Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain

Abstract

Background: Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation. Methods: The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modelling to adjust for confounders. Results: Sex-and age-matched cohorts (n = 71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), selfrated function by 0.403 and 0.308, and the 6MWD by 0.270 and − 0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162. Conclusions: Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain.Significance: Our study showed surprisingly high associations between state and change in catastrophizing to pain relief and functional improvement in chronic pain patients. This is supported by clinical experience and research data, even if the construct and measurement of catastrophizing is under debate. Our findings and those of literature point to more pessimistic self-rating of pain and catastrophizing in fibromyalgia when compared to other conditions. This might obscure positive effects on pain and function achieved by adaptive coping in fibromyalgia.

The Mediating Role of Depression and Pain Catastrophizing in the Relationship between Functional Capacity and Pain Intensity in Patients with Fibromyalgia

“…Treatment goals directed to lessen pain catastrophizing and depression levels should be promoted to reduce the impact of pain in FMS patients' daily function. Indeed, in a recent study, pain catastrophizing has been put forwarded as a potential prognostic factor for rehabilitation associated changes in pain and self-rated physical function (this last in a less extent) in FMS and low back pain [ 71 ]. At this regard, acceptance and commitment therapy (ACT), which is considered an effective therapeutic approach for FMS [ 72 , 73 ], has shown medium-large effect size in the reduction of the FMS impact, measured by the FIQ [ 74 – 77 ].…”

“…Behavioural Neurology and self-rated physical function (this last in a less extent) in FMS and low back pain [71]. At this regard, acceptance and commitment therapy (ACT), which is considered an effective therapeutic approach for FMS [72,73], has shown medium-large effect size in the reduction of the FMS impact, measured by the FIQ [74][75][76][77].…”

“…Assuming depression and pain catastrophizing as part of the transdiagnostic perspective might be important for personalized behaviour management, which is essential for mood regulation as an alternative to pharmacologic treatment in FMS [81]. Most of the studies prompt to include the replacement of maladaptive coping strategies (especially pain catastrophizing) by others more adaptative and mature in the treatment of chronic pain (e.g., [71]); however, our findings go further and encourage a more integrated approach on the management of FMS, not only centred in coping strategies but also in the emotional disturbances-either because of their association with maladaptive coping.…”

The Contribution of the Psychologist in the Assessment and Treatment of Fibromyalgia

“…This also appears to be the case in FMS, where highly complex multivariate models can perform reasonably well, but their clinical utility may be limited, and where simpler models do not seem adequate [135]. Similarly, familiar variables such as catastrophizing are shown to significantly predict some outcomes, but not all, and not typically with strong effects [136]. It may be that current treatment designs and group-based research methods are limited for identifying who will benefit and who will not [137].…”

Comparison of Swiss versus Standard Acupuncture in Patients with Chronic Low Back Pain. A Study Protocol for a Randomized, Controlled, Single-Blind, Parallel Trial

“…The MPI is a reliable and valid self-report instrument that measures the impact of pain on the patient’s life, quality of social support and general activity. 21 , 22 It has been previously shown that this condition-specific instrument, especially the three-item MPI pain severity domain, is highly responsive to changes in pain sensation during a 4-week rehabilitation program in patients with chronic pain. 23 For this reason, patients will be asked to “Rate the level of your pain at the present moment” from 0 (no pain) to 6 (very intense pain); “On average, how severe was your pain in the last week?” from 0 (not at all severe) to 6 (extremely severe); and “How much suffering do you experience because of your pain?” from 0 (no suffering) to 6 (extreme suffering).…”