Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study

  • Banozic, Adriana (Laboratory for Pain Research, University of Split, School of Medicine) ;
  • Miljkovic, Ana (Department of Public Health, University of Split School of Medicine) ;
  • Bras, Marijana (Centre for Palliative Medicine, Medical Ethics and Communication Skills (CEPAMET), School of Medicine, University of Zagreb) ;
  • Puljak, Livia (Laboratory for Pain Research, University of Split, School of Medicine) ;
  • Kolcic, Ivana (Department of Public Health, University of Split School of Medicine) ;
  • Hayward, Caroline (Institute for Genomics and Molecular Medicine, University of Edinburgh) ;
  • Polasek, Ozren (Department of Public Health, University of Split School of Medicine)
  • Received : 2017.07.25
  • Accepted : 2017.11.15
  • Published : 2018.01.01


Background: The aim of this study was to investigate the association between neuroticism, pain catastrophizing, and experimentally induced pain threshold and pain tolerance in a healthy adult sample from two regions of the country of Croatia: the island of Korcula and city of Split. Methods: A total of 1,322 participants were enrolled from the Island of Korcula (n = 824) and the city of Split (n = 498). Participants completed a self-reported personality measure Eysenck Personality Questionnaire (EPQ) and pain catastrophizing questionnaire Pain Catastrophizing Scale (PCS), followed by a mechanical pain pressure threshold and tolerance test. We have explored the mediating role of catastrophizing in the relationship between neuroticism and pain intensity. Results: The results showed that pain catastrophizing partially mediated the relationship between neuroticism and pain intensity, suggesting the importance of pain catastrophizing in increasing vulnerability to pain. The results also indicated gender-related differences, marked by the higher pain threshold and tolerance in men. Conclusions: This study adds to the understanding of the complex interplay between personality and pain, by providing a better understanding of such mechanisms in healthy adults.


  1. Ebert MH, Kerns RD. Behavioral and psychopharmacologic pain management. Cambridge, Cambridge University Press. 2010, p 506.
  2. al Absi M, Rokke PD. Can anxiety help us tolerate pain? Pain 1991; 46: 43-51.
  3. Garron DC, Leavitt F. Psychological and social correlates of the back pain classification scale. J Pers Assess 1983; 47: 60-5.
  4. Jones A, Spindler H, Jorgensen MM, Zachariae R. The effect of situation-evoked anxiety and gender on pain report using the cold pressor test. Scand J Psychol 2002; 43: 307-13.
  5. Tang J, Gibson SJ. A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain 2005; 6: 612-9.
  6. Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol 2004; 59: 795-805.
  7. Marbach JJ, Raphael KG. Phantom tooth pain: a new look at an old dilemma. Pain Med 2000; 1: 68-77.
  8. Wade JB, Dougherty LM, Hart RP, Rafii A, Price DD. A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering, and pain behavior. Pain 1992; 51: 67-73.
  9. Lahey BB. Public health significance of neuroticism. Am Psychol 2009; 64: 241-56.
  10. Smith TW, MacKenzie J. Personality and risk of physical illness. Annu Rev Clin Psychol 2006; 2: 435-67.
  11. Payne LA, Seidman LC, Lung KC, Zeltzer LK, Tsao JC. Relationship of neuroticism and laboratory pain in healthy children: does anxiety sensitivity play a role? Pain 2013; 154: 103-9.
  12. Malt EA, Olafsson S, Lund A, Ursin H. Factors explaining variance in perceived pain in women with fibromyalgia. BMC Musculoskelet Disord 2002; 3: 12.
  13. Affleck G, Tennen H, Urrows S, Higgins P. Neuroticism and the pain-mood relation in rheumatoid arthritis: insights from a prospective daily study. J Consult Clin Psychol 1992; 60: 119-26.
  14. Vassend O, Roysamb E, Nielsen CS. Five-factor personality traits and pain sensitivity: a twin study. Pain 2013; 154: 722-8.
  15. Goubert L, Crombez G, Van Damme S. The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: a structural equations approach. Pain 2004; 107: 234-41.
  16. Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between neuroticism and depression in relation to catastrophizing and pain-related anxiety in chronic pain patients. PLoS One 2015; 10: e0126351.
  17. Vervoort T, Goubert L, Eccleston C, Bijttebier P, Crombez G. Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain. J Pediatr Psychol 2006; 31: 674-83.
  18. Swinkels-Meewisse IE, Roelofs J, Verbeek AL, Oostendorp RA, Vlaeyen JW. Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain. Clin J Pain 2006; 22: 45-54.
  19. Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 2001; 17: 52-64.
  20. Vendrig AA, Hoofs MH, van Akkerveeken PF, Lamberts-Hopkes KJ. Multidisplinary approach to chronic back pain: postrehabilitation resumption of work the same 3-4 years later as after 6 months. Ned Tijdschr Geneeskd 2000; 144: 2207-9.
  21. Lee JE, Watson D, Frey Law LA. Lower-order pain-related constructs are more predictive of cold pressor pain ratings than higher-order personality traits. J Pain 2010; 11: 681-91.
  22. Geisser ME, Haig AJ, Wallbom AS, Wiggert EA. Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain 2004; 20: 61-9.
  23. Rollman GB. Measurement of experimental pain in chronic pain patients: methodological and individual factors. In: Pain measurement and assessment. Edited by Melzack R. New York (NY), Raven Press. 1983, pp 251-8.
  24. Zisk RY, Grey M, MacLaren JE, Kain ZN. Exploring sociodemographic and personality characteristic predictors of parental pain perceptions. Anesth Analg 2007; 104: 790-8.
  25. Thorn BE, Ward LC, Sullivan MJ, Boothby JL. Communal coping model of catastrophizing: conceptual model building. Pain 2003; 106: 1-2.
  26. Miljkovic A, Pehlic M, Budimir D, Gunjaca G, Mudnic I, Pavic A, et al. Can genetics aggravate the health of isolated and remote populations? The case of gout, hyperuricaemia and osteoarthritis in Dalmatia. Rural Remote Health 2013; 13: 2153.
  27. Vitart V, Biloglav Z, Hayward C, Janicijevic B, Smolej-Narancic N, Barac L, et al. 3000 years of solitude: extreme differentiation in the island isolates of Dalmatia, Croatia. Eur J Hum Genet 2006; 14: 478-87.
  28. Polasek O, Kolcic I, Smoljanovic A, Stojanovic D, Grgic M, Ebling B, et al. Demonstrating reduced environmental and genetic diversity in human isolates by analysis of blood lipid levels. Croat Med J 2006; 47: 649-55.
  29. Eysenck HJ, Eysenck SB. Manual of the Eysenck personality questionnaire: (EPQ-R Adult). San Diego (CA), Educational and Industrial Testing Service. 1994.
  30. Eysenck HJ, Eysenck SB. Prirucnik za Eysenckov upitnik licnosti EPQ (djeca i odrasli). Jastrebarsko, Naklada Slap. 2003.
  31. Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 524-32.
  32. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173-82.
  33. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York (NY), Guilford Press. 2013.
  34. France CR, France JL, al'Absi M, Ring C, McIntyre D. Catastrophizing is related to pain ratings, but not nociceptive flexion reflex threshold. Pain 2002; 99: 459-63.
  35. Rhudy JL, Martin SL, Terry EL, France CR, Bartley EJ, DelVentura JL, et al. Pain catastrophizing is related to temporal summation of pain but not temporal summation of the nociceptive flexion reflex. Pain 2011; 152: 794-801.
  36. Wee LE, Sin D, Cher WQ, Li ZC, Tsang T, Shibli S, et al. “I'm healthy, I don't have pain”- health screening participation and its association with chronic pain in a low socioeconomic status Singaporean population. Korean J Pain 2017; 30: 34-43.
  37. Ghobadifar MA. An update on the management of diabetic neuropathic pain: a few comments. Korean J Pain 2015; 28: 158-9.
  38. Komasi S, Soroush A, Bahremand M, Saeidi M. Irrational beliefs predict pain/discomfort and emotional distress as a result of pain in patients with non-cardiac chest pain. Korean J Pain 2016; 29: 277-9.
  39. Thorn BE, Clements KL, Ward LC, Dixon KE, Kersh BC, Boothby JL, et al. Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain. Clin J Pain 2004; 20: 275-82.
  40. Sullivan MJ, Martel MO, Tripp DA, Savard A, Crombez G. Catastrophic thinking and heightened perception of pain in others. Pain 2006; 123: 37-44.
  41. Osborn J, Derbyshire SW. Pain sensation evoked by observing injury in others. Pain 2010; 148: 268-74.
  42. Ferracuti S, De Carolis A. Relationships among Eysenck's extraversion, Rorschach's Erlebnistypus, and tolerance of experimental tonic pain (Cold Water Pressor Test). Percept Mot Skills 2005; 100: 237-48.
  43. Burns JW, Glenn B, Bruehl S, Harden RN, Lofland K. Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis. Behav Res Ther 2003; 41: 1163-82.
  44. Campbell CM, Kronfli T, Buenaver LF, Smith MT, Berna C, Haythornthwaite JA, et al. Situational versus dispositional measurement of catastrophizing: associations with pain responses in multiple samples. J Pain 2010; 11: 443-53.e2.
  45. Kunz M, Chatelle C, Lautenbacher S, Rainville P. The relation between catastrophizing and facial responsiveness to pain. Pain 2008; 140: 127-34.
  46. Lehmann R, Denissen JJ, Allemand M, Penke L. Age and gender differences in motivational manifestations of the Big Five from age 16 to 60. Dev Psychol 2013; 49: 365-83.
  47. Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J, et al. Perceptions by family members of the dying experience of older and seriously ill patients. Ann Intern Med 1997; 126: 97-106.
  48. Chapman BP, Duberstein PR, Sorensen S, Lyness JM. Gender differences in five factor model personality traits in an elderly cohort: extension of robust and surprising findings to an older generation. Pers Individ Dif 2007; 43: 1594-603.
  49. Dixon KE, Thorn BE, Ward LC. An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description. Pain 2004; 112: 188-96.
  50. Mogil JS. Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci 2012; 13: 859-66.
  51. Mogil JS, Bailey AL. Sex and gender differences in pain and analgesia. Prog Brain Res 2010; 186: 141-57.
  52. Mogil JS, Chesler EJ, Wilson SG, Juraska JM, Sternberg WF. Sex differences in thermal nociception and morphine antinociception in rodents depend on genotype. Neurosci Biobehav Rev 2000; 24: 375-89.
  53. Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choiniere M. A systematic literature review of 10 years of research on sex/gender and pain perception - part 2: do biopsychosocial factors alter pain sensitivity differently in women and men? Pain 2012; 153: 619-35.

Cited by

  1. Acceptance versus catastrophizing in predicting quality of life in patients with chronic low back pain vol.32, pp.1, 2019,