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Role of psychosocial factors in the development of multisite pain



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The Journal of Pain recently published a paper that caught our eye for its simple design and clever investigation of the role of psychosocial factors in the development of multisite pain. And if you got stuck on the word development, then you’ll know why we got excited. Previous research into this has been correlational: depression, fear of pain and catastrophising are associated with multisite pain. But could they be playing a causative role?

That kind of question is inherently tricky to ask, but this group hit the nail on the head. They used experimentally induced Delayed Onset Muscle Soreness (DOMS) to investigate the possibility that pre-existing psychosocial status could predict the likelihood that someone would develop multisite pain.

One hundred and nineteen (yes, 119) healthy university students completed questionnaires to assess depression, fear of pain and catastrophic thinking, and then reported on their experience of pain on lifting a heavy canister. They reported pain intensity on a numerical rating scale, and pain sites by shading a body chart. They then performed a set of exercises designed to induce DOMS, and went home. The next day, they came back and repeated the lifting test and pain reports.

The researchers investigated possible influences of gender, depression, fear of pain and catastrophising on (a) pain intensity and (b) number of pain sites. They found that depression influenced neither pain outcome. Pain intensity was affected by gender: women reported more pain sites than men (both before and after DOMS induction), and women had a greater increase in pain after DOMS induction than men had. Pain intensity after DOMS induction was correlated with catastrophising score. Fear of pain did not appear to modulate pain intensity.

The number of painful sites was greater after DOMS induction in both men and women, and both fear of pain and catastrophising appeared to separately influence the number of painful sites after DOMS induction.

This simple but robust study makes a notable contribution to what we know about psychosocial influences on multisite pain: it tells us that fear of pain and catastrophic thinking patterns that exist before pain begins may predict how far that pain will spread, but that depression may not play the same role. Yes, the sample was healthy, and yes, experimental pain lacks the ‘fear factor’ of real-life pain, but this seems like a big step forward. These findings call into question the practice of only addressing psychosocial factors once pain becomes chronic or widespread. Perhaps we should be intervening and addressing these possible ‘risk factors’ in the acute stage. Of course, further research is needed before we can make any dramatic suggestions, and the authors are clear about the limitations of their study and the need for further work. They have also put together a particularly articulate discussion of their work, it is worth reading the full paper. I look forward to reading about the work that builds on this study, as this work is extended to studies in clinical populations and, eventually, to influence clinical practice.

About Tory Madden

Tory MaddenTory arrived from South Africa to start her PhD at BiM.  She is a physiotherapist who worked clinically before turning her focus toward research.  She is interested in pretty much anything related to pain and neuroscience, thanks to some particularly inspirational teaching by Romy Parker during her undergraduate training at the University of Cape Town.
Tory’s research looks at classical conditioning and pain.  She is also an associate editor for BiM.  She tries to spend much of her spare time exercising to compensate for the vast quantity of chocolate that lives in her bottom desk drawer.  Luckily, she loves trail running as much as she does food.


Niederstrasser NG, Slepian PM, Mankovsky-Arnold T, Larivière C, Vlaeyen JW, & Sullivan MJ (2014). An experimental approach to examining psychological contributions to multisite musculoskeletal pain. J Pain, 15 (11), 1156-65 PMID: 25179149

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