The Expression of Pain Behaviors in High Catastrophizers: The Influence of Automatic and Controlled Processes

In the present study, patients with musculoskeletal pain conditions (n = 55) were filmed while performing a lifting task designed to elicit pain behaviors. Patients were asked to perform the lifting task twice, under 2 distinct conditions. In the first condition, patients were asked to rate their pain while lifting a series of weights. In the second condition, patients were asked to estimate the weight of the objects they lifted. The weight estimation condition was conceived as a way to increase the cognitive load associated with the lifting task. The primary purpose of the present study was to examine whether manipulation of cognitive load differentially influenced the expression of pain behaviors in high and low catastrophizers. During the pain rating condition, results indicated that high catastrophizers displayed significantly higher levels of communicative and protective pain behaviors than low catastrophizers. During the weight estimation condition, however, high and low catastrophizers no longer differed in the expression of communicative pain behaviors. These results suggest that increasing cognitive load during a pain-eliciting task may interfere with the expression of communicative pain behaviors in high catastrophizers. The discussion addresses the potential role of automatic and cognitive control processes in the expression of pain behaviors.PerspectiveThe present study provides new insights into the processes that might underlie the expression of pain behaviors in patients with high levels of catastrophizing. Our findings could have implications for the management of patients presenting with pain conditions, particularly those with high levels of catastrophizing.