Top

Published in:

Open Access 01-12-2017 | Research

Pain threshold reflects psychological traits in patients with chronic pain: a cross-sectional study

Authors: Fumie Kato, Tetsuya Abe, Kenji Kanbara, Ikumi Ban, Tadashi Kiba, Sadanobu Kawashima, Yukie Saka, Yasuyuki Mizuno, Mikihiko Fukunaga

Published in: BioPsychoSocial Medicine | Issue 1/2017

Abstract

Background

Chronic pain enhances sensory sensitivity and induces the biased development of psychological traits such as depression and pain catastrophizing, leading to the formation of heterogeneous conditions. Fluctuations in the sensory-related thresholds of non-injured sites (with normal peripheral tissue) in patients with chronic pain are thought to be related to central sensitization. The objectives of this study were to analyze the association between pain tolerance thresholds (PTTs) in non-injured sites and the psychological traits of patients with chronic pain and to evaluate the usefulness of PTT measures in assessments of pathological conditions related to chronic pain.

Methods

This study included 57 patients with chronic pain. The PTTs were measured in non-injured sites with quantitative sensory testing (QST) with electrical stimulation and then classified with cluster analysis. The Short-Form McGill Pain Questionnaire was used to subjectively assess pain in the injured sites. The Minnesota Multiphasic Personality Inventory (MMPI) was used to assess the patients’ psychological traits.

Results

Based on the cluster analysis of PTTs, the patients were classified into a High-Sensitivity group and an Others group consisting of the remaining patients. The results of the MMPI profiles showed that the High-Sensitivity group included significantly more patients with the Neurotic Triad pattern and no patients with the Conversion V pattern. The scores of the hypochondriasis and hysteria scales were significantly lower in the High-Sensitivity group than in the Others group.

Conclusions

This study indicated that patients with chronic pain can be classified according to PTTs in non-injured sites and suggests that patients with High-Sensitivity have characteristic psychological traits. Assessment of PTTs in non-injured sites would be useful for evaluating the psychological condition of patients with chronic pain.

Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979;6:249.

Kouyanou K, Pither CE, Wessely S. Iatrogenic factors and chronic pain. Psychosom Med. 1997;59(6):597–604.CrossRefPubMed

Strong J. PAIN A text book for therapists, Japanese editon. Nagoya: The University of Nagoya press; 2002.

Bonica JJ. The management of pain. 2nd ed. Philadelphia: Lea & Febiger; 1990. p. 19.

Hosoi M, Molton IR, Jensen MP, Ehde DM, Amtmann S, O’Brien S, Arimura T, Kubo C. Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: considering the effect of negative affectivity. Pain. 2010;149:273–7.CrossRefPubMedPubMedCentral

Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17:52–64.CrossRefPubMed

Akhter R, Benson J, Svensson P, Nicholas MK, Peck CC, Murray GM. Experimental jaw muscle pain increases pain scores and jaw movement variability in higher pain catastrophizers. J Oral Facial Pain Headache. 2014;28(3):191–204.CrossRefPubMed

Schlereth T, Heiland A, Breimhorst M, Féchir M, Kern U, Magerl W, Birklein F. Association between pain, central sensitization and anxiety in postherpetic neuralgia. Eur J Pain. 2015;19:193–201.CrossRefPubMed

Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, Huez JF. Psychosocial risk factors for chronic low back pain in primary care: a systematic review. Fam Pract. 2011;28(1):12–21.CrossRefPubMed

10.

Sjörs A, Larsson B, Persson AL, Gerdle B. An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain. BMC Musculoskelet Disord. 2011;12:230.CrossRefPubMedPubMedCentral

11.

Staud R. Peripheral pain mechanisms in chronic widespread pain. Best Pract Res Clin Rheumatol. 2011;25(2):155–64.CrossRefPubMedPubMedCentral

12.

Generaal E, Vogelzangs N, Macfarlane GJ, Geenen R, Smit JH, de Geus EJ, Dekker J, Penninx BW. Biological stress systems, adverse life events, and the improvement of chronic multisite musculoskeletal pain across a 6-year follow-up. J Pain. 2017;18(2):155–65.CrossRefPubMed

13.

Arendt-Nielsen L, Graven-Nielsen T. Central sensitization in fibromyalgia and other musculoskeletal disorders. Curr Pain Headache Rep. 2003;7(5):355–61.CrossRefPubMed

14.

DeSantana JM, Sluka KA. Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain. Curr Pain Headache Rep. 2008;12:338–43.CrossRefPubMedPubMedCentral

15.

Roussel NA, Nijs J, Meeus M, Mylius V, Fayt C, Oostendrop R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth? Clin J Pain. 2013;29:625–38.CrossRefPubMed

16.

van Middendorp H, Lumley MA, Jacobs JW, Bijlsma JW, Geenen R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care Res (Hoboken). 2010;62:1370–6.CrossRef

17.

Park JW, Clark GT, Kim YK, Chung JW. Analysis of thermal pain sensitivity and psychological profiles in different subgroups of TMD patients. Int J Oral Maxillofac Surg. 2010;39:968–74.CrossRefPubMed

18.

Maixner W, Fillingim R, Booker D, Sigurdsson A. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain. 1995;63:341–51.CrossRefPubMed

19.

Backonja MM, Walk D, Edwards RR, Sehgal N, Moeller-Bertram T, Wasan A, Irving G, Argoff C, Wallace M. Quantitative sensory testing in measurement of neuropathic pain phenomena and other sensory abnormalities. Clin J Pain. 2009;25:641–7.CrossRefPubMed

20.

Pavlaković G, Petzke F. The role of quantitative sensory testing in the evaluation of musculoskeletal pain conditions. Curr Rheumatol Rep. 2010;12:455–61.CrossRefPubMedPubMedCentral

21.

Fernández-Carnero J, Fernández-de-Las-Peñas C, de la Llave-Rincón AI, Ge HY, Arendt-Nielsen L. Widespread mechanical pain hypersensitivity as sign of central sensitization in unilateral epicondylalgia: a blinded, controlled study. Clin J Pain. 2009;25:555–61.CrossRefPubMed

22.

Rommel O, Malin JP, Zenz M, Jänig W. Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain. 2001;93(3):279–93.CrossRefPubMed

23.

Boivie J. Central pain and the role of quantitative sensory testing (QST) in research and diagnosis. Eur J Pain. 2003;7(4):339–43.CrossRefPubMed

24.

Edwards RR, Haythornthwaite JA, Tella P, Max MB, Raja S. Basal heat pain thresholds predict opioid analgesia in patients with postherpetic neuralgia. Anesthesiology. 2006;104(6):1243–8.CrossRefPubMed

25.

Olesen SS, Graversen C, Bouwense SA, van Goor H, Wilder-Smith OH, Drewes AM. Quantitative sensory testing predicts pregabalin efficacy in painful chronic pancreatitis. PLoS One. 2013;8(3):e57963.CrossRefPubMedPubMedCentral

26.

Bär KJ, Brehm S, Boettger MK, Boettger S, Wagner G, Sauer H. Pain perception in major depression depends on pain modality. Pain. 2005;117:97–103.CrossRefPubMed

27.

Jiang ZC, Qi WJ, Wang JY, Luo F. Chronic administration of 5-HT1A receptor agonist relieves depression and depression-induced hypoalgesia. ScientificWorldJournal. 2014;2014:405736.PubMedPubMedCentral

28.

Dickens C, McGowan L, Dale S. Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis. Psychosom Med. 2003;65:369–75.CrossRefPubMed

29.

Graham JR. The MMPI: a practical guide. 2nd ed. New York: Oxford University Press; 1987.

30.

Friedman AF, Webb JT, Lewak R. Psychological assessment with the MMPI. Hillsdale: Lawrence Erlbaum Associates, Inc.; 1989.

31.

Leavitt F, Garron DC. Rorschach and pain characteristics of patients with low back pain and “conversion V” MMPI profiles. J Pers Assess. 1982;46:18–25.CrossRefPubMed

32.

Nordin H, Eisemann M, Richter J. MMPI-2 subgroups in a sample of chronic pain patients. Scand J Psychol. 2005;46:209–16.CrossRefPubMed

33.

Crosbie TW, Packman W, Packman S. Psychological aspects of patients with Fabry disease. J Inherit Metab Dis. 2009;32:745–53.CrossRefPubMed

34.

Franz C, Paul R, Bautz M, Choroba B, Hildebrandt J. Psychosomatic aspects of chronic pain: a new way of description based on MMPI item analysis. Pain. 1986;26:33–43.CrossRefPubMed

35.

Raj PP, Chado HN, Angst M, Heavner J, Dotson R, Brandstater ME, Johnson B, Parris W, Finch P, Shahani B, Dhand U, Mekhail N, Daoud E, Hendler N, Somerville J, Wallace M, Panchal S, Glusman S, Jay GW, Palliyath S, Longton W, Irving G. Painless electrodiagnostic current perception threshold and pain tolerance threshold values in CRPS subjects and healthy controls: a multicenter study. Pain Pract. 2001;1:53–60.CrossRefPubMed

36.

Wallin M, Liedberg G, Börsbo B, Gerdle B. Thermal detection and pain thresholds but not pressure pain thresholds are correlated with psychological factors in women with chronic whiplash-associated pain. Clin J Pain. 2012;28:211–21.CrossRefPubMed

37.

Cruz-Almeida Y, King CD, Goodin BR, Sibille KT, Glover TL, Riley JL, Sotolongo A, Herbert MS, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Psychological profiles and pain characteristics of older adults with knee osteoarthritis. Arthritis Care Res (Hoboken). 2013;65:1786–94.CrossRef

38.

Dworkin SF. Somatization, distress and chronic pain. Qual Life Res. 1994;3:77–83.CrossRef

39.

Reesor KA, Craig KD. Medically incongruent chronic back pain: physical limitation, suffering, and ineffective coping. Pain. 1988;32:35–45.CrossRefPubMed

40.

Sardá Jr J, Nicholas MK, Asghari A, Pimenta CA. The contribution of self-efficacy and depression to disability and work status in chronic pain patients: a comparison between Australian and Brazilian samples. Eur J Pain. 2009;13(2):189–95.CrossRefPubMed

41.

Rabey M, Slater H, OʼSullivan P, Beales D, Smith A. Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis. Pain. 2015;156(10):1874–84.CrossRefPubMed

42.

Curatolo M, Müller M, Ashraf A, Neziri AY, Streitberger K, Andersen OK, Arendt-Nielsen L. Pain hypersensitivity and spinal nociceptive hypersensitivity in chronic pain: prevalence and associated factors. Pain. 2015;156(11):2373–82.CrossRefPubMed

43.

Nakashima Y, Kimoto S, Kawai Y. Reliability of pain tolerance threshold testing by applying an electrical current stimulus to the alveolar ridge. J Oral Rehabil. 2014;41:595–600.CrossRefPubMed

44.

Mironer YE, Somerville JJ. Pain tolerance threshold: a pilot study of an objective measurement of spinal cord stimulator trial results. Pain Med. 2000;1:110–5.CrossRefPubMed

45.

Liu SS, Gerancher JC, Bainton BG, Kopacz DJ, Carpenter RL. The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg. 1996;82:98–102.PubMed

46.

Arimura T, Hosoi M, Tsukiyama Y, Yoshida T, Fujiwara D, Tanaka M, Tamura R, Nakashima Y, Sudo N, Kubo C. Pain questionnaire development focusing on cross-cultural equivalence to the original questionnaire: the Japanese version of the short-form MacGill pain questionnaire. Pain Med. 2012;13:541–51.CrossRefPubMed

47.

Takatsuji H, Kobayashi T, Kojima T, Hasebe D, Izumi N, Saito I, Saito C. Effects of orthognathic surgery on psychological status of patients with jaw deformities. Int J Oral Maxillofac Surg. 2015;44:1125–30.CrossRefPubMed

48.

Fukao A, Takamatsu J, Kubota S, Miyauchi A, Hanafusa T. The thyroid function of Graves’ disease patients is aggravated by depressive personality during antithyroid drug treatment. Biopsychosoc Med. 2011;5:9.CrossRefPubMedPubMedCentral

49.

Hayashida K, Inoue Y, Chiba S, Yagi T, Urashima M, Honda Y, Itoh H. Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci. 2007;61:558–63.CrossRefPubMed

50.

Kindler LL, Valencia C, Fillingim RB, George SZ. Sex differences in experimental and clinical pain sensitivity for patients with shoulder pain. Eur J Pain. 2011;15:118–23.CrossRefPubMed

51.

Lautenbecher S. Experimental approaches in the study of pain in the elderly. Pain Med. 2012;13:S44–50.CrossRef

52.

McGill JC, Lawlis GF, Selby D, Mooney V, McCoy CE. The relationship of Minnesota Multiphasic Personality Inventory (MMPI) profile clusters to pain behaviors. J Behav Med. 1983;6:77–92.CrossRefPubMed

53.

Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA. Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Res Ther. 2011;13:R135.CrossRefPubMedPubMedCentral

54.

Louks JL, Freeman CW, Calsyn DA. Personality organization as an aspect of back pain in a medical setting. J Pers Assess. 1978;42:152–7.CrossRefPubMed

55.

Bradley LA, Prokop CK, Margolis R, Gentry WD. Multivariate analyses of the MMPI profiles of low back pain patients. J Behav Med. 1978;1:253–72.CrossRefPubMed

56.

Costello RM, Hulsey TL, Schoenfeld LS, Ramamurthy S. P-A-I-N: a four-cluster MMPI typology for chronic pain. Pain. 1987;30:199–209.CrossRefPubMed

57.

Gatchel RJ, Mayer TG, Eddington A. MMPI disability profile: the least known, most useful screen for psychopathology in chronic occupational spinal disorders. Spine (Phila Pa 1976). 2006;31:2973–8.CrossRef

58.

Kowalczyk WJ, Sullivan MA, Evans SM, Bisaga AM, Vosburg SK, Comer SD. Sex differences and hormonal influences on response to mechanical pressure pain in humans. J Pain. 2010;11(4):330–42.CrossRefPubMed

59.

Riley 3rd JL, Robinson ME, Wise EA, Price DD. A meta-analytic review of pain perception across the menstrual cycle. Pain. 1999;81(3):225–35.CrossRefPubMed

60.

Wang H, Akbar M, Weinsheimer N, Gantz S, Schiltenwolf M. Longitudinal observation of changes in pain sensitivity during opioid tapering in patients with chronic low-back pain. Pain Med. 2011;12:1720–6.CrossRefPubMed

61.

Title: Pain threshold reflects psychological traits in patients with chronic pain: a cross-sectional study
Authors: Fumie Kato
Tetsuya Abe
Kenji Kanbara
Ikumi Ban
Tadashi Kiba
Sadanobu Kawashima
Yukie Saka
Yasuyuki Mizuno
Mikihiko Fukunaga
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BioPsychoSocial Medicine / Issue 1/2017
Electronic ISSN: 1751-0759
DOI: https://doi.org/10.1186/s13030-017-0098-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pain threshold reflects psychological traits in patients with chronic pain: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Longitudinal course of eating disorders after transsexual treatment: a report of two cases

The effect for Japanese workers of a self-help computerized cognitive behaviour therapy program with a supplement soft drink

Association between the blood concentrations of ammonia and carnitine/amino acid of schizophrenic patients treated with valproic acid

Measuring healthy behaviours using the stages of change model: an investigation into the physical activity and nutrition behaviours of Australian miners

Relationship between Alexithymia and latent trigger points in the upper Trapezius

Current state and future prospects for psychosomatic medicine in Japan