Pain catastrophizing as a treatment process variable in cognitive behavioural therapy for adults with chronic pain

Abstract

BackgroundInterdisciplinary cognitive behavioural therapy (CBT) for chronic pain is effective at improving function, mood and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes that cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain. Consequently, pain catastrophizing is commonly targeted in CBT for chronic pain.ObjectivesTo examine change trajectories in pain catastrophizing during treatment and assess the relevance of these trajectories to outcomes at posttreatment.MethodsParticipants included individuals with chronic pain (N = 463) who completed a 3‐week program of interdisciplinary CBT. Pain catastrophizing was assessed weekly over the 3 weeks of treatment and latent growth curve modelling was used to identify trajectories of change.ResultsFindings indicated the presence of two classes of linear change, one with a significant negative slope in pain catastrophizing (i.e. improved class) and the other with a non‐significant slope (i.e. unchanged class). Next, latent growth mixture modelling examined treatment outcome in relation to class membership. These results indicated that individuals in the ‘improved’ PCS class had significantly greater improvement in pain interference and mood, as well as physical and mental quality of life compared to the ‘unchanged’ class.ConclusionsImplications for our findings, in relation to the CBT model, are discussed.

Cognition and Pain: A Review

“…Pain catastrophizing is a maladaptive change, and patients often view pain as uncontrollable, permanent, and destructive. CBT is a vital treatment modality for this class of chronic pain patients (Day et al, 2020;Gilliam et al, 2020). Evidence in fibromyalgia patients suggests the clinical benefits of CBT in reducing pain catastrophizing (Lazaridou et al, 2017).…”

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

“…After CBT sessions, results showed that GM volume (GMV) in the bilateral dorsolateral prefrontal cortex (DLPFC), posterior parietal cortex (PPC), and some other sensory, motor, and affective areas increased, while GMV in the left supplementary motor area (SMA) reduced. They also found that increased GMV in prefrontal and parietal areas was related to decreased pain catastrophizing, which is regarded as an important target for the treatment of CP in the latest research [ 15 ]. These results suggested that after CBT, the brain has a stronger top-down control of pain and a cognitive reassessment of pain and a change in the perception of noxious signals.…”

Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

“…The results of this study can also help inform new treatments for persistent cognitive symptoms after concussion by defining a specific target (i.e., catastrophizing) in the pathway to symptom chronicity. Interventions targeting catastrophizing, such as cognitive behavioral therapy, are effective in chronic pain (Burns et al, 2012; Gilliam et al, 2021; Smeets et al, 2006) and should also be studied in populations with cognitive symptoms in excess of objective cognitive impairment.…”