Pain catastrophizing, pain sensitivity and fear of pain are associated with early life environmental unpredictability: a path model approach

Background Socioeconomic disadvantages in the childhood environment might strongly influence beliefs and behavior characterizing the adult years. When children experience unpredictable and adverse situations, they develop an unpredictability schema with the core belief that situations are unpredictable. Methods In two studies, we examined the association of childhood socioeconomic disadvantages with self-reported pain sensitivity, pain catastrophizing, and pain-related fear. Multidimensional survey measures were used to assess environmental conditions experienced in childhood. In addition, participants completed the Pain Catastrophizing Scale, Pain Sensitivity Questionnaire, Body Awareness Questionnaire, Unpredictability Schema Questionnaire, and Fear of Pain Questionnaire. In Study 1 (N = 252), in separate models, we examined pain sensitivity and pain catastrophizing of a community sample of pain-free young individuals in association with their childhood experiences. In Study 2 (N = 293), in a new sample, but with a wider age range, we examined the association of early life socioeconomic disadvantages with pain-related fear. In both studies, the predictions were tested with Structural Equation Modeling. Our models constituted a path from childhood socioeconomic status and household unpredictability to pain variables via the factors of family resources, unpredictability schemas, and body awareness. Results and conclusions The findings converged on the conclusion that individuals experiencing disadvantageous early life conditions tended to have an elevated level of pain catastrophizing, higher perceived sensitivity to pain, and higher level of pain-related fear. These associations were mediated by an unpredictability schema and body awareness.