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Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Original Article 

Physical, Emotional and Catastrophizing Upshots of Chronic 

Pain the Study On Pain Stress 
Uzma Naseem, Sadaf Ahmed & Shamoon Noushad 

Psychophysiology Research Lab, Uok 

Corresponding author: uzma@aeirc-edu.com 
 

Abstract 

There are original physical basis of pain, even when an anatomical site or pathophysiological basis cannot be 

established, but pain also recognizes the importance of affective, cognitive, behavioral, and social factors as 

contributors to chronic illness behavior. It is also linked with Catastrophizing in relation with sufferer’s threshold of 

pain intensity, pain related disability and psychological distress are found to be significantly high regardless of any 

type of pain. Unlike acute nociceptive pain chronic pain is not self-limiting and usually neurological in origin, it 

may evolve in the damaging of either central nervous system or peripheral nervous system results into anxiety, fear, 

depression, sleeplessness and lack of social interaction so there is a self-perception of stress. In this study Stress has 

been taken as an amplified condition of psychological effects which is being induced by chronic pain. Aim of the 

present study was to highlight the presence of physical and emotional constraint relative to other related stresses like 

traumatic, nutritional and mental stress among chronic pain survivor both by observing the ability and intensity to 

catastrophize. In a cross sectional study, 140 individuals have been enrolled from general population who have been 

suffering from any type of chronic pain with exception of Menopausal women, Cardiovascular diseases, 

Nephropathy and cancer, and age between 18 to 50 years. For evaluation multistage random selection procedure 

have been performed by governing questionnaire to examine their pain duration, intensity, frequency, and degree of 

multi psychological feeling using PCS of Michael JL Sullivan and stress by SSS. It is concluded that sufferers rise to 

the challenge of difficult painful situations that leads to a number of psychophysiological disorders and raised 

emotional distress, especially depressive symptoms, these are often poorly controlled. On the basis of the available 

evidence that it is not clear whether chronic pain sufferers really do have higher levels of distress compared to others 

it is recommended that ability of being catastrophize as well as emotional and physical distress can be improved by 

various relaxation and counselling therapies that can relieve the cycle of pain. 

 

Keywords 
neuropathic, nociceptive, Catastrophizing, rumination. Pain catastrophizing scale (PCS), Sadaf stress scale (SSS), 

Central nervous system (CNS), Peripheral nervous system (PNS). Osteoarthritis (O.A). 

 

Introduction 

Unlike acute nociceptive pain chronic pain is not 

self-limiting and usually neurological in origin, it 

may evolve in the damaging of either CNS or PNS 

results into anxiety, fear, depression, sleeplessness 

and lack of social interaction so there is a self-

perception of stress (Waxman, 2006). The 

Individuals facing chronically stressful incidents are 

being undergone physiological, biochemical, and 

psychological alterations, subsequently in stress 

related neuropsychiatric disorders, such as depression 

or anxiety (Lazarus R, 1984 & Cyril, 2010). 

Moreover, the fundamental changes also being 

observed in the brain called as neuroplasticity 

(Jensen, 2009). In Addition, by brain scanning 

techniques structurally and functionally important 

part of limbic system, the hippocampus involves in 

learning and memory significantly sensitive to stress 

hormone (glucocorticoids) (Cheryl, 2008), appeared 

to be resorbed or shrinked (McEwen, 1968). These 

defective changes leads to experience of pain from 

non-painful stimuli said to be allodynia as well as 

hypersensitivity to pain said to be hyperalgesia. The 

resultant changes in the region of brain are analyzed 

under biophysical techniques via EEG which 

illustrate augmented activity of beta waves. 

Comparatively the decreased activity of alpha 

waves whereas diminished activity of theta waves 

(Jensen, 2009 & Sapolsky, 1986). Sustained stress 

cause tissue trauma which consequently leads to 

biochemical, physiological and psychological 

alteration (Lazarus R, 1984). (Fig: 1). 

Catastrophizing has been constantly associated with 

increased pain sensitivity moreover diminished 

endogenous pain inhibitory controls (Edwards R, 

2005 & Goodin, 2009). Catastrophizing has been 

defined as an exaggerated negative mental set 

brought to bear during actual or anticipated painful 

experience (Alice, 2013). Catastrophizing is a 

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Uzma Naseem 57 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

tendency to magnify or exaggerate the threat value or 

seriousness of pain sensations. The pain 

catastrophizing has been observed across diverse 

patient groups, including mixed chronic pain, low 

back pain, rheumatoid arthritis, aversive diagnostic 

procedures, surgery, dental procedures, burn dressing 

changes, whiplash injuries, and survey samples of 

young adults, asymptomatic individuals participating 

in experimental pain procedures, and varsity athletes 

(Mark 2012 & Kabat 1994). Women and men may 

differ in their emotional responses to pain. Studies 

have revealed that, when responding to pain, girls 

and women show more of an emotional response and 

tend to be more worried and irritated about pain 

(Unruh, 1996). Expectations regarding social roles 

may alter how women and men respond to pain. 

There have been multiple roles for women for 

example caring for children or older adults, 

household and work responsibilities and may attend 

to pain more readily so as to reduce its impact 

(Unruh, 1996). OA is a very common degenerative 

disease affecting up to 70% of adults over the age of 

65 years (Felson, 1998). Women are more likely to 

report OA pain than men (Davis, 1981, Cooper et.al, 

1998 & Felson, 1998). Several investigations have 

revealed that women are more disposed in pain 

catastrophizing to a greater extent than men. A 

relation between gender and catastrophizing has been 

observed in both clinical and experimental research, 

using a variety of assessment instruments. For 

example, in a sample of patients with 

musculoskeletal pain reported that women scored 

higher than men (Jensen et al, 1994 and Rosenstein et 

al, 1983). There are many studies which advocate 

that catastrophizing has led to risk factor for the 

development of pain-related disability (Sullivan et 

al., 2001, Vlaeyen et.al, 2000 & Waddell, 1998) 

Means that physical stresses   are provoked by pain 

catastrophizing due to chronic pain. Poor sleep 

efficiency and frequent awakenings results from little 

slow wave (delta), leads to insomnia. Experimentally, 

it has been observed that people with inadequate 

sleep and poor sleep quality are more disposed to 

having poor control on pain experiences hence 

perceive stress. e.g., poor sleep quality is related to 

greater pain severity (Smith MT 2004). Study was 

carried out on laboratory and clinical studies of sleep 

and pain and revealed about direct or indirect impact 

on pain feelings due to sleep lacking (Flor 1993). 

Psychosocial aspects clarify how sleep associates 

with pain, principally pain catastrophizing.  Some 

studies have displayed being in state of anxiety and 

emotional distress results from poor sleep quality 

which indirectly relates to pain catastrophizing 

(Edell-U, 2002 & Chang PP et. al, 1997). 

Furthermore, individual having poor sleep quality 

suffer from deleterious impact not only on physical 

and mental health, in fact on occupational 

functioning, and overall quality of life (Knudsen 

HK 2007).  

 

The stress and chronic pain is initiated by biological 

response. (chart 2). The link between stress, stressors, 

and chronic pain is complicated and supported by a 

number of biological, psychological, and social 

factors that mediate this association (Anthony K, 

2010). The innate biochemical responses to stress 

modulate the pain perception. Some studies 

illustrated that Pain is often endured in the absence of 

peripheral pathology means that psychogenically. 

Because number of papers proposed that where even 

low ‘stress’ there may be pain. On the other hand, 

stressor may be a trauma and it is associated with a 

peripheral pathology (e.g. Skin abrasion, fracture) 

that directly associates to a painful experience, there 

are several other types of stress (including 

psychological, social, and chemical). The most 

important question here is that how to conclude 

whether pain in the absence of peripheral pathology 

is ‘real’ or not. This can be accessed by Stress 

symptoms caused by peripheral pathologies such as 

irritable bowel syndrome and chronic fatigue etc. by 

analyzing whether the symptoms are fake as part of 

attention-seeking behavior. One of the idea suggested 

that individual that possess low pain threshold will 

undergo pain and depiction will be observed by 

pupillary dilation due to perceiving pain (Hapman 

CR et.al 1999). 

 

Methodology 

Aim of the present study was to demographically 

evaluate the prevalence of chronic pain in male & 

female, identify possible cause of its severity, its 

cascade of amplification leading to physical and 

emotional stresses as well as on psychologic site. 

This study was need to be conducted, because in 

number of reviews, it was observed that increase in 

chronic pain often leads to interruption and 

physically inactive lifestyle, moreover various study 

given the idea about in old age, the coping 

intervention do not effectively work as compare to 

middle age because of aging phenomena. Therefore, 

study was interestingly carried out among adult age 

subjects. In a cross sectional study, 140 individuals 

had been enrolled from general population of 

Karachi, who had been suffering from any type of 

chronic pain, because in acute pain condition being 

undergo catastrophizing very likely to occur in order 

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Uzma Naseem 58 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

to interface unusual stress and brain is not adapted to 

it. In exclusive criteria menopausal women, 

cardiovascular diseases, Nephropathy and cancer and 

severely ill individual were not enrolled. Males and 

females Subject were considered to be eligible if they 

lied in age range between: 18-50. Moreover, it 

contained pain location scale to facilitate in pain 

reporting easily. 

 

 

In addition, the questionnaire was designed precisely 

with different scales. Furthermore, PCS was used to 

analyze level of pain and its related thinking which 

can be completed and scored in less than 5 minutes. 

As this scale contain 13 self-reporting questions 

derived from descriptions of catastrophizing 

described in the literature. This scale also asked 

participants to reflect on past painful events by 

degree of occurrence on 5-point scales 0 means not at 

all while 4 means all the time. Moreover, 

psychological distress such as physical and emotional 

stresses are measured by Sadaf stress scale. 

 

Data was primary collected from hospitals, office, 

and different department within university, Homes, 

and General Shops etc. The respondents were 

randomly selected on stratified random sampling 

basis. We assessed any type of pain by a validated 

self-report questionnaire in the general healthy 

population, next the respondents were instructed to 

report whether they had experienced pain or 

discomfort more than three months. In addition, 

obtaining frequency or occurrence of an event or 

status. The questionnaires included demographic and 

socioeconomic factors, and variables concerning 

lifestyle, work, function, and psychological status to 

be asked. Moreover, participant was usually asked to 

recall pain experience over a period of time to allow 

to obtain maximum possible pain symptoms which 

they had been perceiving. SPSS version 16.0 was 

utilized to analyze the data. Furthermore, Pearson’s 

product movement correlation coefficient was 

analyzed to calculated and find the relationship 

between profile of psychological symptoms and pain 

catastrophizing scale outcomes. Finally, Microsoft 

Office 2013 was used to access graphical 

representations of our different parameters obtained 

via study. 

 

Result 

This survey based adult population study was 

basically conducted to investigate the pattern of pain 

in order to access the behaviors and relative 

psychophysiological aspects which either limits or 

influence different health care issues. With the help 

of findings of our study it was concluded that most of 

the pain enduring subjects were reported by 

Osteoarthritis as compare to other. Moreover, due to 

chronic pain, superficially the type of stresses 

observed by them were emotional and physical stress 

among mental, nutritional and traumatic stresses. On 

the other side among components of catastrophizing, 

subjects were significantly found to be under 

rumination and helplessness, a type of depressive 

disorder. Statistical Analysis Pearson correlation 

coefficients were calculated to explore the most 

abundant interrelations between Rumination, 

magnification and   helplessness with physical, 

mental and emotional stress respectively. Our results 

demonstrated that Intensity of pain and 

catastrophizing were significantly not only 

directionally proportional to each other but also 

plenteous Correlated with helplessness.

 

 

 

 

 

 

 

 

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Uzma Naseem 59 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

55%

30%

51%

HELPLESNESS MAGNIFICATION RUMINATION

 

Figure 1 shows distinct pain location with their prevalence reported by chronic pain survival in our study. 

 

 

 

 

 

 

 

 

 

Figure: 2 shows Depiction of comparative various stress outcomes with obtained by SSS. 

 

 

 

 

 

 

 

 

 

Figure 3 shows three components of pain catastrophizing with respective percentages of findings. 

 

 

 

 

 

 

 

 

 

 

 

Figure 4 shows the increased outcomes of rumination and helplessness in catastrophizing scale at the same 

time significant upshots of physical, mental and emotional stress in Sadaf stress scale. 

 

 

 

 

 

 

 

 

Figure: 5 shows Percentage of incident of chronic pain in male and female significantly females reported 

more than males. 

 

 

 

 

Moodness

Depression

Fatigue

Headache

Conc. Problem

Repeatitive thinking

worry all the time of pain

Anxiously want to pain to go away

68%

67%

68%

67%

64%

61%

43%

55%

Yes No

22%

13%

49%
14% male % female %

Traumatic stress

Physical stress

Nutrional stress

Mental stress

Emotional stress

54

56

49

55

56

muscular pain

headache

joints

burning

visceral pain

19%

9%

26%

1%

5%

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Uzma Naseem 60 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

 

 

 

 

 

 

 

Figure 6 Pearson correlation for physical stress and helplessness. 

   

 

 

 

 

 

 

 

 

Pearson correlation for mental stress and helplessness. 

 

 

 

 

 

 

 

 

 

Pearson correlation for emotional stress and helplessness. 

 

Discussion 

Our findings have supported the assumptions of the 

chronic pain leads to physical and emotional stresses 

and subsequently results into exaggerated thoughts 

which are termed as catastrophizing. Furthermore, 

our study determined that structural differences in 

females as well as nutritional insufficiencies may 

contribute to frequencies of joints pain. Our study 

enforced that behavioural discrimination is also the 

important fact to provoke stress induces catastrophic 

pain (Michael J et. al 2004).  Likewise, in generally if 

women in working field having expose higher than 

men to risk factors for musculoskeletal pain, it will 

also be affected by the prevalence of pain (J Orthop 

.et.al 1996). Because within the same task or 

profession, performance is different. Such as carry 

specific amount of load is given to carry from one 

way to other. Male can finish it in a single time while 

female cannot so. This may cause physical stress 

(Susan H, 2010) However, female hormone estrogen, 

plays a role in cartilage protection. When estrogen 

decreases monthly during the menstrual cycle as well 

as during menopause, the amount of cushioning the 

cartilage provided also decreases and if individuals 

are prone to anxiety, then it is possible that they 

suffer regular back pain for years as a result of stress. 

Moreover, we know that sustain abnormal 

stimulation to neurons may elicit the heat shock 

proteins which provoke beneficial stress in body. But 

if these stresses are diverged into further categories 

of stress like in our results physical and emotional 

stresses shown high even patients taking 

interventions which indicated that they are enduring 

psychogenic pain which require counselling to 

minimize this stress. PCS analysis assessed that great 

number of subjects were under catastrophizing with 

highest percent of Rumination and helplessness, the 

symptoms of depression. Peoples undergo depression 

not only unable to banish sad memories, but also get 

paranoid. Hence, number of studies reflected that 

distress can be improved by various relaxation 

techniques, such as meditation or breathing exercises, 

biofeedback therapy also suggested as to maintain the 

stress level (Paul R, 2012). Studies recommended 

that increasing the focus of treatment on tolerance, 

will decreasing the power of unnecessarily dispiriting 

thoughts and enhancing psychological flexibility 

(Kevinal et. al 2006). 

 

 

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Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

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