31(3):237-43
references.pmid: 15999578
references.citation: Neurology. 2005 Aug 9;65(3):437-43
references.pmid: 16087910
references.citation: J Pain. 2006 Apr;7(4):261-71
references.pmid: 16618470
references.citation: J Occup Rehabil. 2006 Mar;16(1):95-108
references.pmid: 16688486
references.citation: BMJ. 2006 Jun 17;332(7555):1430-4
references.pmid: 16777886
references.citation: Eur J Pain. 2007 May;11(4):415-20
references.pmid: 16815054
references.citation: Ann Rheum Dis. 2007 Mar;66(3):313-9
references.pmid: 16916857
references.citation: Med Hypotheses. 2007;68(1):74-80
references.pmid: 16919887
references.citation: Eur J Pain. 2007 Oct;11(7):779-87
references.pmid: 17303452
references.citation: J Pain. 2008 Aug;9(8):759-66
references.pmid: 18482870
references.citation: Expert Rev Neurother. 2009 May;9(5):745-58
references.pmid: 19402782
references.citation: Pain. 2009 Nov;146(1-2):158-69
references.pmid: 19683873
references.citation: J Pain. 2009 Sep;10(9):895-926
references.pmid: 19712899
references.citation: Eur J Pain. 2010 Apr;14(4):339
references.pmid: 20227310
references.citation: J Pain. 2010 May;11(5):443-453.e2
references.pmid: 20439057
references.citation: J Clin Epidemiol. 2010 Nov;63(11):1179-94
references.pmid: 20685078
references.citation: Pain. 2011 Mar;152(3 Suppl):S2-15
references.pmid: 20961685
references.citation: Neurosci Lett. 2011 Feb 4;489(2):122-5
references.pmid: 21145371
references.citation: Eur J Pain. 2011 Sep;15(8):775.e1-11
references.pmid: 21354838
references.citation: Phys Ther. 2011 May;91(5):700-11
references.pmid: 21451097
references.citation: Curr Rheumatol Rep. 2011 Dec;13(6):513-20
references.pmid: 21833699
references.citation: Clin J Pain. 2012 Sep;28(7):623-7
references.pmid: 22156892
references.citation: Am J Public Health. 2012 Feb;102(2):309-18
references.pmid: 22390445
references.citation: Pain. 2012 Jun;153(6):1193-8
references.pmid: 22480803
references.citation: Spine J. 2012 Jul;12(7):545-55
references.pmid: 22819318
references.citation: J Pain. 2012 Oct;13(10):936-44
references.pmid: 22981090
references.citation: Clin J Pain. 2013 Aug;29(8):673-80
references.pmid: 23370065
references.citation: PLoS One. 2013;8(3):e58885
references.pmid: 23554950
references.citation: Pain. 2013 Nov;154(11):2262-5
references.pmid: 23748115
references.citation: Spine (Phila Pa 1976). 2013 Nov 15;38(24):2098-107
references.pmid: 24026153
references.citation: J Pain. 2013 Dec;14(12):1663-70
references.pmid: 24290446
references.citation: Spine J. 2014 Nov 1;14(11):2639-57
references.pmid: 24607845
references.citation: Arthritis Rheumatol. 2014 Jul;66(7):1800-10
references.pmid: 24729357
references.citation: J Pain. 2014 Jun;15(6):569-85
references.pmid: 24787228
references.citation: Psychosom Med. 2014 May;76(4):302-10
references.pmid: 24804882
references.citation: Clin J Pain. 2015 Sep;31(9):757-767
references.pmid: 25370147
references.citation: AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6
references.pmid: 25430861
references.citation: Pain Med. 2015 Jun;16(6):1137-44
references.pmid: 25545856
references.citation: Pain. 2015 Apr;156 Suppl 1:S24-31
references.pmid: 25789433
references.citation: Exp Brain Res. 2015 Aug;233(8):2391-9
references.pmid: 25963754
references.citation: J Pain Res. 2015 Jun 29;8:311-20
references.pmid: 26170713
references.citation: Clin J Pain. 2016 Feb;32(2):116-21
references.pmid: 26741741
references.citation: Appl Nurs Res. 2016 Feb;29:237-41
references.pmid: 26856520
references.citation: Pain. 1989 Jun;37(3):257-63
references.pmid: 2755707
references.citation: Physiotherapy. 1980 Aug;66(8):271-3
references.pmid: 6450426
references.citation: Pain. 1994 Mar;56(3):289-97
references.pmid: 8022622
references.citation: Spine (Phila Pa 1976). 1997 Feb 15;22(4):427-34
references.pmid: 9055372
references.citation: Clin J Pain. 1997 Mar;13(1):43-9
references.pmid: 9084951