The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain

-Objectives: While existing data on the Fear-Avoidance Model (FAM) of chronic pain pointed to the effects of anxiety sensitivity, pain hypervigilance and pain catstrophizing on pain-related fear, the nature of the multivariate relationships remains unclear. This study explored the possible mediating role of pain hypervigilance in the relationship of anxiety sensitivity and pain catastrophizing with pain-related fear, and their effects on quality of life (QoL) outcomes within the FAM framework. –Methods: A sample of 401 Chinese patients with chronic musculoskeletal pain completed the standardized measures assessing the FAM components and QoL. Structural equation modeling (SEM) was used to evaluate six hypothesized models. –Results: Results of SEM showed adequate data-model fit (CFIs ranging from 0.92-0.94) on models which specified pain hypervigilance as mediator of anxiety sensitivity and pain catastrophizing with pain-related fear on two QoL outcomes (QoL-Physical and QoL-Mental). Net suppression effect of pain catastrophizing on anxiety sensitivity was found in SEM where both anxiety sensitivity and pain catastrophizing were included in the same full model to predict QoL-Physical (CFI=0.95; Sobel z=8.26, p<0.001) and QoL-Mental (CFI=0.93; Sobel z=8.51, p<0.001). –Conclusion: Our findings evidenced that pain hypervigilance mediated the relationship of pain catastrophic cognition and anxiety sensitivity with pain-related fear.