Pain catastrophizing, neuroticism, fear of pain, and anxiety: Defining the genetic and environmental factors in a sample of female twins

Abstract

The objective of the present study was to establish the heritability of pain catastrophizing and its subdomains of helplessness, magnification, and rumination and to further explore the genetic and environmental sources that may contribute to pain catastrophizing as well as to its commonly reported psycho-affective correlates, including neuroticism, anxiety sensitivity, and fear of pain. N = 2,401 female twin individuals from the TwinsUK registry were subject to univariate and multivariate twin analyses. Well validated questionnaires including the Pain Catastrophizing Scale, the Pain Anxiety Symptom Scale, the Ten Item Personality Index, and the Anxiety Sensitivity Index were used to assess the study variables. Moderate estimates of heritability for pain catastrophizing (36%) and the three subdomains of helplessness (35%), rumination (27%), and magnification (36%) were detected. The high correlations observed between the three subdomains were explained mainly by overlapping genetic factors, with a single factor loading on all three phenotypes. High genetic correlations between pain catastrophizing and its psycho-affective correlates of fear of pain and anxiety sensitivity were found, while the genetic overlap between neuroticism and pain catastrophizing was low. Each measure of negative affect demonstrated relatively distinct environmental contributing factors, with very little overlap. This is the first study to show shared genetic factors in the observed association between pain catastrophizing and other measures of negative affect. Our findings provide deeper insight into the aetiology of pain catastrophizing and confirm that it is at least partially distinct from other measures of negative affect and personality that may influence the development and treatment of chronic pain conditions. Further research in males is warranted to check the comparability of the findings.

Fig 1. Path diagram of the best fitting AE Cholesky model depicting the sources of covariance between helplessness, rumination, and magnification of the Pain Catastrophizing Scale.

The variance and covariance of the monozygotic and dizygotic female twin pairs was decomposed into additive genetic (A1-A3) and unshared environmental (E1-E3) factors. Standardized factor loadings with 95% confidence interval are displayed. Squaring the loadings and multiplying them by 100 results in the phenotypic variance explained by the specific factor.

Fig 2. Path diagram of the best fitting AE Cholesky model depicting the sources of additive genetic variance and covariance (A1-A3) between neuroticism, anxiety sensitivity, fear of pain, and pain catastrophizing.

Standardized factor loadings with 95% confidence interval are displayed. Squaring the loadings and multiplying them by 100 results in the phenotypic variance explained by the specific additive genetic factor.

Fig 3. Path diagram of the best fitting AE Cholesky model depicting the sources of environmental variance and covariance (E1-E3) between neuroticism, anxiety sensitivity, fear of pain, and pain catastrophizing.

Standardized factor loadings with 95% confidence interval are displayed. Squaring the loadings and multiplying them by 100 results in the phenotypic variance explained by the specific environmental factor.