Figure 3.

A proposed cognitive-affective model regarding exacerbated pain in a stressful context. Increased unpredictability, a situational factor, evokes both heightened pain-related anxiety (A) and increased pain (B), resulting in a stressful context (shaded by gray). The individual variation in the degree of magnified pain is predicted by the trait factor, pain catastrophizing (C). Note that the change of anxiety per se does not predict the change of pain. Participants with higher pain catastrophizing showed increased hippocampal activation, which is associated with memory and learning of aversive stimuli (D). The current model highlights that both the stressful context (modulated by unpredictability) and the catastrophizing trait are critical to pain experience in a stressful dental setting.