The influence of fear of pain, pain catastrophizing and social stress on nocebo hyperalgesia

Nocebo hyperalgesia is the phenomenon in which negative pain expectations lead to augmented pain experiences. Studies have shown that psychosocial factors might influence nocebo hyperalgesia and facilitate nocebo responses in clinical settings, thus worsening pain. This study aimed to identify whether social stress, fear of pain and pain catastrophizing influence the magnitude of nocebo hyperalgesia. Higher nocebo hyperalgesic responses were anticipated. Additionally, the potential mediating role of subjective stress was explored. Twenty-five healthy male and female participants were recruited and randomly assigned to the experimental (social stress) and control (no-stress) conditions, which underwent the Trier Social Stress Test (TSST) and a friendly version of it (friendly-TSST), correspondingly. Fear of pain and pain catastrophizing were measured with the Fear of Pain Questionnaire-III and the Pain Catastrophizing Scale. Subjective stress was measured on a 0-10 Numeric Rating...Show moreNocebo hyperalgesia is the phenomenon in which negative pain expectations lead to augmented pain experiences. Studies have shown that psychosocial factors might influence nocebo hyperalgesia and facilitate nocebo responses in clinical settings, thus worsening pain. This study aimed to identify whether social stress, fear of pain and pain catastrophizing influence the magnitude of nocebo hyperalgesia. Higher nocebo hyperalgesic responses were anticipated. Additionally, the potential mediating role of subjective stress was explored. Twenty-five healthy male and female participants were recruited and randomly assigned to the experimental (social stress) and control (no-stress) conditions, which underwent the Trier Social Stress Test (TSST) and a friendly version of it (friendly-TSST), correspondingly. Fear of pain and pain catastrophizing were measured with the Fear of Pain Questionnaire-III and the Pain Catastrophizing Scale. Subjective stress was measured on a 0-10 Numeric Rating Scale. A sham electrical stimulation device was applied to induce nocebo along with negative verbal suggestions of pain worsening. Thermal pain stimuli were paired with ON (nocebo trial) and OFF (control trial) visual signs during the acquisition and testing blocks of nocebo conditioning. The first nocebo and control trials of the testing block were compared to estimate the extent of nocebo hyperalgesia. One-way ANOVA, simple linear regression and mediation analysis with the method of bootstrapping were applied (P < 0.05). The one-way ANOVA was non-significant between the social stress and no-stress conditions (P = 0.74). Regression results were non-significant for fear of pain (B = - 0.38, P = 0.11) and pain catastrophizing (B = - 0.30, P = 0.22). Mediation analysis for subjective stress revealed a non significant indirect effect of - 0.009 (95% BCa CI [-1.10, 0.68]). Our study suggests that social stress does not appear to increase the magnitude of nocebo hyperalgesia and that fear of pain and pain catastrophizing might not predict higher nocebo hyperalgesic responses. In addition, subjective stress may not mediate the relationship between social stress and nocebo hyperalgesia. In conclusion, as social stress, fear of pain, pain catastrophizing and subjective stress can co-occur in clinical practices, future research could examine their potential cumulative effect on nocebo hyperalgesia.Show less

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The influence of fear of pain, pain catastrophizing and social stress on nocebo hyperalgesia