Pain Catastrophizing

What is pain catastrophizing?

Pain catastrophizing is a negatively distorted perception of pain as awful, horrible, and unbearable. It is strongly associated with depression and pain. Functional magnetic resonance imaging (fMRI) has shown that pain catastrophizing is independently associated with increased activity in areas related to anticipation of pain, attention to pain, and emotional aspects of pain and motor control.

A study exploring the relationship among catastrophizing, depression, and chronic pain found that elements of catastrophizing, particularly magnification and helplessness, partially mediate the relationship between pain intensity and depressed mood in older adult patients with chronic pain. It also found that these elements completely mediate the relationship between pain intensity and depressed mood in patients 80 years and older. This supports a cognitive-behavioral mediation model and has implications for the treatment of persistent pain in older individuals, especially the “oldest old” who can especially benefit from efforts to reduce catastrophizing.

Catastrophizing is associated with poorer outcomes. One Scandinavian study exploring the relationship among social anxiety, catastrophizing, and return-to-work self-efficacy in chronic pain patients found that social anxiety and pain catastrophizing correlated positively with each other and negatively with the perceived ability to communicate pain-related needs. Social anxiety was found to be a significant predictor of an individual’s ability to communicate pain-related needs to the work environment. Pain severity was not found to be associated with the individual’s confidence in communicating pain-related needs. It was concluded that anxiety and fears relating to pain-related social situations at work may have a significant impact on the return-to-work process and rehabilitation in chronic pain.


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