Stanford: Rename Pain Catastrophizing – May 2020
The term “catastrophizing” has long been insulting to pain patients because of it’s negative implications. It refers to an undesirable over-reaction, a frantic hysterical response, and an unreasonable lack of reasoning. The term implies that we’re crazy and not to be believed about our pain.
Now, the originators of this derogatory “diagnosis” have finally realized this is an inappropriate term and are looking for a better one. Amazingly, they are interested in our opinion:
They’ve created this website for a survey to find out what we pain patients think would be better.
Changing the term is a nice gesture, but the real problem isn’t the word as much as the faulty premise it’s based on: that chronic pain persists because patients find it to be a catastrophe.
And chronic pain certainly qualifies: physical torment every day, increasing limitations on activities, a shrinking social circle, depression, no longer able to work and earn a living. Yet our distress is considered “excessive”, especially by people without disabilities. (I’ve noticed that the nicest and most understanding people are those who have suffered themselves.)
Yet when an outsider decides that our distress is excessive (because our own feelings and fears about our pain are more extreme than theirs), we are accused of over-reacting and making ourselves worse. (Actually, I think the term “pain catastrophizing” is perfectly realistic because it spells out exactly what most doctors think of us chronic pain “crazies”. )
This is a patient-centered project being led by a group of committed pain researchers, patients, patient advocates, and healthcare professionals.
We aim to understand the perspective of patients, researchers and healthcare professionals with regard to the term “pain catastrophizing.”
We will be collecting and collating the information we receive from your responses to help us understand whether it’s time for a change in the use of this term—and to possibly create new terminology that is compassionate, patient-centered, and more considerate for use in the medical community.
Please consider completing one of our anonymous surveys. We have one survey for healthcare professionals or researchers and one for patients.
You do not need to have pain currently to complete the patient survey – we are seeking opinions of people who have experienced pain in the past or have current ongoing pain. Your responses will help us understand how to improve language and patient-centered communication in medical settings. We are inviting participation from people in all countries.
We aim to understand the perspective of patients with long-term pain with regard to the term “pain catastrophizing.”
We plan to research and develop a new term that is patient-centered and more considerate for use in the medical community.
We appreciate your participation and opinions and thank you for your thoughtful contributions. All answers are anonymous and will be kept confidential. For any free-text responses, please do not include any identifying information so we can keep your responses anonymous.
In the mid-2010s, the field of chronic pain management became fixated on the idea that chronic pain might be maintained and/or intensified when a patient is negative or fearful in their thinking or attitude.
This mental state was labeled “catastrophizing“, and some medical professionals came to believe that our chronic pain would be entirely tolerable if we just wouldn’t dwell on what a catastrophe it is.
Dr. Beth Darnall at Stanford University was the champion of this theory for several years, spreading the word far and wide in academia and professional circles, inspiring a heap of biased research, and seeding doubt about the severity of our chronic pain.
She seemed oblivious to how “catastrophizing” was being used by anti-opioid zealots to insist that our pain was mostly a mental issue. Her idea was welcomed and exploited by all who had always doubted our pain was “real” and believed that we wanted/needed opioids only to feed a hidden addiction.
After the disastrous 2016 CDC opioid guideline incited forced opioid tapering regardless of patient circumstances and led to increasing numbers of suicides, it seems Dr. Darnall realized this caricature of her idea was being used by drug-warriors to interfere with the medical treatment of pain patients.
To her great credit, she completely changed her public position to support pain patients’ access to opioids (see Dr. Darnall now supports necessary use of opioids). I hope it’s because she came to understand that in almost all cases, opioids are used only as a last resort.
Summary of articles on catastrophizing through 2016:
- Chronic Pain IS a Catastrophe – Mar2017
Newer scientific articles since then:
- Blaming a patients’ doubts about “getting better” – Aug 2017
- Catastrophizing Not a Factor in Spinal Nociceptive Processing – Sep 2017
- Preoperative Catastrophizing != Postoperative Pain – Sep 2017
- Catastrophizing NOT predictive of poor outcomes – Jun 2019
- Pain catastrophizing measures shown to be invalid – Mar 2020
My thoughts on the subject: