Brain and behavior · 2026
How Affective States Moderate the Relationship of Pain Catastrophizing With Pain Severity in Patients With Acute and Chronic Pain.
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Kuper Quinte T Y, Willemen Jasmijn E, Lousberg Richel, Severeijns Ruud J M, van Amelsvoort Therese A M J, Balthasar Andrea J R
Аннотация
BACKGROUND: Psychological factors, including mood, affect, and pain catastrophizing, critically influence pain perception. We aimed to examine the relationships of these factors with pain trajectories in both acute postsurgical pain (APSP) and chronic non-cancer pain (CNCP) cohorts.
METHODS: We included 31 patients who underwent total knee arthroplasty (TKA) and 21 patients with CNCP. All included patients completed the pain catastrophizing scale (PCS) questionnaire. In addition, patients reported their status within their natural environment (ten times a day for 6 days) using an experience sampling method-a smartphone app, which contains items regarding pain, positive affect (PA), and negative affect (NA).
RESULTS: Pain scores showed a normal distribution in both cohorts; the APSP cohort reported significantly lower overall pain scores than the CNCP cohort (p = 0.003). In both cohorts, affective state was significantly associated with pain severity (p < 0.001). However, PCS scores were not significantly associated with pain severity. Notably, a higher PA was associated with lower pain severity among patients with high PCS scores, with a stronger association in the APSP cohort.
CONCLUSIONS: Our findings indicate that affective state is associated with pain severity in both APSP and CNCP cohorts. The combination of low PA and high PCS may be relevant for identifying individuals with higher pain severity, particularly in the APSP cohort. These results provide a basis for future research on targeted approaches aimed at enhancing PA and reducing catastrophic pain-related thoughts.
STATEMENT OF SIGNIFICANCE: Our study shows that affective states play a key role in pain severity in both acute and chronic pain cohorts. Positive affect is associated with lower pain severity in patients with high PCS scores, with a stronger effect after surgery than in chronic pain. These results suggest that early identification of high catastrophizing and low positive affect may support targeted interventions to enhance recovery and potentially reduce the risk of developing chronic pain.
METHODS: We included 31 patients who underwent total knee arthroplasty (TKA) and 21 patients with CNCP. All included patients completed the pain catastrophizing scale (PCS) questionnaire. In addition, patients reported their status within their natural environment (ten times a day for 6 days) using an experience sampling method-a smartphone app, which contains items regarding pain, positive affect (PA), and negative affect (NA).
RESULTS: Pain scores showed a normal distribution in both cohorts; the APSP cohort reported significantly lower overall pain scores than the CNCP cohort (p = 0.003). In both cohorts, affective state was significantly associated with pain severity (p < 0.001). However, PCS scores were not significantly associated with pain severity. Notably, a higher PA was associated with lower pain severity among patients with high PCS scores, with a stronger association in the APSP cohort.
CONCLUSIONS: Our findings indicate that affective state is associated with pain severity in both APSP and CNCP cohorts. The combination of low PA and high PCS may be relevant for identifying individuals with higher pain severity, particularly in the APSP cohort. These results provide a basis for future research on targeted approaches aimed at enhancing PA and reducing catastrophic pain-related thoughts.
STATEMENT OF SIGNIFICANCE: Our study shows that affective states play a key role in pain severity in both acute and chronic pain cohorts. Positive affect is associated with lower pain severity in patients with high PCS scores, with a stronger effect after surgery than in chronic pain. These results suggest that early identification of high catastrophizing and low positive affect may support targeted interventions to enhance recovery and potentially reduce the risk of developing chronic pain.