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Behavioural inhibition in the context of pain: Measurement and conceptual issues

  • Rena Gatzounis EMAIL logo and Johan W.S. Vlaeyen
Published/Copyright: October 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 17 Issue 1

1 Introduction

In this issue of the Scandinavian Journal of Pain, Mark Jensen and colleagues [1] publish a study testing two specific predictions put forward by the Behavioural Inhibition/Behavioural Activation (BIS/BAS) two-factor model of chronic pain [2]. First, the authors hypothesized that trait behavioural inhibition, namely the tendency to respond to signals of threat with behavioural withdrawal and negative emotions [1], would have a direct negative effect on the psychological and physical functioning of people with chronic pain. Second, the authors also hypothesized the existence of an indirect (moderating) effect of trait behavioural inhibition on the relationship between pain-related cognitions and functioning. Cross-sectional self-report data from 88 chronic pain patients showed partial support for these hypotheses. Trait behavioural inhibition was found to have the expected direct negative effect on depression, but not on physical functioning. The expected moderating effect was only shown for the relationship between fear of movement/re (injury) and depression. This study offers partial support to a newly proposed theory, thus encouraging research in this area.

2 The behaviour of behavioural inhibition

The concepts of behavioural inhibition and behavioural activation are only now starting to be investigated in the field of pain. Previous research in other fields has also shown a direct effect of trait behavioural inhibition on depression (e.g., Gable et al. [3]). Unfortunately, the results did not yield the expected (direct or indirect) effects of trait behavioural inhibition on pain interference, which is how physical functioning was operationalized in the study of Jensen et al. [1]. We believe that this null finding raises an important conceptual issue with regards to the nature of the direct relationship between behavioural inhibition and physical functioning.

Behavioural inhibition is described as an action tendency, but not as an action itself. Its effects on physical functioning will thus presumably be mediated by intermediate behavioural processes. These are likely to reflect attempts to avoid cues, activities or events that are expected to cause pain. Future studies may include measures of avoidance behaviour or other activity patterns, and investigate whether they mediate the relationship between trait behavioural inhibition and physical functioning. Understanding the exact behaviours likely to reflect a high trait behavioural inhibition in the context of (chronic) pain will potentially also lead to modifications or refinements of the 2-factor BIS/BAS model [2].

3 Measuring behavioural inhibition in the context of pain

To measure behavioural inhibition, the authors used the BIS subscale by Carver and White [4]. This is a widely used measure with good psychometric qualities (e.g., Leone et al. [5]). However, this measure reflects “a concern over the possibility of a bad occurrence [...] or a sensitivity to such events when they do occur” (Carver and White, 1994, p. 322 [4]), and, asJensenet al. [1] acknowledge, is not specific to pain. The authors suggest that this generic instrument failed to yield (larger) effects that would otherwise be revealed had a pain-specific measure of behavioural inhibition been used.

Although this is plausible, we wonder what the theoretical implications of such a measure would be. One of the important assets of the 2-factor BIS/BAS model of pain [2], which the present study byJensen et al. [1] partially tested, is that it proposes overarching, pain-irrelevant personality factors that predispose individuals to pain problems. In this way, the measure can predict which individuals are likely to develop chronic pain problems when confronted with pain at some point in their lives (e.g., due to an operation or injury). This characteristic differentiates the 2- factor BIS/BAS model from othertheoretical approaches, such as the Fear-Avoidance Model of pain of Vlaeyen and Linton [6,7], which focus on pain-specific factors. Further, this asset might be lost if trait behavioural inhibition is substituted by pain-specific behavioural inhibition, because the latter will likely overlap too much with existing constructs such as pain-related fear or pain catastrophizing (cf. [8]).

Further, whereas it will be possible to specify behavioural inhibition with regards to pain, the same will likely not be possible with behavioural activation, which by definition focuses on reward, and might thus be a subject of more variability. In our opinion, given that the 2-factor BIS/BAS model of pain was proposed recently [2], it deserves to first undergo rigorous testing before the focus of its main concepts is adjusted from being generic to being specific to pain.

4 Conclusion

The findings presented by Jensen et al. [1] provide partial support to specific expectations put forward by the recently proposed 2-factor BIS/BAS model of pain [2]. Although not all hypotheses were confirmed, it is important that the investigation of the model’s predictions continues. Given the finding that the relationships predicted by the model are to a large degree bidirectional, the accumulating body of research will ideally extend to include also experimental and longitudinal studies that will investigate this bidirectionality of the relationships. Prospective studies, for example with patients about to undergo an operation, might shed light on whether levels of trait behavioural inhibition (as well as trait behavioural activation), predict whether the patient will recover swiftly or will take the maladaptive path to pain chronification.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2017.07.002.

  1. Conflict of interest: None declared.

Acknowledgments

RG is supported by a PhD “Aspirant” grant (grant ID = 11N8215N) funded by the Research Foundation - Flanders, Belgium (FWO Vlaanderen). JWS is supported by the “Asthenes” long-term structural funding - Methusalem grant by the Flemish Government, Belgium (METH/15/011).

References

[1] Jensen MP, Sole E, Castarlenas E, Racine M, Roy R, Miro J, Cane D. Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain. Scand J Pain 2017;17:41–8.Search in Google Scholar

[2] Jensen MP, Ehde DM, Day MA. The behavioral activation and inhibition systems: implications for understanding and treating chronic pain. J Pain 2016;17:529, http://dx.doi.org/10.1016/jjpain.2016.02.001,e1-529.e18.Search in Google Scholar

[3] Gable SL, Reis HT, Elliot AJ. Behavioral activation and inhibition in everyday life. J Pers Soc Psychol 2000;78:1135–49, http://dx.doi.org/10.1037//0022-3514.78.6.1135.Search in Google Scholar

[4] Carver CS, White TL. Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. J Pers Soc Psychol 1994;67:319–33.Search in Google Scholar

[5] Leone L, Perugini M, Bagozzi RP, Pierro A, Mannetti L. Construct validity and generalizability of the Carver-White behavioural inhibition system/behavioural activationsystem scales. EurJ Personal 2001;15:373–90.Search in Google Scholar

[6] Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: astate of the art. Pain 2000;85:317–32.Search in Google Scholar

[7] Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012;153:1144–7, http://dx.doi.org/10.1016Zj.pain.2011.12.009.Search in Google Scholar

[8] Jensen MP, Ward LC, Thorn BE, Ehde DM, Day MA. Measuring the cognitions, emotions, and motivation associated with avoidance behaviors in the context of pain: preliminary development of the negative responsivity to pain scales. Clin J Pain 2017;33:325–34, http://dx.doi.org/10.1097/AJP.0000000000000407.Search in Google Scholar
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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https://doi.org/10.1016/j.sjpain.2017.07.020

Articles in the same Issue

  1. Observational study
  2. Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females
  3. Clinical pain research
  4. Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation
  5. Clinical pain research
  6. The Functional Barometer — An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain — Differences in age gender and origin of pain
  7. Clinical pain research
  8. Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain
  9. Observational study
  10. Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada
  11. Educational case report
  12. Management of patients with pain and severe side effects while on intrathecal morphine therapy: A case study
  13. Clinical pain research
  14. Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain
  15. Observational study
  16. Comparison of patients diagnosed with “complex pain” and “somatoform pain”
  17. Original experimental
  18. Patient perspectives on wait times and the impact on their life: A waiting room survey in a chronic pain clinic
  19. Topical review
  20. New evidence for a pain personality? A critical review of the last 120 years of pain and personality
  21. Clinical pain research
  22. A multi-facet pain survey of psychosocial complaints among patients with long-standing non-malignant pain
  23. Clinical pain research
  24. Pain patients’ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome
  25. Observational study
  26. Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy
  27. Clinical pain research
  28. COMBAT study – Computer based assessment and treatment – A clinical trial evaluating impact of a computerized clinical decision support tool on pain in cancer patients
  29. Original experimental
  30. Quantitative sensory tests fairly reflect immediate effects of oxycodone in chronic low-back pain
  31. Editorial comment
  32. Spatial summation of pain and its meaning to patients
  33. Original experimental
  34. Effects of validating communication on recall during a pain-task in healthy participants
  35. Original experimental
  36. Comparison of spatial summation properties at different body sites
  37. Editorial comment
  38. Behavioural inhibition in the context of pain: Measurement and conceptual issues
  39. Clinical pain research
  40. A randomized study to evaluate the analgesic efficacy of a single dose of the TRPV1 antagonist mavatrep in patients with osteoarthritis
  41. Editorial comment
  42. Quantitative sensory tests (QST) are promising tests for clinical relevance of anti–nociceptive effects of new analgesic treatments
  43. Educational case report
  44. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl
  45. Editorial comment
  46. Severe side effects from intrathecal morphine for chronic pain after repeated failed spinal operations
  47. Editorial comment
  48. Opioids in chronic pain – Primum non nocere
  49. Editorial comment
  50. Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
  51. Observational study
  52. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
  53. Clinical pain research
  54. Opioid tapering in patients with prescription opioid use disorder: A retrospective study
  55. Editorial comment
  56. Sleep, widespread pain and restless legs — What is the connection?
  57. Editorial comment
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  59. Observational study
  60. Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
  61. Editorial comment
  62. The burden of central anticholinergic drugs increases pain and cognitive dysfunction. More knowledge about drug-interactions needed
  63. Editorial comment
  64. A case-history illustrates importance of knowledge of drug-interactions when pain-patients are prescribed non-pain drugs for co-morbidities
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  67. Topical review
  68. Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics
  69. Editorial comment
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  72. PhKv a toxin isolated from the spider venom induces antinociception by inhibition of cholinesterase activating cholinergic system
  73. Clinical pain research
  74. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain
  75. Editorial comment
  76. Towards a structured examination of contextual flexibility in persistent pain
  77. Clinical pain research
  78. Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance
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  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
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  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
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  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
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  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
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