Exactly what is Pain Catastrophizing?

Pain catastrophizing – Wikipedia, the free encyclopedia

Pain catastrophizing is the tendency

  1. to describe a pain experience in more exaggerated terms than the average person,
  2. to ruminate on it more (e.g., “I kept thinking ‘this is terrible'”),
  3. and/or to feel more helpless about the experience (“I thought it was never going to get better”)

People who report a large number of such thoughts during a pain experience are more likely to rate the pain as more intense than those who report fewer such thoughts.

It is generally assumed [and we know how misleading and even dangerous that can be] that the tendency to catastrophize plays a causal role in the pain experience – that is, it causes the person to experience the pain as more intense.   

However, we cannot yet rule out the possibility that at least some aspects of catastrophization may actually be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization

The pain catastrophizing scale is a 13-item self-report scale to measure pain catastrophizing. In the PCS, each item is rated on a 5 – point scale: 0 (Not at all) to 4 (all the time)

It is broken into three subscales being magnification, rumination, and helplessness.

The scale was developed as a self-report measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations.

It is hypothesized that pain catastrophizing is related to various levels of pain, physical disability and psychological disability in clinical and nonclinical populations.

Pain catastrophizing scale

Here it is, the scale that can diagnose catastrophizing by asking a patient to rate their agreement with 13 seemingly simple statements. 

But when I read them carefully, I noticed that these are very, very clever statements.  

Most of them have two parts, both vague but stated in absolute terms, using language that can have multiple meanings. and lead me to so many possible combinations and permutations of beliefs and feelings that I am quickly mired in paralyzing confusion.

Pain Catastrophizing Scale

  1. I worry all the time about whether the pain will end. (H)
    – what if I only worry most of the time and only whether the pain will get better?
  2. I feel I can’t go on. (H)
    – what is meant by “can’t go on” and what you can’t go on with are left to your imagination or current mental focus.
  3. It’s terrible and I think it’s never going to get any better. (H)
    – what if I think it’s terrible but I believe it’s going to get better?
  4. It’s awful and I feel that it overwhelms me. (H)
    – who doesn’t get overwhelmed by their awful pain sometimes?
  5. I feel I can’t stand it anymore. (H)
  6. I become afraid that the pain may get worse. (M)
  7. I think of other painful experiences. (M)
  8. I anxiously want the pain to go away. (R)
  9. I can’t seem to keep it out of my mind. (R)
  10. I keep thinking about how much it hurts. (R)
  11. I keep thinking about how badly I want the pain to stop. (R)
  12. There is nothing I can do to reduce the intensity of the pain. (H)
  13. I wonder whether something serious may happen. (M)

(Note: For the listed items above, (R) Rumination, (M) Magnification, and (H) Helplessness.)

Each item is rated on a 5 – point scale: 0 (Not at all) to 4 (all the time)\

It is important to remember that these studies ask participants to report on pain experiences from their past; the overall level of pain experienced is not controlled

Further, more controlled studies are urgently needed to tease apart these issues of cause and effect.


Research on pain catastrophizing has found that catastrophic thinking is associated with a more intense experience of pain.

Association is only correlation, NOT cause.

It is generally believed that the catastrophic thoughts cause the person to experience pain more intensely.

Following this logic, if the catastrophic thinking can be addressed, then the person’s pain experience might also be reduced

This makes me remember how handwriting analysists claimed the ability to discover the writer’s personality from analyzing their writing. It made me wonder if you could then change your personality by changing your handwriting.

No, it turns out one (handwriting) is an expression of the other (personality) and this is a unidirectional relationship.

The primary treatment for pain catastrophizing is cognitive behavior therapy for chronic pain

These sessions and classes typically span 6 to 12 weeks, and cover a variety of psychobehavioral topics in addition to pain catastrophizing

In 2014, researchers at Stanford University found that a single-session class they developed to specifically to treat pain catastrophizing was effective.

However, to date, there have been no studies that meet the usual standards required for medical treatment intervention studies (for example, where patients are randomly allocated to a treatment or an appropriate control condition, and patients are unaware of which condition is expected to be associated with the better outcome).  

Disclaimer: I am completely in favor of harnessing the powers of our minds to manage our pain. I’m only against the over-simplification of this work and the assumption that one method can be a panacea for all kinds of pain.


3 thoughts on “Exactly what is Pain Catastrophizing?

  1. painkills2

    “to describe a pain experience in more exaggerated terms than the average person”

    Tell me, who is this average person? Is there even such a thing as “average”? Does the average person deal with the additional stress of being disabled, isolated, and poor? Is the average person married, single, young, old, male, or female?

    When someone is sobbing and screaming in grief, are they exaggerating? If someone takes their own life because of depression, are they exaggerating? Who gets to be the judge of who is exaggerating their pain and who is average?

    Psychiatry reminds me of religion, as so much of it is based in belief, no matter how hard it tries to look like medical science (which has its own problems).

    A long time ago, I sent my handwriting to be analyzed. It was like $25 or something. The information I got back fit me pretty good, but it was also general enough to fit a lot of people. Like astrology, the results just told me what I wanted to hear.

    Liked by 2 people

    1. Zyp Czyk Post author

      Speaking of handwriting analysis, doesn’t it imply that if you changed your handwriting, you’d change your personality as well?

      That sounds so silly, but isn’t that exactly what’s happening when they label our responses to our pain as being the problem, instead of the expression of our problem?

      Like confusing correlation with cause, it seems to be confusing a result with the cause.

      Again, I have to state that I very much believe the right kind of meditation could greatly dampen the impact pain has on my life. But this would require years of study and practice – even eight months of daily meditation wasn’t enough.

      I received a Twitter response from a middle-aged person saying he’s been meditating “all my life” and it still doesn’t help with his pain.

      Liked by 2 people

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

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