Chiari malformation Type I (CMI) is a chronic pain syndrome associated with an increase in disability. However, little is known about the relationship between pain and disability among CMI patients. Using a web-based study of 372 adults diagnosed with CMI, we examined pain catastrophizing along with self-reported pain, head and neck disability, loneliness, depression, anxiety, and stress. Our primary analytic method was statistical mediation. Pain catastrophizing was positively correlated with self-reported pain, depression, anxiety, and disability. Finally, pain catastrophizing (rumination and helplessness subscales) mediated the relationship between Pain scores and Disability scores in this sample of CMI patients. Our findings are that pain catastrophizing mediates the effect of pain on disability—but depression does not. The importance of pain catastrophizing in explaining the relationship between pain and disability may provide new insight into more effect treatments for chronic pain and disability in CMI.
AllenPADelahantyDKautKP, et al. (2018) Chiari 1000 Registry Project: Assessment of surgical outcome on self-focused attention, pain, and delayed recall. Psychological Medicine48(10): 1634–1643. https://doi.org/10.1017/S0033291717003117
2.
AllenPAKautKPHoustonJR, et al. (2025a) Episodic memory, Chiari I malformation, personality and coping: The role of chronic pain. Behavioral Sciences15(12): 1678. https://doi.org/10.3390/bs15121678
3.
AllenPALothFLothD, et al. (2025b) Correlation of anterior CSF space in the cervical spine with Chicago Chiari outcome scale score in adult females. Journal of Neurosurgery-Spine42(3): 299–308. https://doi.org/10.3171/2024.7.SPINE24370
ChangSKimWHJungYE, et al. (2024) Clinical utility of impact of event scale-revised for Diagnostic and Statistical Manual of Mental Disorders-fifth edition posttraumatic stress disorder. Psychiatry Investigation21(8): 870–876. https://doi.org/10.30773/pi.2024.0147
6.
DworkinRHTurkDCRevickiDA, et al. (2009) Development and initial validation of an expanded and revised version of the short-form McGill Pain Questionnaire (SF-MPQ-2). Pain144(1–2): 35–42. https://doi.org/10.1016/j.pain.2009.02.007
7.
EcclestonCCrombezG (1999) Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin125(3): 356–366. https://doi.org/10.1037/0033-2909.125.3.356
8.
FischbeinRSalingJRMartyP, et al. (2015) Patient-reported Chiari malformation type I symptoms and diagnostic experiences: A report from the national Conquer Chiari Patient Registry database. Neurological Sciences36(9): 1617–1624. https://doi.org/10.1007/s10072-015-2219-9
9.
FriedlanderRM (2024) Congenital and acquired Chiari syndrome. New England Journal of Medicine390(23): 2191–2198. https://doi.org/10.1056/NEJMra2308055
10.
GarciaMAAllenPALiX, et al. (2019) An examination of pain, disability, and the psychological correlates of Chiari malformation pre- and post-surgical correction. Disability and Health Journal12(4): 649–656. https://doi.org/10.1016/j.dhjo.2019.05.004
11.
GarciaMARabinowitzEPLevinME, et al. (2023) Online acceptance and commitment therapy for chronic pain in a sample of people with Chiari malformation: A pilot study. Journal of Behavioral and Cognitive Therapy33(3): 152–168. https://doi.org/10.1016/j.jbct.2023.09.001
12.
GarcíaMEppelheimerMSHoustonJR, et al. (2021) Adult Age Differences in Self-Reported Pain and Anterior CSF Space in Chiari Malformation. The Cerebellum.
13.
GarcíaMEppelheimerMSHoustonJR, et al. (2022) Adult age differences in self-reported pain and anterior CSF space in Chiari malformation. Cerebellum21(2): 194–207. https://doi.org/10.1007/s12311-021-01289-w
14.
GholampourSGholampourH (2020) Correlation of a new hydrodynamic index with other effective indexes in Chiari I malformation patients with different associations. Scientific Reports10(1): 15907. https://doi.org/10.1038/s41598-020-72961-0
15.
GholampourSTaherM (2018) Relationship of morphologic changes in the brain and spinal cord and disease symptoms with cerebrospinal fluid hydrodynamic changes in patients with Chiari malformation type I. World Neurosurgery116: e830–e839. https://doi.org/10.1016/j.wneu.2018.05.108
16.
GoelA (2015) Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation. Journal of Neurosurgery Spine22: 116–127.
17.
GoelAJadhavDShahA, et al. (2020) Chiari 1 formation redefined-clinical and radiographic observations in 388 surgically treated patients. World Neurosurgery141: e921–e934. https://doi.org/10.1016/j.wneu.2020.06.076
18.
HayesAF (2018) Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, 2nd edn. Guilford Press.
19.
HayesSCVillatteMLevinM, et al. (2011) Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology7: 141–168. https://doi.org/10.1146/annurev-clinpsy-032210-104449
20.
HoustonMLHoustonJRSakaieK, et al. (2021) Functional connectivity abnormalities in type I Chiari: Associations with cognition and pain. Brain Communications3(3): fcab137. https://doi.org/10.1093/braincomms/fcab137
21.
LabudaRLothDLothF, et al. (2023) Pain and depression account for more than one half of the neck disability variance among adult women with Chiari I. World Neurosurgery171: E478–E485. https://doi.org/10.1016/j.wneu.2022.12.046
22.
LabudaRNolanERabinowitzEP, et al. (2025) Columbia suicide severity rating scale screen scores in adults with Chiari malformation type 1. PLoS One20(10): e0334599. https://doi.org/10.1371/journal.pone.0334599
23.
LeonardJRLimbrickDDJr (2015) Chiari I malformation: Adult and pediatric considerations. Neurosurgery Clinics of North America26(4): xiii–xiv. https://doi.org/10.1016/j.nec.2015.07.002
24.
LovibondSHLovibondPF (1995) Manual for the Depression, Anxiety, Stress Scale. Psychology Foundation.
25.
MarshallPWMSchabrunSKnoxMF (2017) Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS One12(7): e0180788. https://doi.org/10.1371/journal.pone.0180788
26.
McCarthyMJGrevittMPSilcocksP, et al. (2007) The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. European Spine Journal16(12): 2111–2117. https://doi.org/10.1007/s00586-007-0503-y
27.
MilhoratTHChouMWTrinidadEM, et al. (1999) Chiari I malformation redefined: Clinical and radiographic findings for 364 symptomatic patients. Neurosurgery44(5): 1005–1017. https://doi.org/10.1097/00006123-199905000-00042
PetriniLArendt-NielsenL (2024) Pain catastrophizing in the elderly: An experimental pain study. Scandinavian Journal of Pain24(1): 20230035. https://doi.org/10.1515/sjpain-2023-0035
30.
RabinowitzEPRipleyGLevinME, et al. (2024) Limited effects of phone coaching in an RCT of online self-guided acceptance and commitment therapy for chronic pain. Journal of Contextual Behavioral Science34: 100828. https://doi.org/10.1016/j.jcbs.2024.100828
31.
RemesOMendesJFTempletonP (2021) Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sciences11(12): 1633. https://doi.org/10.3390/brainsci11121633
32.
RogersAHFarrisSG (2022) A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. European Journal of Pain26(8): 1611–1635. https://doi.org/10.1002/ejp.1994
33.
RussellDW (1996) UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment66(1): 20–40. https://doi.org/10.1207/s15327752jpa6601_2
34.
ShaoBLearyOPSayiedS, et al. (2025) Cognitive-affective improvement on cerebellar neuropsychiatric rating scale scores in adults and children after decompression of Chiari malformation type I. Neurosurgery97(6): 1450–1458. https://doi.org/10.1227/neu.0000000000003481
35.
SinclairSJSiefertCJSlavin-MulfordJM, et al. (2012) Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of U.S. adults. Evaluation & The Health Professions35(3): 259–279. https://doi.org/10.1177/0163278711424282
36.
SturgeonJAZiadniMSTrostZ, et al. (2017) Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption. Scandinavian Journal of Pain17: 390–396. https://doi.org/10.1016/j.sjpain.2017.09.020
37.
SullivanMJLBishopSRPivikJ (1995) The Pain Catastrophizing Scale: Development and validation. Psychological Assessment7(4): 524–532. https://doi.org/10.1037/1040-3590.7.4.524
38.
TokarDMKautKPAllenPA (2023) Revisiting the factor structure of the short-form McGill Pain Questionnaire-2 (SF-MPQ-2): Evidence for a bifactor model in individuals with Chiari malformation. PLoS One18(10): e0287208. https://doi.org/10.1371/journal.pone.0287208
39.
TrapnellPDCampbellJD (1999) Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality and Social Psychology76(2): 284–304. https://doi.org/10.1037//0022-3514.76.2.284
40.
VernonH (2008) The Neck Disability Index: State-of-the-art, 1991-2008. Journal of Manipulative and Physiological Therapeutics31(7): 491–502. https://doi.org/10.1016/j.jmpt.2008.08.006
Weissman-FogelISprecherEPudD (2008) Effects of catastrophizing on pain perception and pain modulation. Experimental Brain Research186(1): 79–85. https://doi.org/10.1007/s00221-007-1206-7
43.
WheelerCHBWilliamsACCMorleySJ (2019) Meta-analysis of the psychometric properties of the pain catastrophizing scale and associations with participant characteristics. Pain160(9): 1946–1953. https://doi.org/10.1097/j.pain.0000000000001494
44.
WongWSLamHMChowYF, et al. (2014) The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: A preliminary, cross-sectional analysis. Quality of Life Research23(8): 2333–2341. https://doi.org/10.1007/s11136-014-0683-y
