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The Role of Fear of Pain in Headache
Author(s) -
Black Anna Katherine,
Fulwiler Joshua C.,
Smitherman Todd A.
Publication year - 2015
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12561
Subject(s) - psychology , medicine
Background Recurrent headache sufferers are often fearful of pain, which disrupts thought processes, interferes with daily activities, and may maintain headache‐related disability through avoidance and associated negative reinforcement. Objective The aim of this cross‐sectional study was to (1) examine differences in fear of pain ( FOP ) between headache sufferers and non‐headache controls; (2) examine differences in FOP across primary headache diagnostic groups; (3) assess the extent to which FOP predicts headache variables (eg., severity, frequency, disability); and (4) determine whether FOP mediates the relationship between pain severity and headache‐related disability. Methods The sample consisted of 908 young adults ( M age = 19.5 years; 64.9% female). Of those, 237 (26.1%) met the diagnostic criteria for episodic tension‐type headache ( TTH ), 232 (25.6%) for episodic migraine (167 [18.4%] without aura and 65 [7.2%] with aura), 38 (4.2%) for chronic migraine, and 19 (2.1%) for chronic TTH ; 382 (42.1%) served as non‐headache controls. Results FOP differed among groups, with headache sufferers reporting greater FOP than those without headache; migraineurs typically endorsed greater FOP than those with TTH . Among those with headache, FOP significantly predicted headache severity ( R 2 = 6.1%) and frequency ( R 2 = 4.5%), and accounted for more variance in disability ( R 2 = 17.5%) than gender, anxiety, and depression combined (13.8%). Pain severity and disability were strongly associated ( r = 0.61, P < .001), and FOP partially mediated this association (indirect effect point estimate = 0.38; 95% confidence interval: 0.23‐0.57). Conclusions FOP differentiates migraineurs from those without headache and plays a significant role in primary headache, particularly in headache‐related disability. Findings build upon and extend those from previous chronic pain studies and highlight the need for longitudinal and experimental studies to further explore this construct in headache.