{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:18:19Z","timestamp":1759483099139,"version":"3.40.5"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nFear of pain is known to influence pain perception and worsen pain outcomes. However, its relationship with pain threshold remains unclear. Negative emotional states, namely depression, anxiety, and stress, have been found to increase fear of pain. Previous pain experiences, both undergone and observed, can also influence fear of pain. Furthermore, healthcare students\u2019 interactions with pain patients may be influenced by fear of pain and pain perception. This study aimed to assess fear of pain among Portuguese medical and nursing students, analyse its association with sex, negative emotional states, previous pain experiences, and curricular year, and evaluate the influence of fear of pain on heat pain threshold.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nA survey based on validated Portuguese questionnaires was carried out. Participants were then invited for quantitative sensory tests to assess heat pain threshold.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nFear of pain was similar for medical and nursing students. Female students presented a higher fear of medical pain. Stress was associated with an increased fear of severe pain. Previous painful experiences, particularly those involving medical procedures, have been found to be variably associated with fear of pain, depending on the type and characteristics of these experiences. No associations were found between fear of pain and curricular year, nor between heat pain threshold and sex or fear of pain.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThis study highlights relevant aspects of the emotional and cognitive modulation of fear of pain and pain perception in medical and nursing students. The influence of previous pain experiences on fear of pain is also essential because healthcare students are frequently exposed to painful medical situations during their courses. As altered pain perception can influence their role as future healthcare professionals, the study of fear of pain and its modulators in healthcare students represents an important research field.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314094","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T18:54:35Z","timestamp":1732215275000},"page":"e0314094","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The interplay of fear of pain, emotional states, and pain perception in medical and nursing students: A cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"given":"Jo\u00e3o Miguel","family":"Romualdo","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6478-1008","authenticated-orcid":true,"given":"Elisabete","family":"Borges","sequence":"additional","affiliation":[]},{"given":"Isaura","family":"Tavares","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2119-4479","authenticated-orcid":true,"given":"Daniel H.","family":"Pozza","sequence":"additional","affiliation":[]}],"member":"340","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"issue":"9","key":"pone.0314094.ref001","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"SN Raja","year":"2020","journal-title":"Pain"},{"issue":"1","key":"pone.0314094.ref002","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1152\/physrev.00040.2019","article-title":"Cellular Circuits in the Brain and Their Modulation in Acute and Chronic Pain","volume":"101","author":"R Kuner","year":"2021","journal-title":"Physiol Rev"},{"key":"pone.0314094.ref003","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.neubiorev.2019.10.007","article-title":"The interaction between stress and chronic pain through the lens of threat learning","volume":"107","author":"I Timmers","year":"2019","journal-title":"Neurosci Biobehav Rev"},{"issue":"10289","key":"pone.0314094.ref004","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/S0140-6736(21)00393-7","article-title":"Chronic pain: an update on burden, best practices, and new advances","volume":"397","author":"SP Cohen","year":"2021","journal-title":"Lancet"},{"key":"pone.0314094.ref005","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jot.2021.07.005","article-title":"Global, regional and national burden of low back pain 1990\u20132019: A systematic analysis of the Global Burden of Disease study 2019.","volume":"32","author":"S Chen","year":"2022","journal-title":"J Orthop Translat."},{"issue":"4","key":"pone.0314094.ref006","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.apmr.2023.07.003","article-title":"Association Between Pain Coping and Symptoms of Anxiety and Depression, and Work Absenteeism in People With Upper Limb Musculoskeletal Disorders: A Systematic Review and Meta-analysis","volume":"105","author":"R N\u00fa\u00f1ez-Cort\u00e9s","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"key":"pone.0314094.ref007","first-page":"87","article-title":"Evaluating psychosocial contributions to chronic pain outcomes","author":"SM Meints","year":"2018","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"5","key":"pone.0314094.ref008","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1037\/bul0000228","article-title":"Fear of pain and pain intensity: Meta-analysis and systematic review","volume":"146","author":"T Markfelder","year":"2020","journal-title":"Psychol Bull"},{"issue":"8","key":"pone.0314094.ref009","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/ejp.1994","article-title":"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.","volume":"26","author":"AH Rogers","year":"2022","journal-title":"Eur J Pain."},{"issue":"1","key":"pone.0314094.ref010","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.pmn.2023.04.003","article-title":"Influence of Family-Learned Fear-of-Pain on Patients","volume":"25","author":"Y Fang","year":"2024","journal-title":"Pain Manag Nurs"},{"issue":"14","key":"pone.0314094.ref011","article-title":"Determinants of Poor Mental Health of Medical Students in Portugal-A Nationwide Study.","volume":"11","author":"V D\u2019Alva-Teixeira","year":"2023","journal-title":"Healthcare (Basel)."},{"key":"pone.0314094.ref012","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.nepr.2016.11.002","article-title":"Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015.","volume":"22","author":"K Turner","year":"2017","journal-title":"Nurse Educ Pract"},{"key":"pone.0314094.ref013","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2147\/AMEP.S302897","article-title":"Depression and Anxiety Among Medical Students: A Brief Overview.","volume":"12","author":"AA Mirza","year":"2021","journal-title":"Adv Med Educ Pract"},{"key":"pone.0314094.ref014","first-page":"1074370","article-title":"The role of self-reported fear and disgust in the activation of behavioral harm avoidance related to medical settings.","volume":"14","author":"B Birk\u00e1s","year":"2023"},{"key":"pone.0314094.ref015","doi-asserted-by":"crossref","first-page":"114433","DOI":"10.1016\/j.physbeh.2023.114433","article-title":"Correlation between psychosocial stresses, stress coping ability, pain intensity and degree of disability in patients with non-specific neck pain","volume":"275","author":"KY Moon","year":"2024","journal-title":"Physiol Behav"},{"issue":"6","key":"pone.0314094.ref016","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.pmn.2023.04.015","article-title":"The Effect of Preoperative Fear of Pain on Postoperative Pain Levels and the Amount of Analgesic Consumption.","volume":"24","author":"F \u00dcst\u00fcnel","year":"2023","journal-title":"Pain Manag Nurs"},{"key":"pone.0314094.ref017","doi-asserted-by":"crossref","first-page":"825","DOI":"10.2147\/JPR.S128850","article-title":"Sex differences in fear of pain: item-level analysis of the Fear of Pain Questionnaire III","volume":"10","author":"SM Vambheim","year":"2017","journal-title":"Journal of Pain Research"},{"issue":"3","key":"pone.0314094.ref018","doi-asserted-by":"crossref","first-page":"e2094","DOI":"10.1002\/pri.2094","article-title":"Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study.","volume":"29","author":"H Pinho","year":"2024","journal-title":"Physiother Res Int."},{"issue":"3","key":"pone.0314094.ref019","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines12030671","article-title":"Correlation between Different Psychological Variables in Women with Fibromyalgia with Symptoms of Neurogenic Inflammation: A Cross-Sectional Study.","volume":"12","author":"V Riquelme-Aguado","year":"2024","journal-title":"Biomedicines"},{"issue":"2","key":"pone.0314094.ref020","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.physio.2017.10.001","article-title":"Kinesiophobia is associated with pain intensity but not pain sensitivity before and after exercise: an explorative analysis","volume":"104","author":"HB Vaegter","year":"2018","journal-title":"Physiotherapy"},{"issue":"Suppl 3","key":"pone.0314094.ref021","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00482-015-0093-2","article-title":"Quantitative sensory testing (QST).","volume":"35","author":"M M\u00fccke","year":"2021","journal-title":"Schmerz"},{"issue":"5","key":"pone.0314094.ref022","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.rbr.2015.10.006","article-title":"The European Portuguese adaptation of the Fear of Pain Questionnaire","volume":"56","author":"S Cardoso","year":"2016","journal-title":"Rev Bras Reumatol Engl Ed"},{"key":"pone.0314094.ref023","article-title":"Contribui\u00e7\u00e3o para o estudo da adapta\u00e7\u00e3o portuguesa das Escalas de Ansiedade Depress\u00e3o e Stress de Lovibond e Lovibond.","volume":"36","author":"J Pais-Ribeiro","year":"2004","journal-title":"Psycologica."},{"issue":"1","key":"pone.0314094.ref024","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/ejp.1074","article-title":"Fear of Pain Questionnaire-9: Brief assessment of pain-related fear and anxiety.","volume":"22","author":"DW McNeil","year":"2018","journal-title":"Eur J Pain."},{"issue":"Pt 2","key":"pone.0314094.ref025","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1348\/014466505X29657","article-title":"The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample.","volume":"44","author":"JD Henry","year":"2005","journal-title":"Br J Clin Psychol."},{"key":"pone.0314094.ref026","volume-title":"Manual for the Depression Anxiety Stress Scales.","author":"SH Lovibond","year":"1995","edition":"2"},{"issue":"2","key":"pone.0314094.ref027","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/pm\/pnab290","article-title":"Development of a Novel Brief Quantitative Sensory Testing Protocol That Integrates Static and Dynamic Pain Assessments: Test-Retest Performance in Healthy Adults.","volume":"23","author":"MJ De Vita","year":"2022","journal-title":"Pain Med"},{"issue":"4","key":"pone.0314094.ref028","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines11041023","article-title":"Outcomes of a QST Protocol in Healthy Subjects and Chronic Pain Patients: A Controlled Clinical Trial.","volume":"11","author":"P Dias","year":"2023","journal-title":"Biomedicines"},{"issue":"5","key":"pone.0314094.ref029","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1002\/ejp.1183","article-title":"Predicting drug efficacy in chronic low back pain by quantitative sensory tests","volume":"22","author":"J Schliessbach","year":"2018","journal-title":"Eur J Pain"},{"issue":"5","key":"pone.0314094.ref030","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24054665","article-title":"Spinal Cord Injury and Complications Related to Neuraxial Anaesthesia Procedures: A Systematic Review.","volume":"24","author":"DH Pozza","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"8","key":"pone.0314094.ref031","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.ejpain.2008.10.002","article-title":"Habituation and short-term repeatability of thermal testing in healthy human subjects and patients with chronic non-neuropathic pain","volume":"13","author":"CM Agostinho","year":"2009","journal-title":"Eur J Pain"},{"issue":"11","key":"pone.0314094.ref032","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1016\/j.clinph.2010.03.055","article-title":"Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing","volume":"121","author":"V Heldestad","year":"2010","journal-title":"Clin Neurophysiol"},{"key":"pone.0314094.ref033","doi-asserted-by":"crossref","first-page":"703","DOI":"10.2147\/JPR.S91923","article-title":"Fear of pain potentiates nocebo hyperalgesia","volume":"8","author":"PM Aslaksen","year":"2015","journal-title":"J Pain Res"},{"issue":"8","key":"pone.0314094.ref034","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18084098","article-title":"Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9","volume":"18","author":"P Piwowarczyk","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0314094.ref035","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.3233\/WOR-205054","article-title":"Pain fear levels and affecting factors of health students in the university","volume":"71","author":"E Y\u0131lmaz","year":"2022","journal-title":"Work"},{"issue":"5","key":"pone.0314094.ref036","doi-asserted-by":"crossref","first-page":"104438","DOI":"10.1016\/j.jpain.2023.11.021","article-title":"Racial Differences in Movement-Related Appraisals and Pain Behaviors Among Adults With Chronic Low Back Pain.","volume":"25","author":"A Kissi","year":"2024","journal-title":"J Pain"},{"issue":"1470","key":"pone.0314094.ref037","first-page":"51","article-title":"Ethnic- and sex-related differences in pain characteristics, psychological distress and pain-related disability in patients attending a New Zealand teaching hospital pain service.","volume":"131","author":"A Burri","year":"2018","journal-title":"N Z Med J."},{"issue":"1","key":"pone.0314094.ref038","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1186\/s12891-023-06513-8","article-title":"Group- and sex-related differences in psychological and pain processing factors in people with and without patellofemoral pain: correlation with clinical outcomes","volume":"24","author":"AFB Botta","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"pone.0314094.ref039","doi-asserted-by":"crossref","first-page":"11332","DOI":"10.1038\/s41598-024-61409-4","article-title":"The proteus effect on human pain perception through avatar muscularity and gender factors","volume":"14","author":"Y Yim","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0314094.ref040","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7334\/psicothema2020.328","article-title":"Evolution of Gender Stereotypes in Spain: From 1985 to 2018.","volume":"33","author":"M Moya","year":"2021","journal-title":"Psicothema."},{"key":"pone.0314094.ref041","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.2147\/JPR.S162123","article-title":"The roles of gender and profession on gender role expectations of pain in health care professionals","volume":"11","author":"DM Wesolowicz","year":"2018","journal-title":"J Pain Res"},{"issue":"2","key":"pone.0314094.ref042","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s40368-020-00527-9","article-title":"Does previous dental care experience make the child less anxious? An evaluation of anxiety and fear of pain","volume":"22","author":"DSM Lima","year":"2021","journal-title":"Eur Arch Paediatr Dent"},{"issue":"2","key":"pone.0314094.ref043","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1002\/ejp.2182","article-title":"Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials","volume":"28","author":"LH Lin","year":"2024","journal-title":"Eur J Pain"},{"issue":"879","key":"pone.0314094.ref044","first-page":"1205","article-title":"[Pain neuroscience education: a practice in motion].","volume":"20","author":"J Fert","year":"2024","journal-title":"Rev Med Suisse."},{"issue":"5","key":"pone.0314094.ref045","first-page":"338","article-title":"Chronic Pain Education in Portugal: Perspectives from Medical Students and Interns.","volume":"32","author":"I Crist\u00f3v\u00e3o","year":"2019","journal-title":"Acta Med Port"},{"issue":"3","key":"pone.0314094.ref046","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1080\/00325481.2017.1297668","article-title":"Chronic pain management in medical education: a disastrous omission","volume":"129","author":"JD Loeser","year":"2017","journal-title":"Postgrad Med"},{"key":"pone.0314094.ref047","doi-asserted-by":"crossref","first-page":"167","DOI":"10.51642\/ppmj.v31i04.404","article-title":"MISSING VALUES AND OUTLIERS IN RESEARCH DATA.","volume":"31","author":"J Rashid","year":"2021","journal-title":"Pakistan Postgraduate Medical Journal"},{"issue":"2","key":"pone.0314094.ref048","doi-asserted-by":"crossref","first-page":"e382","DOI":"10.1016\/j.teln.2024.01.002","article-title":"The relationship between nursing students\u2019 pain beliefs and fear of pain: A descriptive and correlational study","volume":"19","author":"\u0130 K\u00f6se Tosun\u00f6z","year":"2024","journal-title":"Teaching and Learning in Nursing"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314094","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T18:54:57Z","timestamp":1732215297000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314094"}},"subtitle":[],"editor":[{"given":"Mojtaba","family":"Kordrostami","sequence":"first","affiliation":[]}],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":48,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0314094","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,11,21]]}}}