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Intolerance of Uncertainty, Anxiety Sensitivity and Health Distress Predicted Self-Reported and Clinician Rated Pain During Upper Endoscopy Though Pain Catastrophizing
No full textCONTROL ID: 2910419
CURRENT CATEGORY: Clinical Practice
CURRENT SUBCATEGORY/DESCRIPTORS: Patient Reported Outcomes: IBD, GERD, Functional Disorders, Other
PRESENTATION TYPE: AGA Institute Oral or Poster
PRESENTER: Rossella Palma
PRESENTER (EMAIL ONLY): [email protected]
Abstract
TITLE: INTOLERANCE OF UNCERTAINTY, ANXIETY SENSITIVITY AND HEALTH DISTRESS PREDICTED SELFREPORTED
AND CLINICIAN RATED PAIN DURING UPPER ENDOSCOPY THOUGH PAIN CATASTROPHIZING
AUTHORS (LAST NAME, FIRST NAME): Palma, Rossella1
; Pontone, Stefano1
; Panetta, Cristina1
; La Spina, Gaia3
;
Foglia, Anastasia3
; Raniolo, Marilena1
; Tomai, Manuela2
; Lauriola, Marco3
INSTITUTIONS (ALL):
1. Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
2. Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Rome, Italy.
3. Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy.
ABSTRACT BODY:
Abstract Body: Background: Endoscopic examination is stressful for patients, producing anxiety and fear, which
increase pain and discomfort. According to the fear-anxiety-avoidance model1
pain perception is affected by
catastrophizing thoughts. Other dispositions influence PC and pain perceptions. Intolerance of Uncertainty (IU) has
been recognized as related to chronic pain and anxiety2
. Anxiety Sensitivity (AS) was associated with PC, chronic
pain and accounted for the relationship of pain with anxious arousal3,4
.
Methods: 39 patients referred for upper endoscopy at the Endoscopy Unit of SAPIENZA University of Rome
participated in this study. Before endoscopy, patients completed the following scales: Anxiety Sensitivity Index (ASI);
Intolerance of Uncertainty Index (IUI); Hospital Anxiety and Depression Scale (HADS), Penn State Worry
Questionnaire (WQ). During endoscopy pain was rated by the Pain Assessment in Advanced Dementia Scale
(PAINAD). After endoscopy, patients reported about pain during the procedure (SR-PAIN). The Pain Catastrophizing
Scale (PCS) was also administered to assesses patient’s aptitude for catastrophic pain. Pain ratings were blinded as
to psychological test results. The study was approved by the local ethical committee.
Results: A non parametric mediation model for small samples (PLS-SEM, Fig. 1) was fitted to the data (R2
= .57 and
.25 for SR-Pain and PAINAD, respectively). IU was associated with WQ, AS, and HADS. In turn, both AS and HADS
predicted PC. In turn, PC was associated with SR-PAIN and with PAINAD. Indirect effects of IU on SR-PAIN and
PAINAD were both significant. HADS but not WQ predicted SR-PAIN. AS was predictive of both pain variables and
mediated the effect of IU (Tab. 1).
Conclusion: IU affected pain and discomfort through increasing anxiety sensitivity, health distress, and pain
catastrophizing. This model was consistent with the fear-anxiety-avoidance model1
and with recent evidence showing
that affective dispositions affect one’s experience of pain2–4. This is the first study showing a relation between IU and
AS with painduring a medical procedure.
1. Asmundson G, Norton P, Vlaeyen J. Fear-avoidance models of chronic pain: An overview. In: Press OU, ed.
Understanding and Treating Fear of Pain. ; 2004:26-43.
2. Fischerauer SF, Talaei-Khoei M, Vissers FL, et al. Pain anxiety differentially mediates the association of pain
intensity with function depending on level of intolerance of uncertainty. J Psychiatr Res. 2018;97(0):30-37.
3. Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, et al. The Key Role of Pain Catastrophizing in the Disability of
Patients with Acute Back Pain. Int J Behav Med. 2017;24(2):239-248.
4. Zvolensky MJ, Bakhshaie J, Paulus DJ, et al. Exploring the Mechanism Underlying the Association Between Pain
Intensity and Mental Health Among Latinos. J Nerv Ment Dis. 2017;205(4):300-307.
TABLE:
Note: The PDF table below is only an approximation of the HTML content and may not match formatting exactly.
Tab 1. Indirect effects for independent variables in Partial Least Squares Structural Equation
Modeling (PLS-SEM). Estimates are based on 5000 bootstrap resampings.
Indirect
Effect
Original
Sample
Mean
Bootstrap
Samples
Mean
Bootstrap
Samples SD
t-value p-level
WQ ---> SR
Pain
0.123 0.121 0.133 0.929 0.353
AS ---> SR
Pain
0.331 0.346 0.125 2.644 0.008
HADS --->
SR Pain
0.245 0.240 0.125 1.967 0.049
IU ---> PCS 0.416 0.445 0.116 3.574 0.000
WQ --->
PAINAD
0.081 0.088 0.099 0.816 0.415
AS --->
PAINAD
0.216 0.244 0.109 1.988 0.047
HADS --->
PAINAD
0.160 0.167 0.093 1.727 0.084
IU --->
PAINAD
0.205 0.246 0.102 2.010 0.045
IU ---> SR
PAIN
0.314 0.342 0.093 3.359 0.001
WQ = Worry Questionnaire PSWQ-A
SR Pain = Patient's Self-Reported Pain
AS = Anxiety Sensitivity Index
HADS = Hospital Anxiety and Depression Scale
IU = Intolerance of Uncertainty
PCS = Pain Catastrophizing Scale
PAINAD = Physcian Rated Pain by Pain Assessment in Advanced Dementia
Fig. 1. Partial Least Squares Structural Equations Modeling (PLS-SEM). Model fitted to upper endoscopy patient
data. Blue circles represent latent variables. Yellow rectangles represent empirical indicators. Estimates are
standardized regression path coefficients. Bold arrows connecting latent variables represent significant effects (p <
.05)
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