Reducing Chronic Pain by Controlling Pain Catastrophizing

Pain catastrophizing can influence pain-related outcomes through a range of theoretical mechanisms.

Pain as a symptom, which is now considered the fifth vital sign, accounts for approximately 80% of physician visits and an estimated US$100 billion annually between healthcare expenditures and lost productivity. Experts increasingly recognize psychosocial factors as important moderators and determinants of the pain experience. One factor drawing a good deal of attention from healthcare professionals is pain catastrophizing.

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What is pain catastrophizing?

The term catastrophizing was formally introduced by Albert Ellisand subsequently adapted by Aaron Beck to describe the maladaptive cognitive style patients with anxiety and depressive disorders often employed. At the core of their definitions was the concept of an irrationally negative forecast of future events. Similarly, pain-related catastrophizing is broadly conceived as a set of exaggerated and negative cognitive and emotional schema brought to bear during actual or anticipated painful stimulation.

Pain catastrophizing can influence pain-related outcomes through a range of theoretical mechanisms, including:

• Activation of negative pain schemas
• Maladaptive appraisals of pain-related stressors and coping resources
• Attention biases to pain-related stimuli
• Solicitation of social support through the expression of exaggerated pain behaviors

Past research also suggests that pain catastrophizing is related to alterations in pain modulation pathways. For example, recent findings suggest that pain catastrophizing interferes with descending inhibitory pathways and enhances pain-facilitation pathways.

According to an article in the journal Expert Review of Neurotherapeutics, research associates catastrophizing pain with increases in narcotic usage, post-surgical pain ratings, and/or depression after surgery. While no one looks forward to a post-surgical or post-injury pain, an irrational fear of it can make a recovery especially difficult.

Addressing and reducing pain catastrophizing

Mental health experts often use techniques known as cognitive-behavioral therapy to help a patient address their catastrophic thinking. These techniques require the person to be aware that they are experiencing catastrophic thinking, to recognize their actions, and to try to stop and correct their irrational thinking. Here are five things to use to reduce pain catastrophizing.

Examine your thoughts

Examining the automatic thoughts that are present in pain patients is a major goal of cognitive-behavioral therapy. When pain worsens, the patient may have automatic thoughts like, “This pain has never been as bad as this” or “I'm getting much worse.”

These thoughts often lead to more physical and psychological distress. Recognizing an automatic thought is the first step. Next, the patient must rationally dispute the catastrophic cognitions. Replacing negative cognitive schema and automatic thoughts are important techniques to address not only pain, but also anxiety and depression.

Say “stop”

To cease the repetitive, catastrophic thoughts, a patient may have to say out loud or in their head “stop!” or “no more!” These words can keep the stream of thoughts from continuing and help to change the course of thinking.

Embrace appropriate physical activity

Another aspect of cognitive-behavioral therapy involves the practical application of skills that permit better coping with day-to-day pain. Finding an appropriate level of activity is important. On days when pain is relatively good, they often find themselves nearly immobilized the following day. Other people may restrict movement too much for fear of worsening their pain.

Prolonged inactivity can lead to further problems with mobility and pain. Healthcare and rehabilitation professionals should encourage activity, but in a manner that is not likely to exacerbate pain. Practice monitoring pain during activity and stopping the activity before pain becomes severe. Frequent rest periods may be helpful in allowing the patient to continue the activity without significant exacerbation of pain. In turn, this may lead to increased functioning.

Practice relaxation techniques

Relaxation training is often a component of cognitive-behavioral therapy for pain issues. Patients may benefit from progressive muscle relaxation, stretch-based relaxation, deep breathing, and autogenic training techniques.

Developing mastery over techniques that offer some relief from pain symptoms enables patients to feel that they have some control over their illness. This may help combat the learned helplessness that is so often a part of the life of a patient living with pain.

Focus on self-care

Catastrophic thoughts are more likely to take over when a patient is tired and stressed. Getting enough rest and engaging in stress-relieving techniques, such as exercise, meditation, and journaling, can all help a person feel better.

An interdisciplinary pain management approach

Research shows that employing an interdisciplinary pain management approach (medical, interventional, behavioral, social, etc.) can be both efficacious and cost-effective in managing chronic pain conditions. This interdisciplinary pain management approach is based upon the biopsychosocial model of pain. The biopsychosocial model views pain as the result of a dynamic interaction of biological, psychological, and social factors that perpetuate and may even worsen the clinical presentation.

Thus, besides simultaneously dealing with the biological aspects of pain, psychosocial components also need to be simultaneously taken into account. Pain catastrophizing is one of these important psychosocial components. Indeed, just as one would not overlook the assessment/treatment of depression and potential medication misuse often found in chronic pain patients, constructs such as pain catastrophizing and other fear-avoidance beliefs also should not be overlooked.

This article was written by Kristen , MSPT, DPT, CLT