Catastrophizing, pain, and social adjustment in scleroderma: Relationships with educational level

Robert R. Edwards, Layne Goble, Amy Kwan, Ian Kudel, Lynanne McGuire, Leslie Heinberg, Fred Wigley, Jennifer Haythornthwaite

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


OBJECTIVES: Low educational attainment is related to numerous adverse health outcomes, and some evidence suggests that psychosocial variables may mediate education's effects. Moreover, the relationship between psychosocial functioning and health-related outcomes may be moderated by educational level, with individuals lower in formal education being more susceptible to the deleterious effects of negative cognitive and affective states. The present study sought to characterize such interrelationships between educational level and pain-related catastrophizing. METHODS: We investigated the association of self-reported educational level with pain and social disability, we evaluated catastrophizing's potential mediating role in those associations, and we also investigated education as a moderator of catastrophizing's effects on pain and social disability in a sample of patients with scleroderma, a frequently painful autoimmune disorder. RESULTS: First, education-related differences in pain report were accounted for by catastrophizing and depression. Second, after controlling for demographic factors, disease severity, and depressive symptoms, education moderated the relationship between catastrophizing, pain affect, and social function. Specifically, catastrophizing was more highly associated with greater reporting of affective pain among those with less formal education. In addition, catastrophizing inversely correlated with social disruption among individuals with less formal education. DISCUSSION: Collectively, study findings support multiple models of interaction between education and pain-related cognitive/affective functioning, though in both mediational and moderational analyses, lower levels of formal education act as a risk factor for adverse pain-related outcomes.

Original languageEnglish (US)
Pages (from-to)639-646
Number of pages8
JournalClinical Journal of Pain
Issue number7
StatePublished - Sep 2006


  • Catastrophizing
  • Coping
  • Education
  • Scleroderma

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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