Pain Vigilance and Awareness Questionnaire (PVAQ) This instrument assesses awareness, vigilance, preoccupation and observation of pain [21]. The original PVAQ consists of 16 items and has been validated for use in chronic pain samples and non-clinical samples. The Spanish version con-sists of two related subscales, corresponding to two factors.

Introduction The most prominent and disabling symptom of knee osteoarthritis (OA) is pain. The well-documented discordance between radiographic and symptomatic knee OA (,) suggests the experience of pain in individuals with knee OA cannot be fully explained by peripheral pathophysiology alone. Indeed, psychosocial factors, such as anxiety, depression, and coping style have been implicated in OA-related pain and disability (,,). The fear-avoidance model of pain provides a suitable heuristic for conceptualizing the contributions of psychosocial factors to the experience of OA-related pain (). This model posits that a cycle of pain chronicity and disability may be initiated when the appraisal of pain is influenced by negative psychosocial factors. The resultant maladaptive appraisal gives rise to pain-related fear and anxiety, as well as associated safety seeking behaviors such as avoidance/escape, which can be adaptive in the acute pain stage, but paradoxically exacerbate persistent pain.

The long-term consequences, such as enhanced disability or depression, in turn may lower the threshold at which subsequent pain is detected and/or enhance the intensity of the pain experience. Hypervigilance represents an important aspect of the fear-avoidance model that may contribute to OA-related pain. Rollman () defined hypervigilance as an enhanced state of sensory sensitivity accompanied by an exaggerated scan or search for threatening information. It has been proposed that some individuals who live with chronic or recurrent pain may develop a pain-specific ‘hypervigilance’ as a result of continual effort to detect painful sensations and other pain-related information, which may in turn exacerbate the pain experience (). Generalized hypervigilance (i.e., heightened vigilance for internal and external signals in addition to pain) and pain-specific hypervigilance have been studied in several samples of adults with disorders characterized by recurrent or persistent pain. For example, pain hypervigilance was positively associated with greater pain intensity, emotional distress, psychosocial disability and pain-related health care utilization in patients with chronic back pain ().

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McDermid () showed that patients with fibromyalgia and rheumatoid arthritis reported greater generalized hypervigilance and displayed greater sensitivity to experimental pain compared to controls. The association of pain hypervigilance with increased clinical and experimental pain may be related to central sensitization, a phenomenon in which nociceptive pathways in the central nervous system become sensitized by repeated or sustained nociceptive input ().

Evidence of central sensitization has been demonstrated in a number of disorders characterized by chronic or recurrent pain (,), including knee OA (). Theorists have posited that some OA patients may have a greater propensity to develop central sensitization, which may underlie the discordance between symptomatic and radiographic OA (). Although the impact of psychosocial factors on central sensitization has yet to be well characterized, pain hypervigilance has been postulated to play a role in central sensitization via descending pain modulatory pathways (). The relationship between pain hypervigilance and central sensitization has not been examined among persons with knee OA. Therefore, in the present study, temporal summation of heat pain, a widely used quantitative sensory testing method that invokes neural mechanisms related to central sensitization (), was specifically examined in relation to pain hypervigilance.

We also sought to determine whether pain hypervigilance is related to reports of clinical OA pain and disability. In addition, to determine the relationship between pain hypervigilance and pain modality, three major types of stimuli used in laboratory pain research (i.e., heat pain, pressure pain, cold pain) were assessed. The following hypotheses were tested: 1) pain hypervigilance will predict greater severity of clinical pain and disability; 2) pain hypervigilance will predict greater sensitivity to experimental pain stimuli beyond what can be explained by clinical pain and; 3) pain hypervigilance will predict greater temporal summation of heat pain after adjusting for confounding variables, including clinical pain. Demographic variables (age, ethnicity, gender, and education) and depressive symptoms were statistically controlled for in all analyses. In addition, clinical pain intensity and situational passive coping were added as additional covariates for analyses examining experimental pain sensitivity. Participants The current study is part of a larger ongoing project that aims to enhance the understanding of biopsychosocial factors contributing to pain and functional limitations among individuals with knee osteoarthritis (Understanding Pain and Limitations in Osteoarthritic Disease, UPLOAD). The UPLOAD study is a multi-site investigation that recruits participants at the University of Alabama at Birmingham and the University of Florida.