Perceived Control and Negative Affect Predict Expected and Experienced Acute Clinical Pain: A Structural Modeling Analysis

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Abstract
Objectives Risk factors for elevated levels of clinical and experimental pain have been shown to be independently predicted by the individual's perception of personal control, negative emotional states, and pain expectancy. In this study we examine the mutual simultaneous association of these factors in the experience of dental extraction pain. Methods Using structural equation modeling we examined the relationship between desired and predicted personal control, negative emotional state and the expectation of pain to predict worst treatment pain. A convenience sample of 381 patients receiving walk-in emergency dental treatment were enrolled. Half of the patients were randomly selected for generating the measurement model, the hold-out subsample was used to confirm the model. Results Overall fit indices were adequate for both models [χ2/df≥1.37, Comparative Fit Index (CFI)≥0.96, Standardized Root-Mean-Square Residual (SRMR)≤0.05, Root Mean Square Error of Approximation (RMSEA)≤0.06], coefficients of determination were meaningful (R2≥0.14), and factor loadings (β's) were significant (P's<0.001) for each step in both models. Discussion A sequential pathway was revealed wherein patients' desire for control over the aversiveness of treatment and their prediction of having control over those events (whether desired or not) facilitated a negative emotional state. Negative emotional state in turn influenced expected treatment pain and subsequently the level of treatment pain actually experienced. We conclude that the perception of personal control is a clinically important and cognitively-mediated factor that influences the level of acute pain experienced during stressful clinical procedures.