Pain Catastrophizing: Psychological and Physiological

Pain Catastrophizing Not Just Psychological

The term ‘pain catastrophizing’ was first used to describe a maladaptive style of coping with pain that people with anxiety and depression used.

Defining Pain Catastrophizing

“Pain catastrophizing can be defined as a maladaptive coping style that includes hopelessness, expanded rumination, and pain magnification,

These three components of catastrophizing are captured in the Pain Catastrophizing Scale (PCS), which is often used to screen for pain catastrophizing. The PCS includes these assessments:

When I am in pain:

  1. I can’t stop thinking about how much it hurts.
  2. I worry something bad might happen.
  3. There’s nothing I can do to reduce the intensity of the pain.

“It is hard to say how common pain catastrophizing is. To some extent, it is expected in people with pain. It is rare to have no catastrophizing, common to have some, but uncommon to have lots of catastrophizing. It may depend on the type of pain and how threatening it is,”

Our data suggest that it may affect 5 to 10% of people with chronic pain.

The Causes and Consequences of Pain Catastrophizing

The short answer is we don’t know the cause, and certainly multiple factors contribute.

Physiologic components may include inflammation and inflammatory mediators like cortisol. Functional MRI studies tell us that catastrophizers have increased activity in parts of the brain that are responsible for anticipation and emotion,

There may also be a genetic component. Pain catastrophizing may run in families.

The consequences of pain catastrophizing are better known than the cause. Catastrophizing has been associated with:

  • increased severity of acute and chronic pain,
  • more postoperative pain,
  • longer recovery,
  • exaggerated usage of the healthcare system,
  • increased disability, and
  • a destructive influence on a person’s support network.

“We see poor outcomes in general,” said Campbell. “We also see more depression. Depression and pain catastrophizing seem to be bidirectional.”

Treatment for Pain Catastrophizing

studies have shown SSRIs not to be very effective or to be less effective. For now, the mainstay of treatment is cognitive behavioral therapy (CBT). This may include learning better coping skills, and practicing acceptance and mindfulness

“But we still have to treat the pain. It is a bit of the chicken and the egg. Which comes first? If we reduce that pain, catastrophizing gets better. If we reduce the catastrophizing, pain gets better,”

Bottom Line on Pain Catastrophizing

“The key takeaway is that pain catastrophizing is not just a psychological experience. Doctors need to resist the temptation to label these patients as negative or difficult.

This is a real condition that needs to be recognized and managed. As we include it in more studies, we will learn more about how to treat it,”

Again, we have the “chicken and the egg” problem:

Are we catastrophizing because our pain IS catastrophic, or is our attitude making the pain catastrophic? And, even if our pain is catastrophic, does the emotional expression of our pain worsen it?

A recent study implies “No”: Saying “Ow” Improves Pain Tolerance.

However, I personally can put the hint of a “blaming the patient” attitude aside and admit that if I dwell on my pain catastrophe (which it definitely is), I lose sight of all the positive in life and fall into negativity. When I focus on my pain and its myriad of depressing and frightening consequences, I become depressed and frightened.

Focus is like a magnifying glass, useful and necessary to explore and examine life, but it enlarges anything it’s used on. Focusing on my pain issues makes them seem bigger, more important, and more scary.

Regarding the “blaming the patient” attitude, whether I have a “right” or “reason” to catastrophize my pain, which I do, is irrelevant.  What’s clear is that it causes a person even more grief.

So to answer the question: “Are we catastrophizing because our pain IS catastrophic, or is our attitude making the pain worse?”, I would say “both”.

The only thing that matters is how I feel, mentally, emotionally, physically, and no matter what level of pain I’m in, I find that I feel much better when I focus on “the rest of life” besides my pain. 


4 thoughts on “Pain Catastrophizing: Psychological and Physiological

  1. painkills2

    Since I’ve reached a level of acceptance with my pain, I believe catastrophizing is no longer a part of my life. Anyway, I don’t think I ever considered my chronic pain condition as a catastrophe… Floods and hurricanes are a catastrophe. Child abuse is a catastrophe. The drug war is a catastrophe. Google includes the Holocaust under its definition of catastrophe.

    And the acceptance of my pain condition does not lessen the severity of my pain levels. In other words, if I did participate in catastrophizing my pain in the past, I don’t any longer. And yet, it doesn’t matter at all to my pain levels.

    Seems to me this is just a term that psychiatrists and other doctors like to use to explain increases in pain levels because they just don’t understand what it’s like to live in constant pain. They don’t understand what makes pain worse, and blaming stress and using the word “catastrophizing” are easy. (How about blaming the weather instead? At least that has some validity.)

    But what they’re really doing is blaming the patient for her inability to manage the pain. As always, it’s our fault, not the fault of the medical industry, which doesn’t have a clue about the best way to treat chronic pain.

    Liked by 1 person

    1. Zyp Czyk Post author

      You’re right.

      We all have pain at some point in our lives, and this makes the average person/doctor believe they understand pain. What they don’t understand is that chronic pain isn’t anything like the pain from an injury that evetually heals.

      Most of us with chronic pain wouldn’t have understood it before it happened to us either. So, the problem is less with them not understanding than with them believing they understand, which is much more damaging.

      Liked by 1 person

  2. Payne Hertz

    Chronic pain is a catastrophe. If your house burns down you can buy a new one. If you lose your job you can get another one. If the love of your life leaves you, there are other people out there you can love. But if you lose your health, your ability to work, enjoy life and look after yourself, that can’t be replaced. Uou’re basically screwed unless you can get other people to help you. Millions of lives are destroyed by chronic pain and lack of access to effective treatments. I would call that a holocaust.

    There is an unmistakable undercurrent of patient blaming and contempt in much of the literature I have seen on the biopsychosocial darwinism model. It fits in with a certain mindset in our society that is you are sick, disabled or poor it is due to weakness and lack of character and you need to toughen up and fix the problem yourself. Needless to say insurance companies like this model as it gives them a “scientific” reason for denying disabled people benefits and forcing them back to work.

    While it is common sense that psychological and social factors play a role in dealing with pain, the CBT people tend to downplay if not ignore the biological and social factors while making wild assertions about the psychological aspects based on no real evidence. Pain is one of the primary drivers of human behavior, yet the “behavioral science” people think it’s no big deal and is easily bypassed with mind over matter techniques. 100,000 years of human history prove them wrong.

    How does anybody know if you are “magnifying” your pain and what is the scientific criteria for determining this? If focusing on your pain is “catastrophizing” then why do they recommend mindfulness as a primary coping strategy? The fact is most people use distraction as a means of avoiding or dealing with problems like pain. This ranges from harmless things like reading or going for walks to destructive things like using drugs or drinking alcohol. Entire industries are devoted to keeping us distracted, unaware and unthinking.

    The fact so many people are willfully oblivious to reality and don’t want to face the harsh realities of life is one of the reasons problems like chronic pain have been ignored for so long. We need more catastrophizing and less minimizing and fantasizing.


  3. Pingback: Chronic Pain IS a Catastrophe | EDS and Chronic Pain News & Info

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