Psychological, cognitive factors and contextual influences in pain and pain-related suffering as revealed by a combined qualitative and quantitative assessment approach

Previous psychophysiological research suggests that pain measurement needs to go
beyond the assessment of Pain Intensity and Unpleasantness by adding the evaluation of
Pain-Related Suffering. Based on this three-dimensional approach, we attempted to elucidate
who is more likely to suffer by identifying reasons that may lead individuals to report
Pain and Pain-Related Suffering more than others. A sample of 24 healthy participants
(age range 18±33) underwent four different sessions involving the evaluation of experimentally
induced phasic and tonic pain. We applied two decision tree models to identify
variables (selected from psychological questionnaires regarding pain and descriptors
from post-session interviews) that provided a qualitative characterization of the degrees
of Pain Intensity, Unpleasantness and Suffering and assessed the respective impact of
contextual influences. The overall classification accuracy of the decision trees was 75%
for Intensity, 77% for Unpleasantness and 78% for Pain-Related Suffering. The reporting
of suffering was predominantly associated with fear of pain and active cognitive coping
strategies, pain intensity with bodily competence conveying strength and resistance and
unpleasantness with the degree of fear of pain and catastrophizing. These results indicate
that the appraisal of the three pain dimensions was largely determined by stable psychological
constructs. They also suggest that individuals manifesting higher active coping
strategies may suffer less despite enhanced pain and those who fear pain may suffer
even under low pain. The second decision tree model revealed that suffering did not
depend on pain alone, but that the complex rating-related decision making can be shifted
by situational factors (context, emotional and cognitive). The impact of coping and fear of pain on individual Pain-Related Suffering may highlight the importance of improving cognitive
coping strategies in clinical settings.