Person. indioid. DI# Vol. 4. No. 5. pp. 559-561. 1983 0191.8869/83 %3.00+0.00 Printed in Great Britain. All rights reserved Copyright 0 1983 Pergamon Press Ltd

Personality variables and pain expectations

SHIRLEY PEARCE and SERI PORTER

Department of Psychology, University College London, Gower Street, London WClE 6BT. England

(Received 5 November 1982)

Summary-A number of studies have suggested that personality variables may be implicated in the experience of pain. Neuroticism (N) has been shown to be related to pain intensity whilst Extraversion (E) has been implicated in the likelihood of an individual to engage in pain behaviours, e.g. complaints of pain and taking pills. This study aims to look at the role of these personality variables in the expectations of pain in subjects not currently experiencing pain. A questionnaire was developed to assess expectations of: (1) pain intensity and (2) the likelihood of engaging in pain behaviours. N, as measured by the EPQ, was shown to be significantly correlated with expectations of pain intensity but E was not found to be significantly correlated with expectations of engaging in pain behaviours. The results are discussed in the context of current debates about the role of personality variables in the development of chronic-pain states.

INTRODUCTION

The role of individual differences in pain experience has received increasing attention over the last decade. This interest has been associated with changes in the theoretical understanding of pain. The traditional view of pain as primarily a sensation whose intensity is closely related to the extent of physical damage and hence the level of activity in the nociceptive pathways has given way to the view of pain as a multidimensional experience consisting of physiological, subjective and behavioural components (Fordyce, 1978; Sternbach, 1978). The relationship between these components is now known to be desynchronous, i.e. the extent of pain behaviours-e.g. complaints of pain, taking tablets--is not always directly proportional to the extent of subjective distress or activity in the nociceptive system. A number of psychological factors have been shown to influence the relationship between the components. These include: the meaning of the situation (Beecher, 1956) social situational influences (Craig, 1978) anxiety state (Weisenberg, Kreindler, Schachat and Verboff, 1975) predictability and control (Thompson, 1981), cultural factors (Wolff and Langley, 1968; Zborowski, 1952) and personality variables (Lynn and Eysenck, 1961; Bond, 1981).

Personality and pain Lynn and Eysenck (1961) found a significant positive correlation between pain tolerance levels and Extraversion (E)

scores measured by the EPI. These observations fit with studies by Petrie (1967) which show relationships between pain tolerance and perceptual reactance, although these findings have come under more recent criticism (Elton, Vagg and Stanley, 1978; Petrie, 1978). Reducers in Petrie’s terms were shown to have higher tolerance for pain whilst augmenters were shown to tolerate less pain in an experimental situation. Eysenck has shown similar response patterns between augmenters and introverts on the one hand and reducers and extraverts on the other.

Apparently contradictory findings were obtained by Eysenck (1961) in a clinical population where extraverts tended to rate their pain as more severe than introverts. However, this does not represent a discrepant finding if the multidimensional view of pain described above is adhered to. Complaints of pain, i.e. pain behaviour, which is what was measured in Eysenck’s clinical study may be desynchronous with subjective experience which is what was measured in the Lynn and Eysenck (1961) and Petrie (1967) studies. This would suggest that increasing levels of E may increase the likelihood of pain behaviours irrespective of the levels of activity in the physiological and subjective systems.

This interpretation is supported by Bond and Pearson (1969) who showed that amongst a group of women with advanced cancer of the cervix all with high Neuroticism (N) scores, extraverts were more likely to complain to nursing staff about their pain despite the fact that the introverts had slightly higher levels of pain as measured by analogue scales.

Neuroticism has also been implicated in the experience of pain. Several studies have shown that ratings of pain severity are directly related to levels of N (Eysenck, 1961; Lynn and Eysenck, 1961; Pilling, Brannick and Swanson, 1967; Bond and Pearson, 1969; Bond, 1971. 1973). In general it would seem that the severity of subjective distress is influenced by N levels whilst the likelihood of engaging in pain behaviours is influenced by the levels of E.

It is unclear whether these personality variables affect only response to pain or whether they also affect general expectations of pain and discomfort prior to painful experiences. Petrovich (1957) argued that each individual is predisposed to judge pain in others in a characteristic way dependent on his own experience and reactions to pain. Using the Pain Apperception Test (PAT), a projective technique, he showed a correlation between ratings of pain experienced by others and N as measured by the Maudsley Personality Inventory (Eysenck, 1956). However, subsequent reports have failed to replicate Petrovich’s results and the PAT has come under criticism for being too ambiguous and complex (Merskey and Spear, 1967; Elton, Burrows and Stanley, 1979). Elton used an alternative projective test, the Melbourne Pain Apperception Film (MPAF) and showed significant correlations between MPAF scores and pain threshold and tolerance to ischaemic pain for pain-free subjects, chronic-pain patients without obvious pathology and pain patients with a clearly organic basis to their pain. Unfortunately, Elton failed to look at personality variables that might influence PAT scores and hence was not in a position to replicate Petrovich’s results. One of the possible causes for the ambiguity and unreliability of the PAT

is that the subject is asked to rate how much pain the person in the picture is experiencing. In the study reported here a questionnaire was designed to assess the amount of pain the subjects themselves would expect to experience in a number of situations. The aim of the study was to iook at the role of personality variables in influencing these expectations. From the results of the studies outlined above the following hypotheses were made:

559

560 NOTES AND SHORTER COMWJNICATIONS

(I) Pain intensity expectations would be correlated with N scores. (2) Expectations of the likelihood of engaging in pain behaviours would be correlated with E scores.

METHOD

College students living in the same hall of residence (N = 51) were asked to complete both the EPQ (Eysenck and Eysenck, 1975) and a Pain Questionnaire. The Pain Questionnaire consisted of a list of IO situations which are traditionally considered painful. Items were chosen on the grounds that they were relatively infrequent situations and hence Ss were unlikely to have familiarized themselves with the situation or ‘habituated’ to the pain. In addition, the situations were all non-clinical, i.e. not illness related so that the possible role of personality variables in response to illness would be unlikely to confound the results.

PAIN QUESTIONNAIRE Please rate each of the following pain situations in terms ofz (a) the intensity of pain you would expect to experience in that situation; and (b) how hkely you

would bc to direct the attention of a friend. present at the time of the injury, to the site of the pain. For each judgemcnt please circle the mat appropriate rating on the scale O-6

Pain rating &haviour ratine

0 I 2 3 4 5 6 0 I 2 3 4 Excruciating Extremely

Pain stimulus No pain pal” unlikely

TB injectton 0 I 2 3 4 5 6 0 I 2 3 4

Burnmg arm on

oven while taking 0 I 2 3 4 5 6 0 1 2 3 4 out a cake

Pulhng ofi a sticking plaster from a hairy part of the body

Cutting your finger on paper

0 I 2 3 4 5 6 0 I 2 3 4 5 6

0 I 2 3 4 5 6 0 I 2 3 4

Burmng your tongue 0 I 2 3 4 5 6 0 I 2 3 4

Stepping on a drawing pi” while barefoot 0 1 2 3 4 5 6 0 I 2 3 4

Biting your tongue 0 I 2 3 4 5 6 0 I 2 3 4

Stubbing your big toe 0 I 2 3 4 5 6 0 I 2 3 4

Someone touchine your bare arm - with a lighted 0 I 2 3 4 5 6 0 I 2 3 4

cigarette

Slamming your

finger in P car door

0 I 2 3 4 5 6 0 I 2 3 4

5 6 Extremely

hkcly

5 6

5 6

5 6

5 6

5 6

5 6

5 6

5 6

5 6

For each situation the S were asked to make two ratings each on a ‘I-point numerically-anchored scale. The first rating was called a Subjective Pain rating and the Ss were asked to rate the intensity of the pain they would expect to experience. The second rating was called a Pain Behaviour rating and was an attempt to assess the likelihood of the S engaging in pain behaviours. The Ss were asked to rate how likely they would be to direct the attention of a friend present at the time of the injury to the site of the pain.

The questionnaires were scored by summing the individual ratings to arrive at a composite Subjective Pain score and a Pain Behaviour score.

The reliability of the Pain Questionnaire had heen previously established by administering it to 10 Ss who completed the questionnaire on two occasions between 24 and 48 hr apart. Test-retest reliability for the Subjective Pain rating was found to be high with a correlation coefficient of 0.92 (P < 0.001). The Pain Behaviour ratings showed a correlation of 0.83 (P < 0.01) which, although not quite such a high correlation, is still significant.

RESULTS

The results are presented in Table 1. The first hypothesis, that expectations of pain intensity would be correlated with N scores on the EPQ, was confirmed

Table I. Correlations of personality variables with Pain Intensity and Behaviour Exnectation ratings (N = 511

Expcctcd Pain Intensity

Behaviour ratine

Neuroticism EXtIWerSlO” Psychoticism Lie

0.34. 0.08 0.03 0.02

0.22 0.04 0.04 0.00,

l P < 0.02

NOTES ANI) SHOKTEK COMMUNICATIONS 561

(I = 0.34. P -c 0.02). As expected, N was not correlated with Pain Behaviour scores and E scores were not correlated with Pain Intensity Expectation scores.

Hypothesis 2 was, however, not confirmed. E scores were not significantly correlated with Pain Behaviour scores. Neither Psychoticism nor Lie scores correlated with either of the two Pain Expectation scores.

DISCUSSION

Previous studies suggest that N scores may predict the perceived intensity of pain whilst E scores may predict the extent of pain behaviours. This study has shown that expectations of pain intensity are also related to N. This finding lends support to the view that high levels of N may predispose an individual to experiencing higher levels of pain intensity in response to noxious stimulation. It is hard to extrapolate from expectations of the intensity of non-clinical pain as assessed in this study to the role of personality variables in the development of chronic clinical pain states. However, it is tempting to consider this finding in the light of arguments about the role of personality variables in the development of chronic pain. If it is the case that individuals with high N scores have expectations of higher levels of pain it is possible that under conditions of minimal trauma they may experience more pain than individuals with low N scores. Hence they may be more likely to develop painful conditions than low N subjects. This would conflict with the view that the high N scores that have frequently been observed amongst populations of chronic-pain patients are a resulf of the pain condition rather than a causal factor. At first sight it would also conflict with the findings reported by Sternbach and Timmermans (1975) where N scores were shown to be reduced as a consequence of successful treatment of the pain. Bond suggests that high N may predispose an individual to experiencing more pain and developing a chronic-pain condition, but during this condition N scores may increase even further and be reduced again if the condition is successfully treated.

The failure to find the expected correlation between E and ratings of the likelihood to engage in pain behaviours may be due to a number of factors. Of these, the most likely are: (a) inadequacies of the questionnaire, e.g. the concept of ‘directing the attention of a friend’ may be too ambiguous to adequately assess the individual’s view of his likelihood to engage in pain behaviours, or alternatively it may be too restricting to construe all pain behaviours in terms of gaining another person’s attention; and (b) self-report of pain behaviours may be unrelated to the actual pain behaviours observed at the time of injury. Fordyce, for example, has frequently criticized the reliance on self-report of pain behaviours in chronic-pain patients and places much greater value in direct observation or spouses’ reports of pain behaviour.

CONCLUSIONS

The study reported here confirms the view that personality variables influence not only reports of pain at the time of stimulation but also individuals’ expectations of pain in a number of non-clinical pain situations. N was shown to be significantly related to expectations of pain intensity. The role of E in predicting the likelihood of pain behaviour is not confirmed in this study and possible reasons for this are discussed.

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