Introduction/Aim:

The risk constructs based on psychological risk factor (e.g. pain catastrophizing, PC) and sensitization risk factor (e.g. pressure pain threshold, PPT) are important in research and clinical practice. While most research looks at individual constructs, but doesn’t consider how different constructs might interact within the same individual. A cumulative impact evaluation of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological PC and sensitization PPT risk factors on pain-related outcomes (activity avoidance, pain severity and disability) considering covariates. 

Methods:
We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis who completed all measures of this study.
Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability and pain severity). Subgroups were constructed by dichotomizing (median split) of PC and PPT scores, resulting in 4 groups: 1. low catastrophizing and low sensitivity (N=26), 2. high catastrophizing and low sensitivity (N=27), 3. low catastrophizing and high sensitivity (N=25) and 4. high catastrophizing and high sensitivity (N=31).

Results: 
One-way ANOVA revealed significant group differences (p < .05, η² = .08 to .14) on all outcomes of this study (except functional avoidance) and post hoc analysis indicated the significance differences are between group 1 and 4 (p < .05). A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = .8 to 1).

Discussion/Conclusions:
The study suggests both higher level of pain catastrophizing and pressure sensitivity has a cumulative impact in risk screening for pain-related outcomes, considering gender in functional avoidance (task related outcome). This finding has important clinical and theoretical implications.

A CUMULATIVE IMPACT OF PSYCHOLOGICAL AND SENSITIZATION RISK FACTORS ON PAIN-RELATED OUTCOMES