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:
- I can’t stop thinking about how much it hurts.
- I worry something bad might happen.
- 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.