Psychosomatic Medicine
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Published online before print September 8, 2009, 10.1097/PSY.0b013e3181b49584
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Psychosomatic Medicine 71:861-868 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Pain Catastrophizing in Patients with Noncardiac Chest Pain: Relationships With Pain, Anxiety, and Disability

Rebecca A. Shelby, PhD, Tamara J. Somers, PhD, Francis J. Keefe, PhD, Susan G. Silva, PhD, Daphne C. McKee, PhD, Lilin She, PhD, Sandra J. Waters, PhD, Indira Varia, MD, Yelena B. Riordan, BS, Verena M. Knowles, RN, PhD, Michael Blazing, MD, James A. Blumenthal, PhD and Paige Johnson, MBA

From the Department of Psychiatry and Behavioral Sciences (R.A.S., T.J.S., F.J.K., D.C.M., I.V., Y.B.R., V.M.K., J.A.B., P.J.) and Duke Clinical Research Institute (S.G.S., L.S., M.B.), Duke University Medical Center, Durham, North Carolina; and the Department of Psychology (S.J.W.), North Carolina Central University, Durham, North Carolina.

Address correspondence and reprint requests to Francis J. Keefe, Duke University Medical Center, Box 90399, Durham, NC 27708. E-mail: keefe003{at}mc.duke.edu

Objective: To examine the contributions of chest pain, anxiety, and pain catastrophizing to disability in 97 patients with noncardiac chest pain (NCCP) and to test whether chest pain and anxiety were related indirectly to greater disability via pain catastrophizing.

Methods: Participants completed daily diaries measuring chest pain for 7 days before completing measures of pain catastrophizing, trait anxiety, and disability. Linear path model analyses examined the contributions of chest pain, trait anxiety, and catastrophizing to physical disability, psychosocial disability, and disability in work, home, and recreational activities.

Results: Path models accounted for a significant amount of the variability in disability scales (R2 = 0.35 to 0.52). Chest pain and anxiety accounted for 46% of the variance in pain catastrophizing. Both chest pain (β = 0.18, Sobel test Z = 2.58, p < .01) and trait anxiety (β = 0.14, Sobel test Z = 2.11, p < .05) demonstrated significant indirect relationships with physical disability via pain catastrophizing. Chest pain demonstrated a significant indirect relationship with psychosocial disability via pain catastrophizing (β = 0.12, Sobel test Z = 1.96, p = .05). After controlling for the effects of chest pain and anxiety, pain catastrophizing was no longer related to disability in work, home, and recreational activities.

Conclusions: Chest pain and anxiety were directly related to greater disability and indirectly related to physical and psychosocial disability via pain catastrophizing. Efforts to improve functioning in patients with NCCP should consider addressing pain catastrophizing.

Key Words: noncardiac chest pain • catastrophizing • anxiety • disability

Abbreviations: NCCP = noncardiac chest pain.






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Copyright © 2009 by the American Psychosomatic Society