• Melanie Louise Plinsinga, Viana Vuvan, Liam Maclachlan, David Klyne, Thomas Graven-Nielsen, Bill Vicenzino, Paul Hodges, and Bjarke VaegterHenrikHPain Research Group, Pain Center, Odense University Hospital, Odense, Denmark.Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark..
• School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
• Pain. 2023 Jul 1; 164 (7): 159315991593-1599.

AbstractReduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between -0.15 and 0.11, P ≥ 0.08; total: β between -0.27 and -0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.Copyright © 2023 International Association for the Study of Pain.

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