Pain psychology delves deep into the construct of catastrophising, a phenomenon associated with negative outcomes in individuals experiencing pain. Catastrophising is characterized by an exaggerated negative mental set during actual or anticipated pain experiences, leading to increased pain intensity, distress, and disability. Cognitive biases linked to catastrophising include interpretive bias, attentional bias, and attentional fixation, all contributing to a heightened focus on the negative aspects of pain situations.
The origins of the term ‘catastrophising’ lie in mental illness research by Ellis and Beck, later adopted in the pain domain by Sullivan and colleagues as an ‘exaggerated threat appraisal’. However, the term has raised concerns in the way it has been utilized in describing individuals living with pain. While catastrophising is strongly correlated with unfavorable outcomes, it is essential to explore the deeper dimensions of what it truly signifies and how individuals with pain perceive and experience this phenomenon.
Reflecting on recent global events, such as the onset of the Covid-19 pandemic, we can all relate to moments of collective catastrophising. The fear and uncertainty during such periods highlight the human tendency to anticipate the worst outcomes in the face of unknown circumstances. Similarly, individuals with chronic pain conditions, such as complex regional pain syndrome or severe unresponsive low back pain, may find themselves engulfed in overwhelming worry and distress, despite reassurances from healthcare providers.
Examining the measurement aspect, a study by Crombez and colleagues focused on the content validity of prevalent pain catastrophising measures. Their analysis revealed discrepancies in how various instruments align with the construct of catastrophising, raising questions about the accuracy of these measures in assessing the phenomenon. The study’s findings challenge existing beliefs and call for a reevaluation of the instruments used to gauge catastrophising in pain research.
Addressing the need for a standardized approach to measure the perceived threat of pain in individuals, the debate around renaming catastrophising to ‘pain-related worry’ gains momentum. While some argue that this trivializes the impact of catastrophising, others suggest that the term realigns focus on the core aspect of worry in pain experiences. Nonetheless, redefining and refining concepts in pain psychology remains integral to advancing our understanding of pain-related distress.
In the upcoming discussion, we will delve into the perspectives of individuals living with pain, shedding light on their personal experiences and challenges in coping with pain-related worry. Stay tuned for more insights into the complex interplay between catastrophising and chronic pain.
References:
Crombez, G., De Paepe, A. L., Veirman, E., Eccleston, C., Verleysen, G., & Van Ryckeghem, D. M. L. (2020). Let’s talk about pain catastrophizing measures: an item content analysis. PeerJ, 8, e8643. https://doi.org/10.7717/peerj.8643
Crombez, G., Scott, W., & De Paepe, A. L. (2024). Knowing What We Are Talking About: The Case of Pain Catastrophizing. Journal of Pain, 25(3), 591-594. https://doi.org/10.1016/j.jpain.2023.12.014
Rosenstiel AK, Keefe FJ. 1983. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17(1):33–44
Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17(1), 52-64.
Sullivan, M. J. L., & Tripp, D. A. (2024). Pain Catastrophizing: Controversies, Misconceptions and Future Directions. Journal of Pain, 25(3), 575-587. https://doi.org/10.1016/j.jpain.2023.07.004
Vlaeyen JWS, Geurts SM, Kole-Snijders AMJ, Schuerman JA, Groenman NH, Van Eek H. (1990). What do chronic pain patients think of their pain? Towards a pain cognition questionnaire. British Journal of Clinical Psychology 29(4):383–394
