As hypothesized, children who reported current pain problems evidenced significantly higher global fears of anxious arousal and elevated pain catastrophizing relative to children who did not report current pain problems after controlling for key sociodemographic characteristics (i.e., age, sex, and maternal education). Additional analysis of AS dimensions indicated that children with current pain problems reported greater fears of the physical consequences of anxiety sensations, and heightened fears of the psychological consequences of anxious arousal. However, children with and without current pain problems did not differ on fears of the social consequences of anxiety. Also as hypothesized, AS and pain catastrophizing were moderately, positively associated (range: r’s = .29 to .56). Contrary to expectation, AS but not catastrophizing was significantly associated with the presence of current pain problems after controlling for sociodemographic characteristics (see ). However, both AS and catastrophizing were independently associated with somatization. Moreover, analyses of the AS dimensions indicated that AS psychological and AS unsteady concerns were significantly associated with somatization, accounting for 5% and 4% of incremental variance, respectively.
The findings of moderate, positive correlations between AS and pain catastrophizing are consistent with similar findings in non-clinical adults (Drahovzal et al., 2006
). As discussed by Drahovazal et al., it has been posited (Sullivan, Thorn, Rodgers, & Ward, 2004
) that pain catastrophizing is a cognitive construct (i.e., an exaggerated negative mental set in relation to pain) which is related to and yet partially distinct from fear of pain, an emotional construct (i.e., negative emotional reaction to pain involving escape/avoidance behavior). Drahovazal et al. purport that like catastrophizing, AS is a cognitive construct and thus AS and catastrophizing are empirically separable but overlapping constructs that may be conceptualized as a common cognitive dimension — i.e., the general tendency to catastrophize the meaning of aversive physical sensations.
This conceptualization is somewhat at odds with the present finding of an association between AS and the presence of current pain problems but no such relationship for catastrophizing. In support of their conceptual model, Drahovazal et al. (2006) found that both
AS and catastrophizing independently predicted the presence of headache pain. Since Drahovazal et al. studied adults, it may be that differences due to age and/or cognitive development are responsible for this divergence. It is also possible that our findings may be due to the non-clinical nature of the current sample since a recent investigation found stronger relationships among catastrophizing, pain, and pain behaviors in children with chronic pain, compared to non-clinical children (Vervoort et al., 2006
). However, the Drahovazal sample was also non-clinical. Alternatively, pain catastrophizing may be especially relevant to the experience of headaches rather than pain symptoms in general. Nevertheless, post-hoc analyses of headache group membership (headache pain - yes/no) (data not shown) in the present sample yielded similar results to that reported for overall pain.
The current results are consistent with Drahovazal et al.’s (2006) findings that global AS but not catastrophizing predicted both headache pain intensity and the number of accompanying physical symptoms (e.g., nausea; vomiting). Drahovazal et al.’s analysis of the AS subscales indicated that AS psychological concerns predicted headache intensity whereas AS physical concerns predicted the number of physical symptoms. Similarly, in the present sample, children with current pain problems reported elevated AS physical and AS psychological concerns relative to children without pain problems. The current findings support Drahovzal et al.’s conclusion that the AS construct appears to provide additional information in the prediction of pain experiences beyond that explained by catastrophizing alone.
In the present study, both AS and catastrophizing were associated with somatization in multivariate analyses. It should be noted however, that global AS accounted for more than twice the incremental variance in somatization (11%) compared to catastrophizing (5%). The current results agree with prior work in a younger sample of non-clinical children aged 8-13 years (M
= 10.6) which found that somatization was associated with the frequency of pain symptoms and with AS (Muris et al., 2004
). This earlier study did not examine the AS dimensions nor pain catastrophizing. The current analysis indicated that AS psychological, AS unsteady concerns and catastrophizing were all significantly associated with somatization; each construct accounted for roughly the same amount of variance (4%, 5%, and 6% respectively) (see ).
The current findings are consistent with recent data pointing to high levels of comorbidity across chronic pain, somatoform and anxiety disorders (Wang, Juang, Fuh, & Lu, 2007
). The considerable overlap among these conditions is consistent with the view that there may be a common vulnerability to develop fears related to somatic and emotional symptoms and suggests that interventions targeting this common vulnerability may prove beneficial.
Caveats to the present findings should be mentioned. First, AS, catastrophizing and somatization were all assessed by questionnaires and thus, the results may be due to shared method variance. Second, the assessment of current pain problems was limited to a single interview question, although there is preliminary support for the validity of this item. Future work may include more established measures of current pain, pain-related disability, and a variety of assessments for measuring these constructs. Finally, the current study was cross-sectional and correlational in nature and so no inferences regarding causality may be made. Additional longitudinal studies are needed to determine whether AS and catastrophizing constitute cognitive vulnerability factors that lead to the development of chronic pain in children.
As Drahovzal et al. (2006)
point out, the clinical and conceptual utility of the constructs AS and catastrophizing depend on the extent to which they may be distinguishable from each other and from other related constructs (e.g., fear of pain) as well as their ability to predict pain-related outcomes. Although AS and catastrophizing appear to tap a general tendency to catastrophize aversive physical sensations, the present findings suggest that AS is more salient than catastrophizing in the experience of pain and somatization among non-clinical children. One clinical implication of this study to be tested in future research is the possibility that interventions focused on reducing AS in children may prevent the development of chronic pain. Additional work may examine whether interventions addressing both AS and catastrophization lead to lower levels of somatization. Understanding how the inter-related cognitive styles of AS and catastrophizing contribute to pain and somatization in children may inform the development of targeted intervention efforts directed at alleviating these distressing symptoms.