Fear of Pain as a Predictive Discriminator for Chronic Pain: A Meta-Analysis
Asmundson, R. N.
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Fear of pain (FOP), which refers to pain-related fear and pain-related anxiety, has survival value in allowing an individual to avoid or escape potentially dangerous situations (Asmundson, Norton, Crombez, 2004). However, excessive FOP may result in catastrophic expectations regarding pain. For some these expectations may result in maladaptive chronic pain (pain lasting longer than three months). Individuals with high FOP are more likely to develop chronic pain than individuals with low FOP. The purpose of the project was to empirically determine, using available information from studies, what constitutes high and low FOP for the Pain Anxiety Symptom Scale (PASS; McCracken, Zayfert, Gross, 1992), the Pain Anxiety Symptom Scale-20 (PASS-20; McCracken & Dhingra, 2002), the Fear of Pain Questionnaire (FPQ-III; McNeil & Rainwater, 1998), and the Pain Catastrophizing Scale (PCS; Sullivan, Bishop, & Pivik, 1995). Cut-off scores for high and low FOP may help to identify those who are at risk for developing chronic pain. Using independent t-tests and a large effect size (r>.25) as indicative of a significant difference, chronic pain groups were found to report statistically significant higher scores on the PASS, PASS-20, and PCS than the healthy control group. A cut-off score (i.e., pooled chronic sample M minus .5 SD) of 63 for the PASS, 30 for the PASS-20 and 18 for the PCS is suggested to identify individuals potentially at risk for pain chronicity. These results are discussed in terms of their implications and directions for future research. Cut-off scores for a variety of fear of pain measures may help to identify those who are at risk for developing chronic pain. A cut-off score of 63 for the PASS, 30 for the PASS-20 and 18 for the PCS is suggested to identify individuals potentially at risk for pain chronicity.