Pain Catastrophizing: Controversies, Misconceptions and Future Directions

Sullivan, Michael; Tripp, Dean A.

doi:10.1016/j.jpain.2023.07.004

Cited by 10 publications

(13 citation statements)

References 155 publications

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Section: Discussionmentioning

confidence: 94%

“…Initially defined by Sullivan et al 15 as an exaggerated negative mindset toward actual or anticipated pain, characterized by magnification, rumination, and helplessness, "catastrophizing" was relatively ignored by the spine community until recently, but its role in AIS is probably non-negligible. 16 As a matter of fact, the catastrophizing level appeared to be highly correlated with pain intensity (assessed by NRS) in the series of Teles et al, but its role remains controversial in the pediatric population as mentioned by Chidambaran et al 14,17 Pain assessment tool. Based on the recent literature, there is now sufficient evidence that pain-level assessment should be included in the latest best practice guidelines before any spinal surgery and that interventions such as cognitive behavioral therapy should be considered in the pain management strategy.…”

Section: Discussionmentioning

confidence: 94%

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Is scoliosis a source of pain?

Ilharreborde,

Simon,

Shadi

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Pain in scoliosis is definitely a hot topic with growing popularity. The literature remains very controversial, with a pain prevalence ranging from 23% to 90%, but this can be explained by the great heterogeneity of the numerous series. The aim of this review was to report results from the literature regarding pain in relation to scoliosis regardless of the etiology. Methods: A bibliographic search in Medline and Google database from 2003 to March 2023 was performed. Relevant literature was analyzed, summarized, and discussed based on authors’ experience. A 1-year prospective series of adolescent idiopathic scoliosis patients was also included to compare with the existing literature. Results: A total of 126 adolescent idiopathic scoliosis patients were included, with a mean preoperative Cobb angle of 64.5° (range, 45°–112°). Reported pain prevalence was 34.1%. Pain and no-pain groups were very different in their self-reported experience, with a very low mean visual analogue scale score of 0.5 (± 0.6) in the no pain group, while visual analogue scale averaged 5.6 (± 1.2) in the pain group (p < 0.001). No significant difference was found between groups regarding the most relevant demographic and radiological parameters. Conclusion: Evidence-based literature on “scoliosis as a source of pain” remains ambiguous. There seems to be a consensus on the lack of direct relationship between deformity magnitude and back pain intensity. A comprehensive evaluation of the patient is therefore necessary before any treatment, including medical history, clinical examination, and relevant imaging for any child with scoliosis and back pain. Level of evidence: Level VI

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Is scoliosis a source of pain?

Ilharreborde,

Simon,

Shadi

et al. 2023

Journal of Children's Orthopaedics

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“… 39 , 40 In addition, the emerging pattern of findings supports the view that the relationship between PCS and pain experience could be likely bidirectional, as the experience of pain could give rise to catastrophic thinking, contributing to adverse pain outcomes. 41 It has been shown that PCS was associated with greater acute pain intensity and increased risk of persistent pain after cesarean section. 26 , 42 In the present study, pregnant women with PCS had significantly higher pain scores after cesarean section, which in turn may have increased their risk of ongoing pain and postpartum depression.…”

Section: Discussionmentioning

confidence: 99%

Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study

Ren,

Guo,

Tang

et al. 2024

JPR

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Purpose This study aimed to investigate the effects of different psychological personalities and pain catastrophizing levels on postoperative analgesia in patients undergoing cesarean section. Patients and Methods Puerperas who underwent cesarean section at our hospital between January and August 2023 were recruited into the study and assessed using the Eysenck Personality Questionnaire-Revised Short Scale (EPQRSC) and Pain Catastrophizing Scale (PCS). Data on the numerical pain intensity at rest and during activity 24 h after surgery, number and dosage of analgesia pumps, and satisfaction with analgesia were recorded. According to the numerical pain score during activity 24 h post-operation, the patients were divided into the analgesia incomplete group (≥4) and control group (<4). Univariate analysis, Spearman correlation analysis, and binary logistic regression analysis were used to evaluate the influence of personality characteristics and PCS on postoperative analgesia. Results A total of 778 women were included in the study. The incidence of inadequate analgesia was 89.8%. The satisfaction rate of analgesia was 66.8%. Univariate analysis showed that extraversion; neuroticism; PCS; numbers of previous cesarean delivery; ASA; analgesic satisfaction; and 24-h analgesia pump compressions and dosage were associated with postoperative analgesia after cesarean section ( P <0.05). Using binary logistic regression analysis, the first cesarean section (odds ratio [OR]=0.056, 95% confidence interval [CI]=1.913–19.174), the number of 24-h analgesic pump compressions (OR=8.464, 95% CI=0.356–0.604), extraversion (OR=0.667, 95% CI=0.513–0.866), neuroticism (OR=1.427, 95% CI=1.104–1.844), and PCS (OR=7.718, 95% CI=0.657–0.783) were factors affecting postoperative analgesia. Conclusion The incidence of inadequate analgesia after a cesarean section was high (89.8% on the first day after surgery). Formulating accurate analgesia programs for women undergoing cesarean section with extraversion, neuroticism personality characteristics, and pain catastrophizing behaviors is necessary for improving their postoperative analgesia effects and satisfaction and promoting postpartum comfort.

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“…The PCS is a validated measure designed to assess catastrophic pain-related thinking, capturing elements such as rumination, magnification, and helplessness. Pain catastrophizing is considered a core psychological factor within the FAM, reflecting an individual’s tendency to magnify the threat value of pain and feel helpless in coping with it 27 . By incorporating the PCS, we aimed to examine the construct validity of the TSK by evaluating its association with pain catastrophizing, as it represents a relevant and specific psychological factor linked to fear, avoidance behaviors, and the development of chronic pain.…”

mentioning

confidence: 99%

“…Pain catastrophizing is considered a core psychological factor within the FAM, reflecting an individual's tendency to magnify the threat value of pain and feel helpless in coping with it. 27 By incorporating the PCS, we aimed to examine the construct validity of the TSK by evaluating its association with pain catastrophizing, as it represents a relevant and specific psychological factor linked to fear, avoidance behaviors, and the development of chronic pain. This study's primary objective was to evaluate the reliability, construct validity (as assessed through its correlation with the PCS), and structural validity of the Persian version of TSK-11 in individuals with upper limb CRPS.…”

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confidence: 99%

Fear of Movement in People with CRPS

Farzad,

MacDermid,

Packham

2023

The Clinical Journal of Pain

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Background: People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations. Objective: To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine if the factor structure aligns with the original two-factor model, consisting of “activity avoidance” and “somatic focus.” Methods: People with CRPS (n=142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency and test-retest reliability (intra-class correlation coefficient), and convergent construct validity. Confirmatory and Exploratory factor analyses (CFA, EFA) were performed to evaluate the structural validity. Results: The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (ICC=0.93, 95% CI: 0.92 to 0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity (r=0.81). CFA demonstrated that the original two-factor model did not fit. EFA derived a two-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these two factors as Fear-avoidance, Magnification & Helplessness. Discussion: The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original two-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 proposed consisting of subscales for Fear Avoidance beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures’ content validity and relative uniqueness.

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Pain Catastrophizing: Controversies, Misconceptions and Future Directions

Cited by 10 publications

References 155 publications

Is scoliosis a source of pain?

Is scoliosis a source of pain?

Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study

Fear of Movement in People with CRPS

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