What is catastrophizing in pain?

The tendency to focus inordinately on the painful sensation, to magnify the damage and to perceive the sensation as uncontrollable is known as pain catastrophizing.

The catastrophizing of pain is related to cognitive and emotional processes, and can increase and feed back into mood disturbances such as anxiety or depression. If not adequately treated, this vicious cycle can be perpetuated and make it difficult to treat depression and chronic pain.

Chronic pain is multidimensional and is not only physical, but is also closely related to psychological factors. In recent years a multitude of studies have been conducted and published that relate disability caused by pain and the subjective perception of pain. Understanding health as a state of biopsychosocial well-being helps to understand the relationship between both factors. It was in this context that the psychologist Albert Ellis first used and introduced the concept of pain-related catastrophizing.

In a study published in Translational Behavioral Medicineits authors ask whether reducing pain catastrophizing is indeed an effective mechanism for treating chronic pain. To answer the question, they conducted an extensive data analysis and concluded that reductions in pain catastrophizing are directly related to better pain treatment outcomes.

The role of concern

Worry is the perception of a threat that triggers a response that manifests as anxiety. When the threat cannot be avoided, worry generates a problem to be solved. Therefore, worry is the cognitive attempt to solve the problem of an immediate or future danger.

Different people cope with worry through different mechanisms. Some tend to avoid facing the problem directly, others perceive that coping by preparing for the worst-case scenario is beneficial. In psychology, worry has been defined as a chain of negative affect-laden thoughts, and catastrophizing as the process that exacerbates the adverse effects of worry.

Catastrophizing as an emotional regulator

To understand how a catastrophic attitude affects the perception of pain, it must be understood as part of the process of emotional regulation. Emotional regulation is the process by which people influence or can influence their emotions, and is essential for maintaining a positive attitude that is conducive to a good state of health.

Psychologist James J Gross, professor of psychology at Stanford University and director of the Stanford Psychophysiology Laboratory, distinguished two main strategies for regulating emotions:

1. Re-evaluation: By which the individual consciously or unconsciously modifies the meaning of an emotional stimulus; that is, changing the meaning of a situation to reduce its impact.
2. Suppression: It is characterized by the inhibition of the emotional expression provoked by the stimulus.

In his research, he was able to demonstrate that people who regulate their emotions through reappraisal are able to reduce the negative emotional experience.

Taking refuge in abstract questions such as “Why do I have to suffer pain? Or in problems to which we can no longer find a solution in questions such as What could I have done to prevent it, is another way of avoiding confrontation with the existing problem. This does not bring us closer to a solution and prevents the activation of responses at both the emotional and somatic levels.

People with chronic pain tend toward catastrophic worry as an unconscious attempt to minimize negative emotions arising from distress or stress.

Measure and assess pain sensation

Today, the catastrophizing of pain remains a subject of study and continues to generate debate among the scientific community. Understanding its implications is one of the key elements for the improvement of chronic pain treatments and intervention strategies. For this reason, assessing catastrophization is of great relevance for a comprehensive approach to pain. Although there is still a lack of knowledge in this field, some multidisciplinary strategies have already shown promising results.

Measuring the sensation of pain felt by a person is a complex task. To achieve an approximation, it requires the collaboration of a multidisciplinary team that takes into account both physical and psychological aspects. Continuous monitoring of the evolution of the different treatments is another key aspect to reduce the impact and individual perception of chronic pain.

At Instituto Aliaga, we are experts in the treatment of pain through a holistic approach. Contact us, we can help you!

References:

• T.D.Borkovec, Elwood Robinson, Thomas Pruzinsky, James A. De Pree – Preliminary exploration of worry: Some characteristics and processes – Behaviour Research and Therapy doi.org/10.1016/0005-7967(83)90121-3
• John W BurnsMelissa A Day, Beverly E Thorn – Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain? – Transl Behav Med 2012 Mar;2(1):22-9. doi: 10.1007/s13142-011-0086-3.
• James J Gross – Emotion regulation: affective, cognitive, and social consequences – Psychophysiology 2002 May;39(3):281-91. doi: 10.1017/s0048577201393198.