“Pain Catastrophizing” Term Correction

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:

Stanford | Rename Pain Catastrophizing

They’ve created this website for a survey to find out what we pain patients think would be better. 

Pain catastrophizing measures shown to be invalid

Let’s talk about pain catastrophizing measures: an item content analysis [PeerJ] – Mar 2020

This article points out what we’ve been saying all along: chronic pain IS a catastrophe and denying that is “magical thinking”.

Finally, someone is questioning the easy and dismissive beliefs that our pain is simply a mental problem or attitude. This explanation was uncritically embraced by a healthcare system that doesn’t know how (or isn’t allowed) to treat pain effectively.

All the self-report questions used to measure this artificial construct simply represent very normal concerns about a life-changing condition that impacts every aspect of life.

Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature.

Catastrophizing NOT predictive of poor outcomes

Pain coping skills training doesn’t improve knee arthroplasty outcomes– by Bruce Jancin – June 2019

Here’s the research I’ve been waiting for to disprove the hype around the idea that “catastrophizing leads to more pain and worse outcomes”. In this study, they expected to get results confirming this “catastrophizing hypothesis“, but they found no such thing.

They did find that when patients’ pain was relieved after successful knee replacement (80% success rate), their catastrophizing score was also dramatically reduced, regardless of which trial arm they were in.

This is contradictory to many less rigorous studies that showed catastrophizing leading to worse outcomes. But this prospective randomized study shows what pain patients have always known:

When pain is relieved, so is catastrophizing. 

Pain Minimized or Dismissed as Catastrophizing

Our Pain is being Minimized or Dismissed as Catastrophizing

When does normal concern about relentless pain become excessive and catastrophizing?

Who has the power to make this decision?

I’m exasperated and offended by the recent over-promotion and over-simplification of the latest popular theory about chronic pain, which uses the derogatory term “catastrophizing” to describe our well-founded concerns about our pain.  

Pain Catastrophizing: What Clinicians Need to Know

Pain Catastrophizing: What Clinicians Need to Know – Apr 2017 – By Robert J. Gatchel, PhD, ABPP and Randy Neblett, MA, LPC, BCB

during the past 2 decades, chronic pain clinical researchers began to emphasize the important role that certain specific sets of negative beliefs (such as catastrophizing and fear avoidance) play in the maintenance and exacerbation of chronic pain

Gatchel et al define pain catastrophizing as

“an exaggerated negative orientation toward actual or anticipated pain experiences…current conceptualizations most often describe it in terms of appraisal or as a set of maladaptive beliefs.”  

Nora Volkow on Rx opioids, chronic pain and ‘hype’

Nora Volkow on prescription opioids, chronic pain and ‘hype’ – Opioid Watch – Nonprofit News from The Opioid Research Institute – July 2018

Research psychiatrist Nora Volkow, MD—the director of the National Institute on Drug Abuse for the past 15 years—is one of the world’s foremost authorities on addiction. Her pioneering work with brain imaging has changed society’s understanding of the phenomenon.

By showing how addictive drugs alter the brain’s chemistry, she helped prove that addiction was a chronic disease rather than a moral failing.

What follows is part 1 of a two-part interview, which was conducted by email. All links in her answers are to supporting references Volkow provided.  

Absolutes in Chronic Pain Treatment Can Backfire

Absolutes in Chronic Pain Treatment Can Backfire – National Pain Report – Oct 2017 by Ed Coghlan

Beth Darnall PhD is a pain psychologist, noted researcher and Clinical Professor at the Stanford University as well as successful author on chronic pain.

She and her research team have just landed a major grant to study chronic pain. We interviewed her on the grant, the opioid controversy and the National Pain Strategy

Beth Darnall is the main proponent of the “catastrophizing” theory about chronic pain, which is that the patient’s fears of pain supposedly cause most of chronic pain’s amplification.  

Preoperative Catastrophizing != Postoperative Pain

Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up – free full-text /PMC4869354/ – BMC Musculoskelet Disord. – May 2016

Conclusions: No associations were found between preoperative pain catastrophizing and pain eight weeks or one year after surgery.

The decrease in PCS-scores challenges evidence regarding the stability of pain catastrophizing. However, larger studies of psychological risk factors for pain after TKA are warranted.

This paper shows us that “catastrophizing” is actually distress from the severity of pain. 

Catastrophizing Not a Factor in Spinal Nociceptive Processing

Pain Catastrophizing is Not Associated With Spinal Nociceptive Processing in People With Chronic Widespread Pain – The Clinical Journal of Pain – September 2017

“…we could find no evidence of a significant relationship between pain catastrophizing and measures of spinal nociceptive processing”

This seems significant in light of the push to blame so much of our chronic pain on catastrophizing. At least this proves that our pain doesn’t originate from catastrophizing.

Pain catastrophizing has been associated with

Temporal Summation (Additive Properties) of Pain

“Temporal Summation of Pain” is just a fancy and scientifically specific way of saying that repeated pain is additive: after we’ve been whacked once, another hit in the same spot hurts more; If we get hit there over and over, we start cringing because it hurts more and more.

Evoked Temporal Summation in Cats to Highlight Central Sensitization Related to Osteoarthritis-Associated Chronic Pain: A Preliminary Study – Free full-text PMC4032234 – PLoS One. 2014 May

In cats, osteoarthritis causes significant chronic pain.

Chronicity of pain is associated with changes in the central nervous system related to central sensitization, which have to be quantified.