The Relationship Among Emotional Regulation and Pain Catastrophizing in Chronic Pain Patients: Implications for Social Work Practice and Research

Background/Purpose: Chronic pain is a growing concern in the United States and particularly for marginalized populations. Pain is not just a medical issue; it is a social justice issue and for those most vulnerable in our society. Attentional and emotional factors, which may modulate pain, are also often key targets for social work interventions. Specifically, protective factors can often decrease pain, such as the ability to effectively regulate emotions. Conversely, pain catastrophizing which involves rumination, magnification and helplessness, may exacerbate pain. While there is evidence that supports the association between emotional regulation and pain, additional research is needed to better understand the relationships among these variables. The aim of this study is to investigate the role of emotion regulation in exacerbating the pain experience explicitly through pain catastrophizing.

Methods: This cross-sectional survey examined demographic, clinical, and psychosocial factors among chronic pain patients. Eligibility included: ages ≥18, chronic pain (3 months or longer), and currently taking opioid medications. Data collected included demographics, substance use, mental health, health and psychosocial characteristics. Descriptive and univariate statistics were used to characterize the population. A multi-level path analysis with latent variables was conducted using structural equation modeling (SEM). Factors included the Difficulties in Emotion Regulation Scale (DERS) with six subconstructs: Goals, strategies, non-acceptance, awareness, impulse and clarity, and the Pain Catastrophizing (PCS) including three subconstructs: helplessness, magnification and rumination. The structural model included DERS as the predictor, PCS as the mediator, and Pain Severity and Interference as the outcome variables. Indirect effects were tested through bootstrapping given its advantage of not making distributional assumptions.

Results: Participants (n=120) had a mean age of 51.3 years (SD=12.9), were 61.6% female (n=74), 13.4% employed full time, 8.3% part time, 28.3% were unemployed, and 50% of the participants were receiving disability, and 73.3% had complete some education beyond high school . SEM results revealed that the two factors DERS and PCS were well identified with good construct validity. Further, there were significant direct effects of DERS on pain catastrophizing (b=.45, z =3.73, p <.001),as well as pain catastrophizing on pain interference (b=.47, z =4.38, p <.001) and pain severity respectively (b=.32, z =2.98, p <.01). The direct effects of DERS on pain were no longer significant after accounting for the indirect effects of DERS via pain catastrophizing on pain severity (Db=.14, z =2.36, p<.05) and on interference (Db=.21, z =2.91, p<.01). Thus, pain catastrophizing fully mediated the paths from emotion dysregulation to all pain outcomes.

Conclusion and Implications: Emotional regulation and pain catastrophizing may serve a critical role in influencing pain severity and interference in chronic pain patients. These data highlight the interplay of psychosocial factors, including emotion regulation and pain catastrophizing, which can potentially help social workers develop more robust pain management protocols. In particular, modulation of emotional regulation and catastrophizing may be effective in chronic pain patients . In order to better establish these findings, future research should employ longitudinal designs to examine these relationships over time, and in larger national samples.