Adaptive body awareness predicts fewer central sensitization-related symptoms and explains relationship between central sensitization-related symptoms and pain intensity: A cross-sectional study among individuals with chronic pain

Abstract

Background: Central sensitization (CS), defined as the amplification of neural signaling within the CNS that elicits pain hypersensitivity, is thought be a characteristic of several chronic pain conditions. Maladaptive body awareness is thought to contribute and maintain CS. Less is known about the relationship between CS and adaptive body awareness.

Purpose: This cross-sectional study investigated relationships among self-reported adaptive body awareness (Multidimensional Interoceptive Awareness Scale-2; MAIA-2), CS-related symptoms (Central Sensitization Inventory; CSI), and pain intensity and further delineate potential direct and indirect links among these constructs.

Methods: Online surveys were administered to 280 individuals with chronic pain reporting elevated CSI scores. Strategic sampling targeted respondents to reflect the 2010 census. Pearson's correlations characterized overall relationship between variables. Multiple regression analyses investigated potential direct links. A path analysis assessed mediational effects of CS-related symptoms on the relationship between adaptive body awareness and pain intensity.

Results: CSI demonstrated strong, inverse correlations with some MAIA-2 subscales, but positive correlations with others. Higher CSI scores predicted greater pain intensity (b = 0.049, p ≤ 0.001). Two MAIA-2 subscales, Not-Distracting (b = -0.56, p ≤ 0.001) and Not-Worrying (b = -1.17, p ≤ 0.001) were unique predictors of lower CSI. Not-Distracting (b = -0.05, p = 0.003) and Not-Worrying (b = -0.06, p = 0.007) uniquely predicted lower pain intensity. CSI completely mediated the relationship between adaptive body awareness and pain intensity [point estimate = -0.04; 95% bootstrap confident intervals (CI) = -0.05 to -0.02].

Conclusions: Findings also support future research to explore causal relationships of variables. Findings suggest that frequency of attention to bodily sensations is distinct from cognitive-affective appraisal of bodily sensation, and the two distinct higher order processes may have divergent influences on perceived pain and CS-related symptoms. Results also support future research to explore causal relationships of variables.

Keywords: body awareness; central sensitization; chronic pain; interoceptive awareness; mediation; predictors.