Understanding Pain Catastrophizing: Putting Pieces Together

Abstract

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.

Activity Patterns and Functioning. A Contextual–Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

“…Furthermore, given the multidimensional nature of pain catastrophizing [ 41 ], it is especially interesting to direct actions towards the specific component involved. As has been pointed out, although pain catastrophizing has been considered as one of the most relevant psychological predictors of chronicity and disability related to pain, there are important problems still remaining in relation to its conceptualization [ 72 ]. Clarifying the construct and analyzing the elements involved in each case is essential for the development of more personalized, and consequently, more effective interventions [ 72 ].…”

“…As has been pointed out, although pain catastrophizing has been considered as one of the most relevant psychological predictors of chronicity and disability related to pain, there are important problems still remaining in relation to its conceptualization [ 72 ]. Clarifying the construct and analyzing the elements involved in each case is essential for the development of more personalized, and consequently, more effective interventions [ 72 ]. This multidimensionality could explain the fact that most interventions aimed at modifying pain catastrophizing produce only modest benefits, unless targeted to people showing high levels of this variable [ 31 ].…”

“…This multidimensionality could explain the fact that most interventions aimed at modifying pain catastrophizing produce only modest benefits, unless targeted to people showing high levels of this variable [ 31 ]. The analysis of the literature has indicated different strategies to decrease pain catastrophizing including stop thinking, rational-emotive therapy, emotional regulation, behavioral inhibition and behavioral activation (BIS/BAS) systems, acceptance and commitment therapy, and interoceptive sensitivity [ 72 ]. Further investigation regarding patient profiles will result in greater efficacy and efficiency of treatments.…”

Pain catastrophizing mediates rapid benefits of accessing in‐person chiropractic care during the COVID‐19 lockdown

“…Previous data showed that pain cognitions, particularly catastrophizing, strongly influenced pain intensity, pain interference and their relationship (Hirsh et al, 2011 ). Catastrophizing itself is not only dependent on previous painful experiences but can also be influenced by environmental factors (Petrini & Arendt‐Nielsen, 2020 ). During COVID‐19, psychological distress, catastrophizing, sedentarism and social isolation may all contribute to swell the burden of pain (Alzahrani et al, 2019 ; Hammig, 2019 ; Joseph et al, 2020 ; Zhaoyang et al, 2020 ).…”

A bifactor structural model of the Hungarian Pain Catastrophizing Scale and latent classes of a clinical sample

“…From a theoretical point of view our results questioned the magnification component of pain catastrophizing, which is in line with a recent psychometric study by Cook and colleagues (2021). Identifying the key elements of pain catastrophizing is not just a methodological question but a more basic conceptual one (Petrini and Arendt-Nielsen, 2020), pointing out the need for a more cohesive understanding of pain catastrophizing.…”