This is a complicated subject with many theories:

Tang J, Gibson SJ.(2005). A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety.J Pain. 2005 Sep;6(9):612-9.

Abstract. The present study examined the interactive effects of state and trait anxiety on pain threshold and subjective pain intensity. State anxiety was manipulated in 15 low trait anxious (LTA) individuals and 17 high trait anxious (HTA) individuals, who rated their anxiety level and subjective pain intensity in response to noxious electrical experimental pain stimuli. A difference in pain threshold between HTA and LTA participants was NOT found; however, higher state anxiety led to an increase in reported pain intensity for all participants. Furthermore, HTA individuals reported significantly higher levels of anxiety and pain intensity than LTA individuals across all pain and anxiety conditions. There was no interaction between state and trait anxiety on pain perception and anxiety ratings. These findings show an additive rather than synergistic effect between state-trait anxiety and subjective pain intensity.

Alexander Ploghaus,Charvy Narain, Christian F. Beckmann, Stuart Clare, Susanna Bantick, Richard Wise et al (2001). Exacerbation of Pain by Anxiety Is Associated with Activity in a Hippocampal Network. The Journal of Neuroscience, December 15, 2001, 21(24):9896–9903

Abstract. It is common clinical experience that anxiety about pain can exacerbate the pain sensation. Using event-related functional magnetic resonance imaging (FMRI), we compared activation responses to noxious thermal stimulation while perceived pain intensity was manipulated by changes in either physical intensity or induced anxiety. One visual signal, which reliably predicted noxious stimulation of moderate intensity, came to evoke low anxiety about the impending pain. Another visual signal was followed by the same, moderate-intensity stimulation on most of the trials, but occasionally by discriminably stronger noxious stimuli, and came to evoke higher anxiety. We found that the entorhinal cortex of the hippocampal formation responded differentially to identical noxious stimuli, dependent on whether the perceived pain intensity was enhanced by pain-relevant anxiety. During this emotional pain modulation, entorhinal responses predicted activity in closely connected, affective (perigenual cingulate), and intensity coding (mid-insula) areas. Our finding suggests that accurate preparatory information during medical and dental procedures alleviates pain by disengaging the hippocampus. It supports the proposal that during anxiety, the hippocampal formation amplifies aversive events to prime behavioral responses that are adaptive to the worst possible outcome.

Etherton J, Lawson M, Graham R (2014).Individual and gender differences in subjective and objective indices of pain: gender, fear of pain, pain catastrophizing and cardiovascular reactivity. Appl Psychophysiol Biofeedback. 2014 Jun;39(2):89-97. doi: 10.1007/s10484-014-9245-x.

Abstract. According to fear-avoidance models of pain perception, heightened fear of pain may increase disruptive effects of pain; however, the extent to which this affects self-reported pain severity versus physiological indices of pain is not well delineated. The current study examined self-report measures and physiological indices of pain during a cold pressor (CP) task. Individual differences in fear of pain and pain catastrophizing were also assessed via questionnaire. The primary aim of the current study was to examine the extent to which individual differences associated with fear and catastrophizing in response to pain influences subjective and physiological measures of pain. A secondary aim was to examine gender differences associated with response to pain. Average subjective pain ratings were higher for females than males. In contrast, males exhibited higher systolic and diastolic reactivity in response to the CP task relative to females, as well as failure to fully recover to baseline levels. Follow-up correlational analyses revealed that subjective pain ratings were positively associated with fear of pain in both sexes, but were not associated with cardiovascular indices. These results suggest that fear of pain and pain catastrophizing do not influence cardiovascular responses to induced pain. Further research is necessary in order to determine whether these gender differences in blood pressure and heart rate response profiles are due to biological or psychosocial influences. Results support the notion that fear of pain increases subjective pain ratings, but does not influence cardiovascular responses during CP pain-induction.

Edwards RR, Kronfli T, Haythornthwaite JA, Smith MT, McGuire L, Page GG. (2008).Association of catastrophizing with interleukin-6 responses to acute pain..Pain. 2008 Nov 15;140(1):135-44. doi: 10.1016/j.pain.2008.07.024.

Abstract

Catastrophizing exerts its deleterious effects on pain via multiple pathways, and some researchers have reported that high levels of catastrophizing are associated with enhanced physiological reactivity to painful stimulation. In this project, 42 generally healthy adults underwent a series of psychophysical pain testing procedures assessing responses to noxious mechanical, heat, and cold stimuli. Pain catastrophizing cognitions were assessed prior to and then immediately after the various pain induction procedures. Blood samples were taken at baseline and then at several time points from the end of the procedures to 1h post-testing. Samples were assayed for serum levels of cortisol and interleukin-6 (IL-6). Both cortisol and IL-6 increased from baseline during the post-testing period (p's

"pain catastrophizing emerged as a full mediator between presurgical anxiety and postsurgical pain intensity." according to:

Armando Almeida, Patrícia R Pinto, Vera Araújo-Soares, Teresa McIntyre: The mediating role of pain catastrophizing in the relationship between presurgical anxiety and acute postsurgical pain after hysterectomy.

ABSTRACT The aim of this study was to examine the joint role of demographic, clinical, and psychological variables as predictors of acute postsurgical pain in women undergoing hysterectomy due to benign disorders. A consecutive sample of 203 women was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Baseline pain and predictors were assessed at T1 and postsurgical pain and analgesic consumption at T2. Several factors distinguished women who had no or mild pain after surgery from those who had moderate to severe pain, with the latter being younger, having more presurgical pain, and showing a less favorable psychological profile. Younger age (odds ratio [OR]=0.90, P

Thank you for your thoughtful responses Beatrice,

I agree that this is a complicate subjects. The research that you have presented highlights the profound influence that negative mental sets (e.g., anxiety, fear, depression, and catastrophizing) have on pain perception. It is also interesting to note that pain catastrophizing mediates the association between anxiety and pain perception in some instances. Perhaps more interesting is the notion that fear of pain shows some degree of physiological specificity and influences immunological function rather than cardiovascular function. You have provided much food for thought here.

I am more interested in the shared/unique roles that trait anxiety and pain catastrophizing play when observers (e.g., healthcare providers, spouses) evaluate the pain of a sufferer. I was wondering if you had thoughts on this matter?

Thanks again for all of your helpful feedback.

You are most welcome:)

Thank you for summarizing and commenting on this interesting article Joel.  The results of this investigation do suggest that anxiety and pain catastrophizing each have a unique contribution to pain the development of TMD.  Interestingly, somatic-symptoms were the psychological variables that differed most between TMD cases and controls.  It occurs to me that autonomic hyperarousal is one way in which trtait anxiety and pain catastrophizing differ.  Perhaps autonomic hyperarousal characteristic of anxiety adds to the sensory component of experienced pain whereas catastrophizing primarily activates the affective component.  Just a thought.

Sincerely,

Josh

This might be relevant....

Wong WS, Fielding R. Suppression of emotion expression mediates the effects of negative affect on pain catastrophizing. Clinical Journal of Pain, 2013. 29: 865-872. Epub 2012. doi: 10.1097/AJP.0b013e31827da3b5

Objectives: Negative affect is associated with individual differences

in pain catastrophizing. Research suggests that variations in emo-

tion regulation may modify negative affect on pain catastrophizing.

Using the process model of emotion regulation, this study exam-

ined the relationships of 2 emotion regulatory strategies, cognitive

reappraisal and expressive suppression, with negative affect and

pain catastrophizing.

Methods: A total of 224 Chinese patients with chronic pain com-

pleted self-report questionnaires measuring pain intensity (the

Chronic Pain Grade Questionnaire), emotion regulation (the

Emotion Regulation Questionnaire), negative affect (the Positive

and Negative Affect Schedule), and pain catastrophizing (the

Pain Catastrophizing Scale). Multiple regression models tested

the moderating and mediating effects of emotion regulation

strategies on the relationship between negative affect and pain

catastrophizing.

Results: Although both cognitive reappraisal (r= ÿ0.14) and

expressive suppression (r=0.37) were significantly associated with

pain catastrophizing in univariate analyses (P0.05). After

adjustment for sociodemographic and pain variables, expressive

suppression mediated the association between negative affect and

pain catastrophizing (b=0.68, Sobel test: z=3.67, P