Negative Emotions, Pain, and Functioning Gabriel Tan Michael E. DeBakey VAMC and Baylor College of Medicine Mark P. Jensen University of Washington School of Medicine John Thornby Baylor College of Medicine Paul A. Sloan Michael E. DeBakey VAMC We used linear structural equations (path model analysis) to examine associations among negative emotions, pain, and functioning in a large sample (N = 511) of veterans with chronic pain. We postulated and tested a model where pain and func- tioning affect negative emotions and where negative emotions affect pain and func- tioning. The findings confirm a strong relationship between negative emotions, pain, and functioning in our sample, particularly as the variable Pain Interference affects Depression. In a significant but weaker relationship, we also found that Anxiety has a direct effect on patients’ perception of their Disability. Specifically, the data support a model where increased Pain Interference, Pain Severity, Depression and Anxiety all lead to increased Disability. Findings that Pain Interference and Depression appear to play a major role in the relationships between pain and negative emotions support the need for experimental studies to understand the causal impact of these variables on patient functioning. In the meantime, the findings suggest that Pain Interference, Depression, and Anxiety, in addition to Pain Severity, should all be targets of chronic pain treatment. Keywords: pain, negative emotions, pain interference, pain functioning A number of investigators have studied the relationships between negative emotions, par- ticularly depression, and pain. It is well ac- cepted among pain experts that negative emo- tions such as depression are related to pain perception and experience (e.g., Banks & Kerns, 1996; Holzberg, Robinson, Geiser, & Gremil- lion, 1996). However, questions concerning the causal associations between pain and negative emotions (e.g., whether depression and other negative emotions such as anxiety and anger result from chronic pain and/or whether nega- tive emotions exacerbate pain experience) have remained largely unresolved. Current models of pain perception argue that the experience of pain is influenced by emo- tional states, and that disability specifically re- sulting from pain is affected by both pain per- ception and emotional state. In support of these models, evidence indicates that states of depres- sion lead to increases in the report of pain (Salovey & Birnbaum, 1989), decreases in the tolerance for experimentally induced pain (Zelman, Howland, Nichols, & Cleeland, 1991), and interpretation of various sensa- tions as painful (Pennebaker, 1982). How- ever, the data are not conclusive, given the finding that depressed patients can also have a higher sensory and pain tolerance then non- depressed patients (for a review and meta- analysis, see Dickens, McGowan, & Dale, 2003). The notion that pain is the catalyst for nega- tive emotional states comes from the belief that pain causes enough of a disruption in an indi- vidual’s life that negative affective states emerge (see Banks & Kerns, 1996). For exam- ple, pain can lead to a sense of hopelessness and helplessness, can interfere with reinforcing or pleasurable activities, and can lead to isolation, sleep disturbances, and frustration. All of these Gabriel Tan, Michael E. DeBakey VAMC and Baylor College of Medicine; Mark P. Jensen, University of Wash- ington School of Medicine; John Thornby, Baylor College of Medicine; Paul A. Sloan, Michael E. DeBakey VAMC. Correspondence concerning this article should be ad- dressed to Gabriel Tan, ABPP, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd (145 Anesthesiol- ogy), Houston, TX 77030, E-mail: tan.gabriel@med.va.gov Psychological Services Copyright 2008 by the American Psychological Association 2008, Vol. 5, No. 1, 26 –35 1541-1559/08/$12.00 DOI: 10.1037/1541-1559.5.1.26 26