Unpacking the relationship between Big Five personality traits and experimental pain: A systematic review and meta-analysis

Pain is essential for survival, but individual responses to painful stimuli vary, representing a complex interplay between sensory, cognitive, and affective factors. Individual differences in personality traits and in pain perception covary but it is unclear which traits play the most significant role in understanding the pain experience and whether this depends on pain modality. A systematic search identified 1534 records (CINAHL, MEDLINE, PsycInfo, PubMed and Web of Science), of which 22 were retained and included in a systematic review. Only studies from the pressure pain domain (n=6) could be compared in a formal meta-analysis to evaluate the relationship between Big Five traits and experimental pain. Pressure pain tolerance correlated positively with Extraversion and negatively with Neuroticism with a trivial effect size (<0.1). While these findings suggest personality might be only weakly related to pain in healthy individuals, we emphasize the need to consider standardization, biases, and adequate sample sizes in future research, as well as additional factors that might affect experimental pain sensitivity.

Intraindividual change in pain tolerance and negative affect over 20 years: findings from the MIDUS study

Pain tolerance, defined as the ability to withstand physical pain states, is a clinically important psychobiological process associated with several deleterious outcomes, including increased pain experience, mental health problems, physical health problems, and substance use. A significant body of experimental work indicates that negative affect is associated with pain tolerance, such that increased negative affect is associated with decreased pain tolerance. Although research has documented the associations between pain tolerance and negative affect, little work has examined these associations over time, and how change in pain tolerance is related to changes in negative affect. Therefore, the current study examined the relationship between intraindividual change in self-reported pain tolerance and intraindividual change in negative affect over 20 years in a large, longitudinal, observation-based national sample of adults (n = 4,665, Mage = 46.78, SD =12.50, 53.8% female). Results from parallel process latent growth curve models indicated that slope of pain tolerance and negative affect were associated with each other over time (r = .272, 95% CI [.08, .46] p = .006). Cohen's d effect size estimates provide initial, correlational evidence that changes in pain tolerance may precede changes in negative affect. Given the relevance of pain tolerance to deleterious health outcomes, better understanding how individual difference factors, including negative affect, influence pain tolerance over time, are clinically important to reduce disease-related burden.

Psychological Profile in Women with Chronic Pelvic Pain

(1) Background: Chronic Pelvic Pain (CPP) is a prevalent medical condition with a complex treatment due to different variables that influence its clinical course. (2) Methods: Psychological variables such as depression, anxiety, catastrophizing or neuroticism have been described as influencing CPP. This is a cross-sectional study of 63 patients with CPP sent for a psychological evaluation due to participation in group therapy for CPP. The main purpose of this study was to characterize the baseline psychological characteristics of women with CPP. The NEO Five Factor Inventory (NEO-FFI), State and Trait Anxiety Inventory (STAI), Beck Depression Inventory-Fast Screen (BDI-FS), Pain Catastrophizing Scale (PCS) and Chronic Pain Acceptance Questionnaire (CPAQ) were performed. (3) Results: The personality profile of patients (NEO FFI) shows high neuroticism, low extraversion and low conscientiousness. The 25.4% of patients had moderate or severe depression according to BDI-FS results, almost half of the patients had high levels of anxiety trait (>P75, 49.2%) and more than half the patients had high levels of anxiety state (>P75, 59.5%). Punctuations of PCS and CPAQ are similar to patients with fibromyalgia. (4) Conclusions: CPP is associated with high levels of depression, anxiety, neuroticism, catastrophizing and low pain acceptance. It is important to develop interventions that can modify these psychological factors in order to improve the clinical course of CPP.

Interaction Between Sex and Cardiac Interoceptive Accuracy in Measures of Induced Pain

Pain perception is influenced by several factors, and among them, affect, sex, and perception of bodily signals are assumed to play a prominent role. The aim of the present study is to explore how sex, cardiac interoceptive accuracy, and the interaction of the latter two influence the perception of experimentally induced pain. We investigated a large sample of young adults (n = 159, 50.9% female, age: 23.45, SD = 3.767), assessing current positive and negative affective state with the Positive and Negative Affect Schedule (both involved as control variables), cardiac interoceptive accuracy with the mental heartbeat tracking task, and pain sensitivity with electrical stimulation on the back of the dominant hand, applying a repeated-measures staircase protocol. Males showed a significantly higher pain threshold and tolerance level than females, whereas cardiac interoceptive accuracy was not associated with pain sensitivity. The impact of sex × cardiac interoceptive accuracy interaction was significant for pain threshold only, while pain tolerance was predicted only by sex. According to these findings, the associations between pain sensitivity, cardiac IAc, and sex might be more complicated than it was supposed in previous studies. Interactions between factors impacting pain perception appear worthy of further investigation.

Diurnal variation, morningness‐eveningness, and momentary affect

The research questions of this study are the following: To what degree can results such as those of Thayer and colleagues (1978a, 1985, 1986, 1988) concerning diurnal variation and differences between diurnal types, obtained for energetic and tense arousal, be (1) replicated, (2) extended to elation and pleasantness, and (3) generalized to positive and negative affect? With regard to energetic arousal, all results were in line with those of Thayer and colleagues. However, regarding tense arousal, there was an unexpected main effect for time of day. For energetic arousal, elation, pleasantness, positive affect, and negative affect, there was (a) a significant main eflect for time of day, (b) a quadratic trend for diurnal variation, and (c) a significant Diurnal Type × Time of Day interaction, There were no significant sex differences in diurnal variation. Two final hypothetical statements are made about the diurnal variation and differences between diurnal types with regard to state scales: (a) the diurnal variation of a state scale cannot be described with a quadratic function if that scale is completely unrelated to energetic arousal; and (b) the characteristic differences between morning types and evening types, especially when measured in the morning and in the evening, will not manifest themselves on a state scale if that scale is entirely unrelated to energetic arousal. Finally, the possible usefulness of the results of this study for practical applications and the development of theories are discussed.

New evidence for a pain personality? A critical review of the last 120 years of pain and personality

BACKGROUND

Personality traits may influence development and adjustment to ongoing pain. Over the past 120 years, there has been considerable research into the relationship between pain and personality. This paper presents new evidence for common personality traits found amongst chronic pain sufferers. In particular, it evaluates evidence for Cloninger's biopsychosocial model of personality in distinguishing typical personality features of chronic pain sufferers. It evaluates this evidence in the context of the past 120 years of research including psychodynamic formulations, MMPI studies, personality disorder investigations, and the influence of neuroticism on chronic pain.

METHODS

A literature search was conducted using PubMed, Medline, PsycINFO, SCOPUS and Cochrane library. Search terms included chronic pain, pain, personality, neuroticism, harm avoidance, self-directedness, attachment, Temperament and Character Inventory (TCI-R), MMPI, MMPI-2, NEO-PI, EPI, Millon Clinical Multiaxial Inventory, Millon Behavioral Health Inventory, Millon Behavioral Medicine Diagnostic, the Personality Assessment Inventory, the Locus of Control Construct and different combinations of these terms.

CONCLUSIONS

Recent descriptive studies using Cloninger's Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic, sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of 'a pain personality'. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support 'a pain personality' and may be confounded by somatic items in the instrument. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples.

CLINICAL IMPLICATIONS

Because harm avoidance reflects a tendency to developed conditioned fear responses, we suggest that higher harm avoidance may create more vulnerability to developing a fear-avoidance response to chronic pain. Furthermore, lower self-directedness may contribute to keeping a sufferer within this vicious cycle of fear, avoidance and suffering. Moreover, we suggest that harm avoidance and self-directedness are broader and more complex constructs than current clinical targets of CBT such as fear-avoidance and self-efficacy. Thus, assessing such personality traits may help to address the complexity of chronic pain presentations. For example, it may help to identify and treat sufferers more resistant to treatment, more prone to comorbidity and more vulnerable to entering the vicious cycle of chronic pain, suffering and disability.

Relationships among Eysenck's Extraversion, Rorschach's Erlebnistypus, and Tolerance of Experimental Tonic Pain (Cold Water Pressor Test)

In a group of 42 healthy volunteers the correlations between the concept of Extraversion-Introversion as defined by Eysenck and Erlebnistypus as defined by Rorschach were analysed to relate these with the tolerance of an experimentally induced tonic pain. We conducted an experimental procedure comprising a test and retest. At test the subjects were administered the Rorschach, the Eysenck Personality Inventory, the Cold Water Pressor Test, a nongraduated Visual Analogue Scale, and the Italian version of the McGill Pain Questionnaire. At retest the experimental induction of pain was measured again. At test subjects who scored higher on the EPI Extraversion scale tolerated pain longer and did not modify their performance at retest. Also, the concepts of Extroversion defined by the Rorschach test and by the Extraversion scale of the Eysenck Personality Inventory shared some psychophysiological features of higher tolerance to pain. These personality features did not influence how subjects qualitatively describe the immediate painful experience.

Cognitive Correlates of Polychronicity

Polychronicity, defined as the ability to cope with stimulus-intense, information-overloaded environments, was operationalized as a 25-item scale assessing the reported degree to which individuals structure their physical and interpersonal environments within the context of time and space. The validity of the construct of polychronicity was assessed by predicting directional relationships to cognitive complexity and intelligence. The analyses support the hypotheses. Results are discussed regarding the ability of the construct to predict coping reactions to overloaded environmental transactions. A theoretical model of polychronicity is advanced.

Sport and Personality: Effects of Type of Sport and Level of Competition

Personal information and personality profiles, using the Cattell 16 PF, were collected from 93 sportsmen and sportswomen. Players involved in team (volleyball) and in individual (squash) sports were represented. Athletes were at a high level of competition (those selected for training at State level) and an average level. Discriminant analysis indicated significant differences in personality characteristics between squash and volleyball players and between high- and average-level competitors. Differences on a larger number of personality dimensions as a function of type of sport were also noted when analyses were carried out on the State (high) level competitors only.

Relationship between Pain Tolerance and Kinesthetic Size Judgment

40 Ss were tested in tasks measuring pain tolerance and kinesthetic size judgment. The results demonstrated a significant relationship between the two types of performance: Ss low in pain tolerance tended to make larger errors in KSJ than Ss with higher pain tolerance. Among Ss with descending series, pain tolerance correlated negatively with degree of overestimation of the standard. The results are consonant with the hypothesis that attentional function is the relevant underlying mechanism.

Some Laboratory Measures of Extraversion-Introversion

The Maudsley Personality Inventory was given to a pool of 309 Ss from which three groups were selected along the extraversion dimension, two to represent each extreme (extravert N = 20, introvert N = 19), and an intermediate group ( N = 19). The three groups were equated for neuroticism. Ss were tested on the following measures: time-judgment, breath-holding, digit repetition, line reproduction, leg persistence, set change, kinaesthetic figural after-effect, and size constancy. Extraverts were superior in breath-holding, had a longer time span in digit repetition, showed longer leg persistence, greater variability in line reproduction, a tendency to underestimation in time judgment, but were inferior in arithmetic computation under slow set change conditions. No significant difference between extraverts and introverts was observed in the kinaesthetic figural after-effect or in size constancy.

Does attachment anxiety increase vulnerability to headache?

BACKGROUND

Attachment-related anxiety and avoidance are potentially important aspects of pain experience and management, but have not been investigated in episodic headache sufferers or in relation to experimentally-evoked headache.

OBJECTIVE

To determine whether adult insecure attachment styles were associated with sensitivity to pain or headache before, during or after stressful mental arithmetic in an episodic migraine or tension-type headache (T-TH) sample.

METHODS

Thirty-eight participants with episodic migraine, 28 with episodic T-TH and 20 headache-free participants intermittently received a mild electric shock to the forehead before, during and after stressful mental arithmetic.

RESULTS

A preoccupied attachment style and attachment anxiety, but not attachment avoidance, were associated with forehead pain and the intensity of headache before and after, but not during stressful mental arithmetic. These relationships were independent of Five Factor Model personality traits. Neither attachment anxiety nor avoidance was associated with episodic migraine or T-TH.

CONCLUSIONS

Anxiously attached individuals may express greater pain or show a stronger attentional bias toward painful sensations than securely attached individuals. However, distraction during psychological stress may override this attentional bias.

Disposition and adjustment to chronic pain

Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

Peer rejection and physical health problems in early adolescence

OBJECTIVE

Rejection from the peer group may constitute an important source of stress that may weaken children's immune system and leave them vulnerable to infection and physical illness. Controlling for family adversity and depressed mood, this study examined the predictive link between peer rejection and physical health problems, as well as the putative moderating effect of adolescents' reactivity/emotional negativity in this context.

METHOD

A total of 122 high school students (50% girls) were assessed over two consecutive years in grades 7 (time [T] 1) and 8 (time [T] 2). More than 90% of the participants were white and French speaking and were from average socioeconomic backgrounds. Physical health problems at T1 and T2 as well as depression symptoms at T1 were assessed using adolescent self-reports. Peer rejection at T1 was assessed through peer nominations. Reactivity/negative emotionality at T1 was assessed via teacher ratings. Family adversity at T1 was assessed via mother reports.

RESULTS

Peer rejection at T1 predicted an increase in physical health problems from T1 to T2, even when controlling for physical health problems and depression symptoms at T1. This result, however, was only true for girls with moderate or high levels of reactivity/negative emotionality. For boys, peer rejection was unrelated to change in physical health problems.

CONCLUSIONS

The present findings are in line with the diathesis stress model of disease and emphasize the need for health education programs that specifically target girls and that foster problem-solving skills to help vulnerable adolescents cope more effectively with peer conflict.

The tridimensional personality theory and pain: harm avoidance and reward dependence traits correlate with pain perception in healthy volunteers

The aim of the present study was to examine the possible role of personality traits in determining the variability of pain perception among individuals. More specifically, it was intended to test whether or not the three personality dimensions suggested by Cloninger in 1987 - mainly harm avoidance (HA), but also reward dependence (RD), and novelty seeking (NS), can predict interpersonal differences in responsiveness to experimental pain. Seventy healthy volunteers participated in the study. Their personality traits were evaluated through Cloninger's tridimensional personality questionnaire (TPQ). Pain threshold (latency to pain onset), pain magnitude (VAS), and pain tolerance (time to withdrawal) were measured by using the cold pressor test. Bonferroni-adjusted correlations were found between HA and the pain parameters as follows: a negative correlation between HA and threshold (rho=-0.297, P(adj)=0.039); no significant correlation between HA and tolerance (rho=-0.219, P(adj)=0.207); and a trend for a positive correlation between HA and VAS (rho=0.266, P(adj)=0.081). Possible correlations between pain perception and the various possible combinations of high and low scoring for each of the three traits were also investigated. Correlations were found only for the combinations of high/low HA and high/low RD. The low HA/low RD combination demonstrated the lowest responsiveness to pain (VAS 65.2+/-21.4; tolerance 107.6+/-71.8 s), whereas the high HA/low RD combination was correlated with the highest responsiveness (VAS 83.3+/-10.8; tolerance 30.8+/-28.4 s). The results indicate that HA personality trait correlates best with pain responsiveness. As such, a high HA are likely to predict a heightened pain response. RD may modify this pattern. The possible relevant behavioral and neuro-chemical mechanisms are discussed.

Emotional stability and facial activity as predictors for pain tolerance

40 subjects were given the Cold Pressor Test. There were large individual differences in the time subjects were willing to keep their hands immersed in the cold water. Predictors indicated for these differences were sex, emotional stability, and facial activity during the test. Emotional stability was measured by means of questionnaire scales and facial activity by ratings on the basis of videotapes.

Experimentally induced pain perception in men and women in the morning and evening

The literature regarding whether or not there are diurnal differences in pain perception in men and women is equivocal. The purpose of this study was to examine the influence of time of day on experimentally induced pain threshold in men and women. A secondary purpose was to measure selected psychological and physiological responses. Pressure (3000 gm force) was applied to the middle digit of the left forefinger for 2-min with the Forgione-Barber pain stimulator. Twenty-nine volunteers (women = 14; men = 15) completed two randomly assigned sessions between 6.00-8.00 in the AM and PM. Selected psychological variables (STAI,POMS) and physiological variables (BP, HR, TEMP) were assessed before application of the pressure stimulus. Data were analyzed with a 2x2 ANOVA. Results indicated that men had significantly higher (p<.05) systolic blood pressure and pain thresholds than women however, there was not a significant time of day effect for pain threshold. Significant time of day effects (p<.05) were found for systolic blood pressure and tympanic temperature. Heart rate, and tympanic temperature were found to be significantly higher (p<.05) in women in comparison to men. It is concluded that pain threshold did not differ in the AM and PM. Furthermore, men were found to have higher pain thresholds compared to the women.

Pain and pain control in children

Focused research on pain and pain control in children has developed primarily in the last 10 years and even now is woefully inadequate in relation to the magnitude of the problem. The available research, inferences from the adult literature, and anecdotal information all indicate the elusive nature of pain. Pain is not solely a fixed neurophysiologic response to a noxious stimulus but a product of the interaction of many variables such as age, cognitive set, personality, ethnic background, and emotional state. These factors exert a tremendous influence on the suffering which surrounds the pain message. Technology exists at present to eliminate or substantially reduce pain in almost all cases. There remains, however, a tendency, which is even more pronounced with respect to children, to underestimate or ignore pain. In an overall approach to pain in children, the following points should be considered: A high index of suspicion is necessary to determine if children are experiencing pain since they may have difficulty verbalizing their discomfort. In infants, physiologic variables should be considered (increased heart rate, palmar sweating, increased respiratory rate), and in preschoolers, time should be taken to ascertain that the child actually understands the word "pain" if it is used in questioning them. Some method of continuous monitoring, such as a visual analogue scan, should be considered as part of the treatment plan. Adequate analgesia should be provided. The appropriate dose should be administered at the appropriate pharmacokinetic time. Too little medication may cause obsessive attention to medication-related issues. Too much medication may cause sedation and lack of mental clarity, which is often anxiety-producing for both the parents and the child. The usefulness of p.r.n. medication has been seriously questioned and a time-contingent as opposed to pain-contingent strategy should be applied. Fears of addiction are generally unwarranted. Adjunctive medication may increase the value of offered narcotics and counteract some of their side effects. Although this monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance. The importance of distraction from pain by nursing, medical, or child life personnel using play techniques cannot be overestimated. Every attempt should be made to relax the child by using creative strategies. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated.(ABSTRACT TRUNCATED AT 400 WORDS)

Tolerance of aversive stimuli in relation to life change

This study investigated the relation between an individual's tendency to tolerate and/or report discomfort and the amount of life change experienced by that individual. The role of attention in this relation was also examined and manipulated through instruction. Eighty college freshman were selected and divided into three groups (high, medium, low) as a function of scores obtained on the College Schedule of Recent Experience (CSRE). Participants were asked to experience two known discomforting stimuli, the cold pressor and loud broad-band noise. Dependent measures included participant's tolerance time, report of discomfort, and amount of attention paid to each of the stimuli. Results indicated that "high"-life change groups tolerated the two discomforting stimuli significantly less than either the "low"- or the "medium"-life change groups. Neither discomfort ratings nor attention was significantly different across groups. Findings are discussed in relation to epidemiological studies of the life change and illness relation.

Relations of pain threshold and pain tolerance in cold water with scores on Maudsley Personality Inventory and Manifest Anxiety Scale

Testing 56 Japanese undergraduates, the relationships between pain threshold and pain tolerance in cold water and personality factors were investigated. Significant negative correlations of moderate magnitude between the pain threshold and scores on Maudsley Neuroticism and the Manifest Anxiety Scale were found. On the contrary, significant positive, moderate correlations between pain tolerance and the Maudsley Extraversion were obtained.

Augmentation-reduction and pain experience

The role of augmentation-reduction in pain tolerance and threshold was examined using Petrie's (1967) criteria for classification of subjects. 14 augmenters did not differ from 14 reducers on pain tolerance and threshold. Trait anxiety correlated with both pain tolerance and threshold, but state anxiety did not.

Psychometric correlates of pain perception

There is disagreement in the literature as to whether responsivity to painful stimuli possesses psychometric correlates. A series of methodological and statistical factors are specified in this paper which could account for the equivocality of the literature. A series of experiments were performed in which (a) various methodological and statistical issues were first resolved and (b) psychometric correlates of pain perception were then identified by means of a stepwise multiple regression procedure. The criterion variable consisted of the psychophysical judgment of pain during a 2-min. exposure to a 3,000 gm. force on the periosteum of the left fore-finger's second digit. The predictor variables consisted of selected psychological states and traits measured by the State-Trait Anxiety Inventory, Somatic Perception Questionnaire, Depression Adjective Checklist, Profile of Mood States, Eysenck Personality Inventory, and the Embedded Figures Test. The test-retest reliability of the pain test ranged from .64 to .84 across trials separated by a 3-wk. period. In the first experiment significant multiple regressions ranging between .57 and .72 were observed and psychological traits (field dependence, extraversion and trait anxiety) accounted for the variance in these analyses. In the next experiment significant multiple Rs ranging from .62 to .68 were observed. This served as cross-validation for the first experiment. The major difference was that psychological states (depression and vigor) as well as traits entered the multiple regression equations for certain of the analyses. It was concluded that selected psychological states and traits are significantly correlated with the perception of pain.