ANXIETY & BACK PAIN

Anxiety & Back Pain

Abstract

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.

Anxiety & Back Pain

Introduction

Health anxiety is characterized by severe and persistent concerns about health. In diagnostic terms, people who are disabled by their health anxiety can receive the diagnosis of 'hypochondriasis' (American Psychiatric Association, 2000; World Health Organization, 1994). Although cases meeting the criteria of hypochondriasis are rare in the community (.2%; Looper & Kirmayer, 2001), lower levels of health anxiety are extremely common in individuals who are physically ill or where there is reason for people to regard their longer-term health status as ambiguous. Elevated health anxiety has been observed among patients undergoing treatment for chronic pain (Hadjistavropoulos, Owens, Hadjistavropoulos, & Asmundson, 2001). In a recent study, Rode, Salkovskis, Dowd, and Hanna (2006) examined the occurrence of severe and persistent health anxiety in patients consecutively recruited from a specialist pain clinic. On the basis of responses to the Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002), these authors conservatively estimated the prevalence of hypochondriasis (i.e., SHAI18) to be at least 37% and of severe health anxiety (i.e., SHAI15) to be at least 51% among patients with chronic pain. These figures were much higher than the rates observed in both controls with pain (hypochondriasis: 3%; severe health anxiety: 18%) and controls without pain (hypochondriasis: 1%; severe health anxiety: 10%), consistent with the possible role of health anxiety as a causal and/or maintaining factor in chronic pain. The value of linking chronic pain to health anxiety lies in the possibility of applying theoretical and empirical work across these currently distinct areas.

The cognitive theory of health anxiety (Salkovskis & Bass, 1997; Salkovskis & Warwick, 1986; Warwick & Salkovskis, 1990) suggests that people with persistent and severe health anxiety have a relatively enduring tendency to misinterpret bodily symptoms and health-relevant information as evidence that they are suffering from ...