Fear of Pain Across the Adult Life Span

Abstract

Background: Pain continues to be an important public health concern, especially given the opioid crisis in industrialized countries. It is important to understand the association between emotions such as fear and anxiety and the experience of pain as both a physiological and affective experience. Fear or anxiety about pain is in fact a well-known predictor of and close associate of pain. Nociception and pain history differ depending on age, yet little empirical evidence exists on how fear of pain varies over the life span. The purpose of this study was to provide a cross-sectional examination of the relations between age and fear of pain across the adult life span.

Methods: Using cross-sectional data from 4,122 participants who completed the Fear of Pain Questionnaire-9, structural equation modeling and regression techniques were used to examine the association between fear of pain and age.

Results: A positive linear association was discovered between age and fear of severe or minor pain, and a negative association was discovered between age and fear of medical or dental pain. Quadratic and cubic relations were also significant for fear of severe pain, fear of medical and dental pain, and overall fear of pain, but not for fear of minor pain.

Conclusions: Unique trajectories for different components of pain-related fear exist across the adult life span and may be affected by increased exposure to medical and dental experiences over time and by the awareness of a greater likelihood of experiencing pain later in the life span.

Keywords: Age; Development; Health Psychology; Pain; Fear of Pain.

Figure 1.

Standardized results and standard errors of a structural equation model (SEM) to show the association between age, gender, and FPQ-9 subscale scores. After using modification indices, items 1 and 2 (FPQ1 and FPQ2) from the Fear of Pain Questionnaire-9 were allowed to correlate, resulting in improved model fit (Root Mean Square Error of Approximation = 0.07; Comparative Fit Index = 0.95; Tucker-Lewis Index = 0.92; Standardized Root Mean Square Residual = 0.03). FPQ-9 = Fear of Pain Questionnaire-9. *P < 0.001.

Figure 2.

Standardized results of a structural equation model (SEM) to show the association between age, gender, and total FPQ-9 score. After using modification indices, items 1 and 2 (FPQ1 and FPQ2) from the Fear of Pain Questionnaire-9 were allowed to correlate, resulting in improved model fit (Root Mean Square Error of Approximation = 0.07; Comparative Fit Index = 0.93; Tucker-Lewis Index = 0.90; Standardized Root Mean Square Residual = 0.04). FPQ-9 = Fear of Pain Questionnaire-9. *P < 0.001.

Figure 3.

Scatterplots for each of the three FPQ-9 subscales and the total FPQ-9 score to show cubic function results. In each scatterplot, the dashed black line indicates women, the solid black line indicates men, and the dashed gray line indicates the overall best-fitting line. FPQ-9 = Fear of Pain Questionnaire-9.

Figure 4.

Top panel: Mean total FPQ-9 scores for each age. Bottom panel: Mean scores by gender (white square and dashed line = women; black triangle and solid line = men). FPQ-9 = Fear of Pain Questionnaire-9.