Adult Attachment Is Not Associated With Conditioned Pain Modulation in Healthy Females in a Neutral Social Context

Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This study investigated whether impaired CPM is seen in pain-free individuals and determined associations with attachment.

A CPM test paradigm was used to determine the differences in the measures of pain across attachment anxiety and avoidance dimensions in pain-free females in a neutral social context. First, static (heat pain threshold, heat pain tolerance, and cold pain intensity) and dynamic (cumulative pain load) measures of pain were explored.

One hundred and three females were recruited (median [IQR] age: 21 [20-23] years). We found no associations between attachment dimensions and static measures of pain (ps > 0.05). Higher attachment anxiety, but not avoidance, was associated with an increase in pain intensity over time (Estimate [95% CI] = 0.15 [0.06-0.25], p-value = 0.002), and increased average test stimulus pain intensity rating both before (Estimate [95% CI] = 0.15 [0.07-0.23], p-value < 0.001) and during (Estimate [95% CI] = 0.36 [0.23-0.48], p-value < 0.001) conditioning. In the 78% (80/103) who completed the full CPM procedure, there was no association between CPM effect and attachment anxiety (Estimate [95% CI] = -3.79 [-8.62 to 1.03], p = 0.122) or avoidance (Estimate [95% CI] = 0.25 [-4.88 to 5.38], p = 0.923). Effective CPM was seen in 90% (72/80).

Impaired CPM was not seen in pain-free individuals suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.

Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This is the first study to investigate a link between attachment and experimental pain using a conditioned pain modulation (CPM) paradigm in a neutral social context. Impaired CPM was not seen in pain-free individuals, suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.