Chronic pain: Catastrophizing

 

Individuals differ in how they perceive pain, and in how they react to any painful experience. Some can work through the pain and make it through the day, while others think about their pain constantly, worry about when it will end and how much worse it will get. This negative emotional response to pain is called pain catastrophizing, Pain 101: The Latest Thinking About Pain Catastrophizing and Why It Matters for Chronic Pain

I don’t think any of us would disagree that when we focus on the pain, it is worse. When we can distract from it and negative thoughts, it helps. But many of do not like to think we are ‘catastrophizing’. Because it sounds like we are making mountains out of molehills. But really it means we can’t stop thinking about how much it sucks climbing that mountain. Instead of climbing the mountain, because we must. The mountain is there and it isn’t going anywhere. So we have no choice but to climb it. And never reach the downhill part. Because, damn, it is the highest mountain ever. And we don’t like the term catastrophizing inherently. Like… exaggeration. Whereas it is more about pain perception, our reaction to pain, and our emotional existence with pain. And we can refer to it as ‘pain appraisal’ instead, as is now in conversation as it doesn’t have that negative connotation to it. Just how we are thinking and reacting to our pain in various ways.

Chronic pain: catastrophizing

“I say this over and over again: Your pain is real, there’s a medical basis for it,” said Dr. Darnall of communicating with her patients. “And we can still find opportunities to help each person be best equipped to help themselves.” Pain Catastrophizing: What Practitioners Need to Know

But we know emotions get tangled into pain and that can lead to negative thought patterns of:

“Pain catastrophizing or negative pain appraisal is a persistent pattern of having difficulty shifting the focus away from the worst aspects of pain,” explained Dr. Darnall. In these cases, people will often ruminate on their pain (eg, “I can’t stop thinking about how much it hurts”); magnify their pain (eg, “I’m afraid that something serious might happen”); and feel helpless to manage their pain (eg, “There is nothing I can do to reduce the intensity of my pain”).Pain Catastrophizing: What Practitioners Need to Know

So we feel when we catastrophize:

  • Helpless about our pain. In that, we have no control over it and nothing will make it better
  • We ruminate of pain and the associated feelings that come with pain
  • We magnify pain and pain outcomes. We will not do things because of pain consequences. We see no future for us. The future seems vastly consumed by pain.

This is a pattern that is well known to me when my depression was in full gear. Depression leads to a lot of rumination on negative realities… and that means pain for me. And I did feel out of control with it, like it couldn’t be managed and I couldn’t sustain a normal life with it. It consumed everything and would in the future.

What helped me through this negative thought pattern was:

  • Treating the comorbid depression with medication
  • Seeing a pain psychologist… one who is familiar with pain and the pain process. This often involves CBT.
  • Meditation
  • Acceptance: that there will be pain, of some sort, regardless of treatment. To stay within my limits and accept those limits.

But these thoughts will occur, as long as there are not frequent, it is part of the pain experience. But catastrophizing can limit the effectiveness of treatment itself. So it is something we have to acknowledge if we do and try different ways to manage It, so it doesn’t manage Us.

The ultimate goal in optimizing self-regulation of pain is to help patients feel that they have more control. Not only does more control make pain more tolerable for patients, it also helps them have a better response to the medical treatment.

Research is underway to better understand how cognitive and emotional regulation of pain can help patients suffer less. Dr. Darnall and others have worked to develop and validate scales to assess mental/emotional patterns in chronic pain,7,8 and to learn how treatments can be applied to shape adaptive neural networks that help steer neurophysiology toward a sense of safety – even in the face of pain. Pain Catastrophizing: What Practitioners Need to Know

And ultimately it IS about control in the sense we want to have Some control over suffering, if not the very real physical sensation of pain itself. We intuitively know some ways while coping to regulate the pain experience. We know distraction, when the pain isn’t too severe, is one way to cope with pain. We discover multiple individual ways to reduce suffering and other ways, such as medication, to reduce the pain itself. And all those ways have to be individually discovered. A psychologist helped me because he made me think about my thinking. And it helped alter my perception of the pain experience. As in, I wasn’t doing myself any favours by ruminating on it in negative ways. And I knew that. I just couldn’t fathom a way around that when in high pain. It was a slippery slope of negative thoughts I couldn’t escape from… except by, say, sleeping. And it took thinking about how I was thinking to find ways around it. Like countering negative thoughts with more realistic thoughts. And that was a good foundation to start with for sure, along with treatment of the comorbid depression.

So just remember one thing: Pain is really, real. Catastrophizing doesn’t mean you are exaggerating the literal pain you are in. It is just about the way we focus on pain, feel emotions like hopelessness with pain, magnify the pain by ruminating on it. All the things we know make the very real pain experience worse.

But the act of catastrophizing negatively affects

  1. treatment outcomes and
  2. how we cope with future pain.

It varies with the intensity of pain and how long we have been in pain.

I can’t say I stopped this, just that it got better. I think very much linked to the depression being medically treated so I could think outside of that dark abyss. And that does help me cope with the pain that exists. A difficult thing at the best of times. But I don’t want to make it more difficult on myself than it has to be. I do want to find new ways to cope and new ways to reduce suffering. This one is a hard one, though. A real hard one since it is easy to ruminate on the pain in our past, present, and future and to feel a hopelessness to control and manage the pain in our lives. It is really easy to slip into, for sure.

More reading:

Pain catastrophizing: a critical review

Suffering from pain is optional: Pain catastrophizing and your brain

Other posts:

CBT for fibromyalgia? Worth it?

Let’s look at ‘thinking positive’

Chronic pain and cognitive therapy

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16 comments

  1. Hmmm… I am going to do some reading! All articles look VERY interesting. I must admit I never had much time for the word catastrophizing. You explained it well. Besides feeling like we have some sort of control, I think it also comes down to management. When you flare, take your mind elsewhere by whatever means necessary. When our depression flares, fight to stay rational. Irrational thoughts beckon and so easily pull us down into the abyss. Excellent post! I have new things to learn! Thank you, Nikki.

    Liked by 1 person

    1. I think we all really do not like the term because of what we feel it means. But when we know what it means we can understand when we do it. But yeah when our depression flares it is indeed a fight to stay rational.

      Liked by 1 person

    1. My pain psychologist is at the pain clinic and specializes in that sort of patient. He also teaches a class called pain 101… which is the basic strategies to coping with pain. Now, most of all that I knew since it was decades before I was sent there for pain. But it was interesting. As a psychologist though he focused on specific ways to help me manage pain.

      Like

      1. I’ve been meaning to come back and comment all week!! You already know that I love this (hence the reblog) and I so agree with concept of catastrophizing pain…..and for some people illness.
        I became really aware of it when I attended an inpatient pain course prior to a trial for spinal cord stimulation. We were a group of 11 all living with chronic pain and we immediately had a huge bond. Our coping strategies were very different, but what I found more fascinating was the way in which people responded the the psychologist and her sessions. I think some of us had already worked through a lot of the stages (having had chronic pain for so long before going to the course!), but I still found the exercises (mental & physical) useful. We had to be in the right frame of mind to have the scs – we had to understand that it wasn’t going to be a cure, but rather a means of helping to control the pain. Some people were unable to accept this and were generally unreceptive to the psychology sessions – and I guess this is where the catastrophizing of the whole situation comes in and that then a good result from the scs was always going to be less likely.
        The word catastrophe summons all sorts of negative thoughts, and I can’t pretend that I never “catastrophize” negatively when the pain is flaring and I feel awful. But to try to understand the nature of catastrophizing has to be useflu in managing our individual conditions and pain. Some days it is easier to be positive than others isn’t it?
        Anyway I feel I am waffling now….but have already started to read some of your extra material, so thanks for sharing, Claire x

        Liked by 1 person

      2. I agree that a psychologist doesn’t help as much when you see no end to it all. But when you have had pain a long time you just want a little better, eh? And I think a lot about how I think about pain, and how that affects me. I catastrophized a lot for sure in the past, and still do from time to time, but it is a bit better

        Liked by 1 person

  2. This was an absolutely and amazing post with great information! I never knew there were pain psychologist out there. I have been living with chronic pain for way too many years and as you know, it isn’t easy. Thank you for the great information and more to read up on. I am looking forward to reading more of what you share. I do hope if you have time, you will check out my site. I do my best to keep things honest and spread as much positivity as I can!! Take care!!

    Liked by 1 person

  3. This is an excellent post, with many good points. Especially as we do know how much worse the pain is when you focus on it, are stressed, or going through a depression rut.
    But we have to remember that we are stronger than we think. ❤

    Liked by 1 person

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