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《Journal of Psychological Science》 2014-01
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Pain- Related Fear: Dominance in Pain Perception over Psychological Distress and Somatization among Young Adults in China

Zhang Xilei;Todd Jackson;Chen Hong;Yang Zhou;Faculty of Psychology,Key Laboratory of Personality and Cognition,Ministry of Education,Southwest University;  
Pain perception,including nociceptive component,sensory- discriminative component( intensity),motivational- affective component( unpleasantness) and cognitive- behavioral component,may be influenced by psychological factors such as pain- related fear,psychological distress,and somatization. Though effect on pain perception of pain- related fear has been widely confirmed and thus based its effect on chronic pain initiation,development and maintenance,no studies have yet assured its dominance against other psychological factors such as psychological distress and somatization. One methodological concern about the research in the area is a reliance on using single scales to measure complex constructs such as psychological distress and pain- related fear. Furthermore,the majority of studies have used chronic pain samples,so it is not clear whether possible elevations in somatization,psychological distress and pain- related fear influenced pain perception or resulted from experiences of ongoing pain. This cross- sectional research was designed to clarify these issues within a general university student sample. A pilot study was designed to evaluate the structure and distinctiveness of somatization,psychological distress and pain- related fear using multiple rather than single measures to represent each factor. Then, the impact of each of these psychological dimensions on pain perception was evaluated within a laboratory pain paradigm. A total of 653 university students( 69. 60% female) completed a battery of five pain- related fear scales,three measures of psychological distress not specifically related to pain,and two somatization scales. Exploratory factor analysis( EFA) and confirmatory factor analyses( CFA) were conducted on random equal subsets of the total sample to determine whether initially derived factor solutions were replicable in a new group. Eight weeks later,105 participants( 70. 45% female) completed the questionnaire battery and the Cold Pressor Test( CPT),with the order effect under control. Hierarchical regression models and moderation / mediation analyses were conducted to assess the effects of these three psychological factors on four indices of pain perception( i. e.,threshold,tolerance,intensity, unpleasantness).EFA results identified a three factor solution consistent with the psychological constructs referenced above. CFA confirmed that this solution had a good fit for the data. The main results were as follows:( 1) the pain- related fear and psychological distress factors significantly and positively predicted both pain intensity and pain unpleasantness,but the impact of psychological distress was fully mediated by pain- related fear,( 2) higher scores on the pain- related fear predicted lower pain tolerance levels to a marginally- significant extent( p =. 097) while neither somatization nor psychological distress had effects,and( 3) among participants reporting high levels of pain- related fear,elevations in somatization had significant negative associations with pain unpleasantness.Mediation of pain- related fear on psychological distress may indicate non- pain- oriented factors influence subjective pain experience primarily through their relations with pain- specific factors. The negative association between somatization and subjective pain experience may indicate that the tendency to focus on somatic symptoms is a protective adaptation that helps to maintain homeostasis,specifically among vulnerable individuals including those who are highly pain- fearful and undergoing noxious stimulation. Taken together,the results indicated that pain- related fear,rather than psychological distress or somatization,was the key dimension associated with exaggerated pain perception,especially regarding subjective intensity and unpleasantness of pain. To cope with accidental pain better in daily life,efforts of reducing exaggerated pain- related fear were recommended.
【Fund】: 国家自然科学基金项目(31371037);; 211工程国家重点学科建设项目(NSKD11005);; 重庆百名海内外高层次人才聚集计划的资助
【CateGory Index】: B842
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