The effect of catastrophizing self-statements on pain perception and the nociceptive flexor reflex (RIII reflex)

Pain catastrophizing, an excessively negative cognitive and emotional orientation toward pain, is one of the most important psychological determinants of the individual pain experience. The neural basis of the association between catastrophizing and enhanced pain perception is only incompletely understood. Recently, several forms of pain modulation by cognitive and emotional factors have been found to at least partly rely on descending pain modulatory pathways that govern spinal gating mechanisms. We used the spinally mediated nociceptive flexor reflex (RIII reflex) to investigate whether spinal nociceptive transmission is affected when participants engage in catastrophizing self-statements.

The effect of catastrophizing self-statements on basal RIII reflex areas, their temporal summation, and the concomitant pain perception was determined in 27 young healthy participants.

Catastrophizing self-statement reversibly enhanced both basal pain perception and RIII reflex areas. Effect sizes for the effect on pain perception were considerably larger than for the effect on spinal nociception. Catastrophizing self-statements did not affect temporal summation of pain perception or temporal summation of the RIII reflex.

The results of present study suggest that the effect of catastrophizing self-statements on pain is predominantly supraspinal, with a smaller but significant contribution from descending pathways. In addition, catastrophizing self-statements seem to predominantly affect mechanisms involved in the processing of single nociceptive stimuli, not their temporal summation.