The Role of Catastrophizing in Chronic Pain

 

This is the second post of a three part series: Understanding Catastrophizing, The Role of Catastrophizing in Chronic Pain, and What Can Be Done About Catastrophizing

Interestingly, a good bit of work is being done to understand pain catastrophizing right now. After all, pain is known to be much more than a sensory experience; rather, it is an experience that involves emotional, cognitive, interpersonal, and cultural factors. Psychosocial factors are now clearly understood to impact the perception of pain and the response to that pain.

There is some consistent evidence that pain catastrophizing is associated with: measures of clinical pain severity, pain-related activity interference, disability, depression, more frequent visits to healthcare professionals, and narcotic usage. In fact, pain catastrophizing was related to increased suicidal ideation in a large sample of chronic pain patients.

One in every four Americans have suffered from pain that lasts more than 24 hours and chronic pain remains the most common cause of long-term disability. Low back pain is the most common (27%), followed by headaches/migraines (15%), neck pain (15%), and facial pain (4%). People with low back pain are much more likely to complain of limited activity and to be in fair or poor health, compared to those without pain. Psychological distress is especially problematic, and people with low back pain are four times as likely to suffer serious psychological distress as someone who is not in pain.

I know from experience that nothing is easy when you are in pain – not sleeping, working, eating, shopping, or socializing. The thing about pain is that it slowly robs you of everything and it is this loss of control that is perhaps the most difficult part of it. I’m one of the “lucky ones” – almost unheard of lucky, really. No narcotics, no surgery, no disability or unemployment…not many people get off quite so easily. I am acutely aware of this when auditing medical charts as part of my job now entails or talking to patients as I have in other positions. In fact, if you leave your house occasionally, you more than likely know someone experiencing chronic pain.

It is very easy to understand how someone might catastrophze pain. Imagine that you have been in pain for a very long time and that there doesn’t seem to be any relief in sight.

Magnification:

“I wonder whether something serious may happen.”

“I become afraid that the pain will get worse.”

“I keep thinking of other painful events.’

Rumination:

“I anxiously want the pain to go away.”

“I can’t seem to get it out of my mind.”

“I keep thinking about how much it hurts.”

“I keep thinking about how badly I want the pain to stop.”

Helplessness:

“I feel I can’t go on.”

“I feel I can’t stand it anymore.”

“There’s nothing I can do to reduce the intensity of the pain.”

“It’s terrible and I think it’s never going to get any better.”

“I worry all the time about whether it will end.”

“It’s awful and I feel that it overwhelms me.”

More than 44 adults die every single day from prescription opiate overdose in America. I don’t think that I need to detail what happens when a doctor cuts off a patient’s supply to opiates after years of providing it. Yet, opiates are still over-prescribed and under-managed, even as the rate of heroin use continues to shatter the lives of an unspeakable number of people. A lot of people don’t have access to the most commonly recommended forms of complementary therapies for pain, including:

  • Natural products
  • Deep breathing
  • Yoga, Tai Chi, or Qi Gong
  • Chiropractic or osteopathic manipulation
  • Meditation
  • Massage
  • Special diets
  • Homeopathy
  • Progressive relaxation
  • Guided imagery
  • Art therapy
  • Music therapy

Even if someone does have access to these therapies, if they are catastrophizing pain and experiencing helplessness, it is unlikely that they will even trust that these things might help. They likely won’t even bother to try. A key target of pain management programs needs to be pain catastrophizing, which can decrease the effectiveness of any pain treatments that a person is willing to try.

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