Numerous studies have noted a link between catastrophizing, depression, emotional distress, and pain expectancies. A new study 1 looks at how pain expectancy affects the mental, physical, and emotional experience of pain and finds that predicting one’s own pain response may have a significant effect in the perception of actual pain.
The study involved 120 previously pain-free students between the ages of 18-32. The students were informed, prior to the study, that they would be involved in pain research—specifically, in correlating the effects of discomfort—and that the study would not physically harm them in any way. Two researchers used moveable armrests to immerse the students’ arms in the ice water at regular intervals. The students were asked to self-measure their own pain catastrophizing using the Pain Catastrophizing Scale (PCS), with questions related to the frequency of 13 feelings they experience during pain. They were also asked to measure their depression levels using the Beck Depression Inventory (BDI), which consists of 21 questions rating symptoms of depression. The students were further asked to predict the amount of pain they would experience during the immersion using a scale of 0-10. During the cold-press immersion, the subjects were asked to describe their levels of pain at 20-second intervals, using a rating scale from 0-10. The scale was posted on the wall in front of them as a visual aid.
While the findings of the study indicate that, as in previous research, there exist a correlation between catastrophizing, accelerated pain, and emotional distress, and that there is a relationship between depression and the experience of emotional distress in response to pain, researchers found little correlation between the experience of pain and depression. Instead, a more accurate predictor of emotional distress in relation to experienced pain is the measure of pain expectancy. When a subject expected less pain than experienced, he reacted to that pain with more emotional distress. Interestingly, the subjects with higher BDI scores tended to self-predict lower pain expectancies and higher levels of emotional distress in relation to the experienced pain.
Researchers theorized that the relationship between emotional distress, depression, catastrophizing, and pain is multifaceted: subjects who expect to feel more pain are prepared for the pain they experience and therefor are less likely to be emotionally distressed by it, while patients who believe they will experience less pain react with emotional distress when confronted with actual pain and are more likely to associate distress with future painful encounters. Further, subjects who rated high on the DPI were more likely to score low on the index that predicted the amount of pain they expected to experience, perhaps suggesting that those prone to depression have a defense mechanism that compels them to anticipate less pain than other subjects might expect. When their actual pain levels are higher than they expected, they react with more emotional distress than subjects scoring lower on the BDI, which, in turn, causes them to have more catastrophic thinking. In other words, these subjects experience their emotional distress due to actual pain, rather than merely imagining more pain due to a depressive nature.
The results of the experiment could mean that patients whose pain expectancy is realistically prepared prior to a procedure will experience less emotional distress in relation to physical pain and even a reduction in the amount of pain experienced. Interventions that target catastrophic thinking may lead to less pain and less emotional distress.