Health Anxiety as a Mediator between Childhood Maltreatment and Pain Catastrophizing in Adults with Chronic Pain: A Path Analysis Study
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Objective: This study examined whether health anxiety mediates the relationship between childhood maltreatment and pain catastrophizing in adults with chronic pain, within the framework of the Fear-Avoidance Model.
Methods and Materials: In a descriptive-correlational design, 260 adults aged 18–40 years with chronic pain were recruited in Hamedan, Iran, from pain clinics, general practices, and online announcements. Participants completed the Childhood Trauma Questionnaire, Pain Catastrophizing Scale, and Health Anxiety Inventory. Path analysis using AMOS 24, with maximum likelihood estimation and 5,000-sample bootstrap, tested direct and indirect effects; SPSS 26 was used for preliminary descriptive and correlational analyses.
Findings: Childhood maltreatment was positively associated with both health anxiety and pain catastrophizing. In the path model, childhood maltreatment showed significant direct effects on health anxiety (β = 0.64, p = .023) and pain catastrophizing (β = 0.41, p < .001), while health anxiety strongly predicted pain catastrophizing (β = 0.59, p < .001). Health anxiety partially mediated the association between childhood maltreatment and pain catastrophizing (indirect effect β = 0.38, 95% CI [0.23, 0.52]), and model fit indices were acceptable (RMSEA = 0.07, CFI = 0.92, GFI = 0.94, χ²/df = 2.12).
Conclusion: Early maltreatment appears to increase pain catastrophizing both directly and indirectly through elevated health anxiety in adults with chronic pain. Screening for childhood maltreatment and health anxiety, and integrating cognitive-behavioral strategies that target illness worries and catastrophic pain appraisals, may enhance trauma-informed chronic pain management.
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