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Selected Research Project
Project Title A Prospective, Longitudinal Study of the Fear-avoidance Model in Chinese Patients with Chronic Pain: Assessing Individual Differences in Pain Catastrophic Cognition and Pain-related Fear
Principal Investigator Prof. Wong Wing Sze
Area of Research Project
Psychological Studies


Project Period
From 09/2010 To 03/2013
Using a Chinese sample of patients with chronic pain, this project aims to examine the following:
  1. The dispositional role of neuroticism and negative affectivity in explaining differences in pain catastrophic cognition;
  2. The mediating role of pain hyper-vigilance in the relationship between anxiety sensitivity and pain-related fear;
  3. The trajectories of FAM components; and
  4. The concurrent interrelationships of FAM components.
Methods Used
This prospective, longitudinal study proposes to address the existing gaps in the research literature regarding the determinants of individual variability in pain catastrophic cognitions and pain-related fear, as well as the trajectories of chronic pain within the FAM framework. The study will also allow us to obtain empirical evidence of FAM among Chinese patients. A sample of 400 Chinese patients with chronic musculoskeletal pain will be recruited from a multi-disciplinary pain clinic in Hong Kong. Measures of the FAM components will be taken at baseline, and at 3, 6, and 12 months following baseline. Linear mixed effect modeling will be used to assess the role of personality traits in pain catastrophic cognition and the underlying mechanisms of pain-related fear. Hierarchical linear modeling and path analyses will be used to evaluate changes of the FAM components over time and the cross-sectional interrelationships between FAM components, respectively.
Summary of Findings

The results of the study demonstrated that (1) neuroticism and negative affectivity were two dispositions at the same conceptual level, and (2) pain hypervigilance mediated the relationship between anxiety sensitivity and pain-related fear. Our findings offer evidence that patients presenting with more neurotic symptom and heightened negative affect probably elicit more catastrophic thoughts about pain. These findings show demonstrate how the interdependence of dispositional factors affects pain adjustment and functioning. More importantly, results of this study add to the existing pain literature on FAM. Thus far, the studies that examined the bidirectional relationships of the key components of the FAM have all been conducted in Western populations. Findings of this study are consistent with the view that the basic premises of the FAM appear to generalize across cultures. These findings provide an important theoretical and empirical base for future research to clarify cultural similarities and differences among patients with chronic pain.

The proposed project will be the first systematic study on pain behavior and adjustment among Chinese patients with chronic pain. The findings will shed light on the trajectories of chronic pain and the design of non-pharmacological strategies to decrease morbidity and control chronicity in a local, as well as an international, context.

*Wong, W. S., Lam, H. M. J., Chen, P. P., Chow, Y. F., Wong, S., Lim, H. S., Jensen, M., & Fielding, R. (2015). The fear-avoidance model of chronic pain: Assessing the role of neuroticism and negative affect in pain catastrophizing using structural equation modeling. International Journal of Behavioral Medicine, 22, 118-131.
*Wong, W. S., Lam, H. M. J., Chow, Y. F., Chen, P. P., Lim, H. S., Wong, S., & Fielding, R. (2014). The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: A preliminary, cross-sectional analysis. Quality of Life Research, 23, 2333-2341.

Biography of Principal Investigator
Wing S. Wong obtained her doctorate from City University of Hong Kong, and completed her post-doctoral training at the medical school of the Chinese University of Hong Kong and the University of Hong Kong. Currently, she is the Head of the Department of Psychological Studies and Director of Centre for Psychosocial Health at the Hong Kong Institute of Education. Her research interests lie in the broad area of adjustment and outcomes of chronic musculoskeletal pain. Her recent projects have examined the behavioral and cognitive processes underlying the development and maintenance of chronic pain and pain-associated disability, psychosocial assessment of pain, and cross-cultural comparison of pain behavior and cognition. Her other research interests include psychosocial factors associated with co-morbid chronic somatic symptoms and health-related risk perception and decision making.
Funding Source
General Research Fund