Background & Aims
People with chronic pain (CP) suffer from depression, anxiety, and anger1. Such emotional distress was shown to be crucial in the development and manifestation of CP2. Although the association between distress and pain is well established, it is still unclear what mechanism might mediate this relationship. Interoception reflects the body’s internal physiological state and is considered the basis for affective states such as pain and emotions. Moreover, interoceptive dysfunction is suggested both in emotion-related mental health3 and in CP conditions4. A recent meta-analysis5 indicated interoceptive sensibility (IS), the self-reported multidimensional tendency to focus on various features of interoceptive signals, differs between CP and pain-free controls (PFC). We hypothesized that individuals with CP will experience greater pain, emotional distress, and differential IS compared to PFCs. Moreover, we expected IS to mediate the relationship between emotional distress and pain severity.
Methods
CP and PFC participants were recruited via social media and completed an online survey. Pain intensity was measured as the average of three pain items (worst and average in past week, and current; range 0-10)6. Emotional distress was measured as the average of the depression, anxiety, and anger PROMIS assessments7 (range 0-40). Interoception was measured by MAIA-2, a questionnaire assessing 8 dimensions of IS8 (range 0-5). Sample included n=239 (35.15% male, age=45.14±14.44) of mixed-etiology CP, meeting inclusion criteria of pain intensity?3, persistent pain of ?3 months, and pain in ?half of days in past 6 months9,10and n=170 PFC (32.35% male, age=48.11±15.32) with no CP, no diagnosed mental health condition, and pain intensity<3. Measures were compared between groups, and correlations were assessed within groups. A bootstrap-based mediation model11 tested whether IS mediated the link between emotional distress and pain intensity. This study was preregistered in OSF on Nov 27th,2023.
Results
Groups did not differ in sex distribution (p=0.56), but CP were slightly younger than PFC (p<0.05). Age was thus included as a covariate in subsequent analyses. CP had higher pain (6.09±1.72) and emotional distress (21.22±6.60) compared to PFC (0.99±0.93, 13.35±3.55; p’s<0.001). There was a group difference in 5 of 8 MAIA-2 subscales: Noticing (3.60±1.07), Attention Regulation (3.310±0.92) and Trusting (3.03±1.31) were higher, while Self-Regulation (2.59±1.15) and Body Listening (2.52±1.23) were lower in CP compared to PFC (2.26±0.54; 2.66±0.58, 2.34±1.24, 3.33±1.07, 2.85±1.05; p’s<0.001). Pain correlated with emotional distress (CP=0.26, PFC=0.31; p’s<0.001) and Trusting (CP=-0.18, p=0.005; PFC=ns). Emotional distress correlated with Noticing (CP=0.22, PFC=0.31; p’s<0.001), Trusting (CP=-0.43, p<0.001; PFC=ns), Self-Regulation (CP=-0.31, p<0.001; PFC=ns), and Body Listening (CP=ns; PFC=-0.33, p<0.001). In CP, a model with Trusting as a mediator between emotional distress and pain was ns.
Conclusions
As hypothesized, individuals with CP demonstrated greater pain, emotional distress, and a differential pattern of IS as assessed using MAIA-2 compared to PFCs. As in a previous meta-analysis5, Noticing was higher, Self-Regulation was lower, and there were no differences in the Not-Distracting and Emotional Awareness sub-scales. However, the other sub-scales showed a reverse pattern (e.g., Trusting), or a nonexistent one (e.g., Not-Worrying, which was lower). Furthermore, similar to one study we found a weak negative correlation between pain and Trusting11, but unlike that study, no correlation was found with Not-Distracting and Not-Worrying. In fact, as another study12, no correlation was found in any of the other sub-scales. Counter to hypothesis, IS did not mediate the link between emotional distress and pain intensity, which was slightly weaker than expected13. These preliminary findings are informative to understanding interoception’s role in pain, though require further scrutiny.
References
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13.Sturgeon, J. A., Dixon, E. A., Darnall, B. D. & Mackey, S. C. Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain 156, 2627–2633 (2015).
Presenting Author
Or Katrieli
Poster Authors
Or Katrieli
B.Sc Dental Medicine
Hebrew University of Jerusalem
Lead Author
Jemma Silvert
Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusale
Lead Author
Marine Granjon
Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusale
Lead Author
Yaron Haviv
Department of Oral Medicine Sedation and Maxillofacial Imaging, The Hebrew University-Hadassah Schoo
Lead Author
Gadi Gilam
Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusale
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial