A Principal Components Analysis of Negative Affect-Related Constructs Relevant to Pain: Evidence for a Three Component Structure

Published:December 16, 2009DOI:


      A number of negative affect-related constructs are important in pain. Some are general, such as anxiety, depression and negative affectivity, whereas others are more specifically pain-related (eg, fear of pain, pain anxiety, and pain catastrophizing). In addition, some more specific fear-related constructs, such as anxiety sensitivity, illness/injury sensitivity, and fear of negative evaluation have emerged as important to pain. Although these various constructs are considered conceptually separate, there is likely to be overlap between them. Since the extent of this overlap is unknown, the aim of the current study was to investigate these constructs in 1 sample in order to identify their common and unique features. Frequently used psychological measures were completed by 508 pain-free participants. Principal components analysis resulted in the extraction of three components: 1) General distress; 2) Fear of pain from injury/insult; and 3) Cognitive intrusion of pain. The results presented here suggest that there is indeed commonality between constructs, which may be due to either an overlap between items within measures or to close conceptual relatedness. The implications of these core dimensions are discussed with reference to future research and theory.


      This article explores the relationships between various negative-affect pain-related measures and discusses the results from a principal components analysis. The findings show that some questionnaires may measure the same latent construct. A measure could be developed to measure these 3 core components more concisely for both clinical and research purposes.

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        • Abrams M.P.
        • Carleton R.N.
        • Asmundson G.J.G.
        An exploration of the psychometric properties of the PASS-20 with a nonclinical sample.
        J Pain. 2007; 8: 879-886
        • Antony M.M.
        • Bieling P.J.
        • Cox B.J.
        • Enns M.W.
        • Swinson R.P.
        Psychometric Properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.
        Psychol Assessment. 1998; 10: 176-181
        • Asmundson G.J.
        • Norton P.J.
        • Vlaeyen J.W.S.
        Fear-avoidance models of chronic pain: An overview.
        in: Asmundson G.J. Vlaeyen J.W.S. Crombez G. Understanding and treating fear of pain. 1st ed. Oxford University Press, Oxford, UK2004: 3-24
        • Asmundson G.J.G.
        • Taylor S.
        Role of anxiety sensitivity in pain-related fear and avoidance.
        J Behav Med. 1996; 19: 577-586
        • Banks S.M.
        • Kerns R.D.
        Explaining high rates of depression in chronic pain: A diathesis-stress framework.
        Psychol Bull. 1996; 119: 95-110
        • Barlow D.H.
        Anxiety and its Disorders.
        2nd ed. Guilford Press, New York, NY2002
        • Carleton R.N.
        • Asmundson G.J.
        • Taylor S.
        Fear of physical harm: Factor structure and psychometric properties of the injury/illness sensitivity index.
        J Psychopathol Behav. 2005; 27: 235-241
        • Clark L.A.
        • Watson D.
        Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications.
        J Abnorm Psycho. 1991; 100: 316-336
        • Comrey A.L.
        • Lee H.B.
        A First Course in Factor Analysis.
        2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1992
        • Conrad R.
        • Schilling G.
        • Bausch C.
        • Nadstawek J.
        • Wartenberg H.C.
        • Wegener I.
        • Geiser F.
        • Imbierowicz K.
        • Liedtke R.
        Temperament and character personality profiles and personality disorders in chronic pain patients.
        Pain. 2007; 133: 197-209
        • Coons M.J.
        • Hadjistavropoulos H.D.
        • Asmundson G.J.
        Factor structure and psychometric properties of the Pain Anxiety Symptoms Scale-20 in a community physiotherapy clinic sample.
        Eur J Pain. 2004; 8: 511-516
        • Crombez G.
        • Vlaeyen J.W.S.
        • Heuts P.H.T.G.
        • Lysens R.
        Pain-related fear is more disabling than fear itself: Evidence on the role of pain-related fear in chronic back pain disability.
        Pain. 1999; 80: 329-339
        • Davidson M.A.
        • Tripp D.A.
        • Fabrigar L.R.
        • Davidson P.R.
        Chronic pain assessment: A seven-factor model.
        Pain Res Manage. 2008; 13: 299-308
        • Drahovzal D.N.
        • Stewart S.H.
        • Sullivan M.J.L.
        Tendency to catastrophize somatic sensations: Pain catastrophizing and anxiety sensitivity in predicting headache.
        Cogn Behav Ther. 2006; 35: 226-235
        • Keefe F.J.
        • Brown G.K.
        • Wallston K.A.
        Coping with rheumatoid arthritis: Catastrophizing as a maladaptive strategy.
        Pain. 1989; 37: 51-56
        • Keefe F.J.
        • Lumley M.
        • Anderson T.
        • Lynch T.
        • Carson K.L.
        Pain and emotion: New research directions.
        J Clin Psychol. 2001; 57: 587-607
        • Keogh E.
        • Asmundson G.J.
        Negative affectivity, catastrophizing, and anxiety sensitivity.
        in: Asmundson G.J. Vlaeyen J.W.S. Crombez G. Understanding and Treating Fear of Pain. 1st ed. Oxford University Press, Oxford, UK2004: 91-115
        • Keogh E.
        • Barlow C.
        • Mounce C.
        • Bond F.W.
        Assessing the relationship between cold pressor pain responses and dimensions of the anxiety sensitivity profile in healthy men and women.
        Cogn Behav Ther. 2006; 35: 198-206
        • Leary M.R.
        A brief version of the fear of negative evaluation scale.
        Pers Soc Psychol B. 1983; 9: 371-375
        • Leeuw M.
        • Goossens M.E.J.B.
        • Linton S.J.
        • Crombez G.
        • Boersma K.
        • Vlaeyen J.W.S.
        The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence.
        J Behav Med. 2007; 30: 77-94
        • Liebert R.M.
        • Morris L.W.
        Cognitive and emotional components of test anxiety: A distinction and some initial data.
        Psychol Rep. 1967; 20: 975-978
        • Lilienfeld S.O.
        • Turner S.M.
        • Jacob R.G.
        Anxiety sensitivity: An examination of theoretical and methodological issues.
        Adv Behav Res Ther. 1993; 15: 147-183
        • Lovibond S.H.
        • Lovibond P.F.
        Manual for Depression Anxiety Stress Scales.
        2nd ed. Psychology Foundation, Sydney, Australia1995
        • MacDonald G.
        • Leary M.R.
        Why does social exclusion hurt? The relationship between social and physical pain.
        Psychol Bull. 2005; 131: 202-223
        • Maller R.G.
        • Reiss S.
        A behavioral validation of the Anxiety Sensitivity Index.
        J Anxiety Disord. 1987; 1: 265-272
        • McCracken L.M.
        • Dhingra L.
        A short version of the pain anxiety symptoms scale (PASS-20): Preliminary development and validity.
        Pain Res Manag. 2002; 7: 45-50
        • McCracken L.M.
        • Zayfert C.
        • Gross R.T.
        The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain.
        Pain. 1992; 50: 67-73
        • McNeil D.W.
        • Rainwater A.J.
        Development of the Fear of Pain questionnaire - III.
        J Behav Med. 1998; 21: 389-410
        • Morris L.W.
        • Davis M.A.
        • Hutchings C.H.
        Cognitive and emotional components of anxiety: Literature review and a revised worry-emotionality scale.
        J Educ Psychol. 1981; 73: 541-555
        • Norton P.J.
        • Asmundson G.J.
        Amending the fear-avoidance model of chronic pain: What is the role of psychological arousal?.
        Behav Ther. 2003; 34: 17-30
        • Osman A.
        • Barrios F.X.
        • Gutierrez P.M.
        • Kopper B.A.
        • Merrifield T.
        • Grittmann L.
        The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples.
        J Behav Med. 2000; 23: 351-365
        • Osman A.
        • Barrios F.X.
        • Kopper B.A.
        • Hauptmann W.
        • Jones J.
        • O'Neill E.
        Factor structure, reliability, and validity of the Pain Catastrophizing Scale.
        J Behav Med. 1997; 20: 589-605
        • Peterson R.A.
        • Heilbronner R.L.
        The Anxiety Sensitivity Index: Construct validity and factor analytic structure.
        J Anx Disord. 1987; 1: 117-121
        • Reiss S.
        • Peterson R.A.
        • Gursky D.M.
        • McNally R.J.
        Anxiety Sensitivity, Anxiety Frequency and the Prediction of Fearfulness.
        Behav Res Ther. 1986; 24: 1-8
        • Roelofs J.
        • McCracken L.M.
        • Peters M.L.
        • Crombez G.
        • van Breukelen G.
        • Vlaeyen J.W.S.
        Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients.
        J Behav Med. 2004; 27: 167-183
        • Schmidt N.B.
        • Cook J.H.
        Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder.
        Behav Res Ther. 1999; 37: 313-323
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.
        • Vagg P.R.
        • Jacobs G.A.
        Manual for the State-trait Anxiety Inventory (Form Y).
        1st ed. Consulting Psychology Press, Palo Alto, CA1983
        • Sullivan M.J.L.
        • Bishop S.R.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Sullivan M.J.L.
        • Thorn B.
        • Haythornthwaite J.A.
        • Keefe F.J.
        • Martin M.
        • Bradley L.A.
        • Lefebvre J.C.
        Theoretical perspectives on the relationship between catastrophizing and pain.
        Clin J Pain. 2001; 17: 52-64
        • Tabachnick B.G.
        • Fidell L.S.
        Using Multivariate Statistics.
        5th ed. Pearson Education Inc, Boston, MA2007
        • Tang J.
        • Gibson S.J.
        A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety.
        J Pain. 2005; 6: 612-619
        • Taylor S.
        The structure of fundamental fears.
        J Behav Ther Exp Psy. 1993; 24: 289-299
        • Vancleef L.M.G.
        • Peters M.L.
        • Gilissen S.M.P.
        • De Jong P.J.
        Understanding the role of injury/illness sensitivity and anxiety sensitivity in (automatic) pain processing: An examination using the extrinsic affective simon task.
        J Pain. 2007; 8: 563-572
        • Vancleef L.M.G.
        • Peters M.L.
        • Roelofs J.
        • Asmundson G.J.
        Do fundamental fears differentially contribute to pain-related fear and pain catastrophizing? An evaluation of the sensitivity index.
        Eur J Pain. 2006; 10: 527-536
        • Vlaeyen J.W.S.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-322
        • Watson D.
        • Clark A.C.
        Affects separable and inseparable: On the hierarchical arrangements of the negative effects.
        J Pers Soc Psychol. 1992; 62: 489-505
        • Watson D.
        • Clark A.C.
        • Tellegen A.
        Development and validation of brief measures of positive and negative effect: The PANAS Scales.
        J Pers Soc Psychol. 1988; 54: 1063-1070
        • Zelman D.C.
        • Howland E.W.
        • Nichols S.N.
        • Cleeland C.S.
        The effects of induced mood on laboratory pain.
        Pain. 1991; 46: 105-111
        • Zinbarg R.E.
        • Barlow D.H.
        • Brown T.A.
        Hierarchical structure and general factor saturation of the Anxiety Sensitivity Index: Evidence and implications.
        Psychol Assess. 1997; 9: 277-284
        • Zvolensky M.J.
        • Goodie J.L.
        • McNeil D.W.
        • Sperry J.A.
        • Sorrell J.T.
        Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population.
        Behav Res Ther. 2001; 39: 683-696