Background & Aims
Interoception (i.e., one’s relation to internal bodily sensations) is increasingly recognized as an important factor underlying chronic pain.1,2 Additionally, improved interoceptive awareness is purported to be a mechanism of change in interventions for chronic pain.3,4 However, the extent to which interoceptive awareness is associated with pain among individuals with chronic low back pain (CLBP) remains understudied. Given research documenting peripheral and central sensory alterations and enhanced pain sensitivity among individuals with CLBP,5,6 identifying psychosocial factors that are associated with pain sensitivity and that can be targeted in nonpharmacologic treatments for chronic pain is vital for treatment optimization. We examined the relationship between interoceptive awareness and laboratory-assessed pain sensitivity among adults with CLBP. Given documented gender differences in pain, we also examined gender differences in the aforementioned associations.
Methods
Baseline data was collected from 115 participants (74 female, mean age = 43.01 years, 71.8% White) enrolled in a study assessing physical activity interventions for CLBP. Participants completed online self-report questionnaires, including a measure of interoceptive awareness (MAIA-2)7 and a laboratory-based quantitative sensory testing (QST) battery of mechanical and thermal stimuli. Four subscales of the MAIA-2 (i.e., Noticing, Not-distracting, Not-worrying, and a Self-regulation composite score), and two QST-derived pain sensitivity metrics (i.e., Pressure Pain Threshold and Heat Pain Threshold) were examined in the present study. T-tests were conducted to assess gender differences in pain sensitivity and MAIA subscales. Separate linear regression models for men and women examined associations between MAIA subscales and pain sensitivity measures while controlling for endogenous pain modulation measured by pain habituation.8
Results
Women demonstrated significantly higher scores on both Pressure Pain Threshold and Heat Pain Threshold (ps < .01). No gender differences were found between the four MAIA subscales (all ps >.32). For women, higher scores on the Not-worrying subscale was associated with higher Pressure Pain Thresholds (B = .295, p = .012) and Heat Pain Thresholds (B = .240, p = .031), controlling for the effect of endogenous pain modulation. No other associations were significant for women. For men, none of the MAIA subscales were significantly associated with either pain sensitivity measure (all ps > .10).
Conclusions
Findings demonstrate that for women with CLBP, aspects of interoceptive awareness, specifically the tendency to not worry about their bodily sensations of discomfort, are associated with more adaptive laboratory-assessed pain sensitivity outcomes, including both higher thermal and mechanical pain thresholds. For males, on the other hand, interoceptive awareness was not associated with either measure of pain sensitivity. Results provide important gender-specific insight into the role of interoceptive awareness in pain sensitivity.
References
1. Di Lernia, D., Serino, S., & Riva, G. (2016). Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neuroscience & Biobehavioral Reviews, 71, 328–341.
2. Horsburgh, A., Summers, S. J., Lewis, A., Keegan, R. J., & Flood, A. (2024). The relationship between pain and interoception: A systematic review and meta-analysis. The Journal of Pain.
3. Gnall, K. E., Sinnott, S. M., Laumann, L. E., Park, C. L., David, A., & Emrich, M. (2024). Changes in interoception in mind-body therapies for chronic pain: A systematic review and meta-analysis. International Journal of Behavioral Medicine.
4. Mehling, W. (2016). Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philosophical Transactions of the Royal Society of London. Series B. Biological Sciences, 371(1708), 20160013.
5. Curatolo M, Arendt-Nielsen L. Central hypersensitivity in chronic musculoskeletal pain. Phys Med Rehabil Clin N Am 2015;26:175–84.
6. Giesecke, T., Gracely, R. H., Grant, M. A., Nachemson, A., Petzke, F., Williams, D. A., & Clauw, D. J. (2004). Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 50(2), 613-623.
7. Mehling, W. E., Acree, M., Stewart, A., Silas, J., & Jones, A. (2018). The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS ONE, 13(12), e0208034.
8. van der Miesen, M. M., Joosten, E. A., Kaas, A. L., Linden, D. E., Peters, J. C., & Vossen, C. J. (2022). Habituation to pain: self-report, electroencephalography, and functional magnetic resonance imaging in healthy individuals. A scoping review and future recommendations. Pain, 10-1097.
Presenting Author
Katherine Gnall
Poster Authors
Katherine Gnall
MSc
University of Connecticut
Lead Author
Crystal Park
PhD
University of Connecticut
Lead Author
Angela Starkweather
PhD
Lead Author
Wolf Mehling
UCSF
Lead Author
Irina Strigo
Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial