Pain Catastrophizing: Biopsychosocial Dimensions

Catastrophizing is a set of negative cognitive and emotional responses to pain that encompasses factors like feelings of helplessness when in pain.  People who catastrophize feel that there’s nothing they can do about the pain that they’re having. They ruminate about pain. They can’t get thoughts of pain out of their head and they tend to magnify the threat value of pain to think that pain represents more physical danger than it actually does.

The trajectories of patients over the course of a variety of painful conditions, whether postoperative pain or an episode of low back pain, will differ widely from one another. Some people will recover quickly. Some people will have pain that persists, worsens, becomes chronic and disabling. Catastrophizing seems to be one of the factors that shunts people toward a more negative or difficult trajectory. So people who are high in catastrophizing tend to be those who are at the greatest risk for experiencing chronic pain after an episode of acute pain. They are the folks who tend to have the most side effects from treatment and to get the least benefit from various analgesic treatments, and so for that reason in particular, it’s an important factor to assess and target in a variety of clinical settings.

We have a variety of tools or measures to assess individual differences in catastrophizing. Most of them are self-report questionnaires. The most common is the Pain Catastrophizing Scale. It’s a 13-item measure that can be easily given and quickly filled out in any clinical setting. For patients who are high in catastrophizing, there are a variety of treatments that can help to reduce that. The most common and most proven efficacious treatment is cognitive behavioral therapy with a psychologist, nurse, or other behavioral healthcare provider.