Anxiety Symptoms and Pain Catastrophizing in a Pediatric Chronic Pain Sample Susan T. Heinze¹, M.S., Kim Anderson Khan², ³, Psy.D., Renee Ladwig3, APRN, LMFT, Keri R. Hainsworth², Ph.D.,

W. Hobart Davies¹, Ph.D., & Steven J. Weisman², ³, M.D. ¹University of Wisconsin-Milwaukee, ²Medical College of Wisconsin, & ³Children’s Hospital of Wisconsin

• Anxiety symptoms and pain catastrophizing (PC) are elevated in children with chronic pain (Tsao et al., 2009; Vervoort et al., 2010).

• These symptoms are also related to decreased quality of life (Tsao et al., 2007; Vervoort et al., 2010).

• Anxiety and PC may indicate an underlying construct of sensitivity to chronic pain; however, these constructs are rarely examined together.

• Youth ages 8-18 (see Table 1) completed measures before beginning treatment at a multidisciplinary pain clinic.

• Self report of pain intensity, frequency, and duration

• Screen for Child Anxiety Related Disorders (SCARED)

• Generalized anxiety, Panic disorder, Separation anxiety, Social anxiety, and School avoidance

• Pain Catastrophizing Scale for Children (PCS-C)

• Rumination, Magnification, and Helplessness

• Anxiety symptoms and PC are related to the pain experience in youth with chronic pain. Additionally, anxiety and PC are closely related constructs themselves.

• Total PC score is a stronger predictor of highest and lowest pain intensity than total anxiety. Pain catastrophizing is a symptom more specific to the pain experience than broad anxiety symptoms. However, anxiety is important to evaluate in children with chronic pain as it is related to pain symptoms and pain catastrophizing, and these symptoms are in turn related to poorer functioning.

• Clinically, pain catastrophizing is important as it may increase pain perception, affect one’s ability to cope with chronic pain, and may be an aspect of underlying anxiety warranting treatment in this population.

PURPOSE/BACKGROUND

MEASURES

TABLE 3: Regression Analysis of Anxiety and PC Predicting Highest Pain Intensity

CONCLUSION

For more information, please contact:Susan T. Heinze, stheinze@uwm.edu

STUDY GOALS

• The goal of this study is to examine the relationships between anxiety symptoms, PC, and chronic pain characteristics.

RESULTS: Correlations between Psychosocial Factors

• Anxiety Symptoms and PC

• Subscale scores of the SCARED were significantly related to one another (r range = .33-.68, all p < .001).

• Subscale scores of the PCS were significantly related to one another (r range = .70-.78, all p < .001).

• Correlations between the total and subscale scores of the PCS and the SCARED were significant (r range = .29 - .62, all p < .001).

• Psychosocial Factors and Pain Intensity

• Total anxiety symptoms and several subscales were positively related to the usual, highest, and lowest pain intensity reported by youth. All PC scores (total and subscales) were related to increasing ratings of usual, highest, and lowest pain intensity (See Table 2).

Total N = 264 Highest pain

(scale 0-10)

M = 8.53

SD = 1.45

Gender 70% female Usual pain

(scale 0-10)

M = 5.79

SD = 2.28

Ethnicity 78% Caucasian Lowest pain

(scale 0-10)

M = 2.74

SD = 2.70

Age M = 14.0

SD = 2.68

Pain duration 40.5% < 1 year

59.5% > 1 year

TABLE 1: Participant Characteristics

* p < .05, ** p < .01

B SE t p ΔR²

Step 1 .057

Anxiety 0.02 0.007 3.49 .001*

Step 2 .059

Anxiety 0.01 0.008 0.65 .520

PC 0.03 0.009 3.652 <.001**

TABLE 4: Regression Analysis of Anxiety and PC Predicting Lowest Pain Intensity

B SE t p ΔR²

Step 1 .020

Anxiety 0.03 0.013 2.03 .044*

Step 2 .084

Anxiety -0.02 0.016 -0.99 .323

PC 0.08 0.018 4.37 <.001**

Lowest pain intensity

Usual pain intensity

Highest pain intensity

Total anxiety .15* .21** .23**

Panic symptoms .17* .23** .25**

Generalized anxiety .14* .21** .23**

Separation anxiety .12 .13 .11

Social anxiety .05 .06 .10

School avoidance .07 .18* .18*

Total pain catastrophizing .31** .22** .34**

Rumination .25** .15** .32**

Magnification .23** .19** .26**

Helplessness .34** .26** .36**

TABLE 2: Correlations between Anxiety and PC with Pain Intensity

• Total anxiety was a significant predictor of highest and lowest pain intensity (See Tables 3 and 4). Entering PC into the model explained a significant amount of variance in pain intensity over anxiety symptoms alone.

RESULTS: Regression Predicting Pain Intensity