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"Catastrophizing."
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When Pain Catastrophizing Is Not Catastrophizing: Identifying Normative From Exaggerated Responses Relative to Referent Pain Intensity
Although pain catastrophizing has been studied widely, there is no consensus on what constitutes an exaggerated response, that is, true catastrophizing, from what might be proportional unpleasant or negative responses to pain. Most available catastrophizing assessments ask respondents to consider when \"in pain,\" with no assessment of these referent pain anchors. Thus, the influence of referent pain on catastrophic thinking remains unclear. We aimed to assess consistency across referent pain scenarios and to characterize \"high\" catastrophizing-representing exaggerated responses relative to referent pain intensity.
A total of 228 adults (152F) completed this observational study. The Pain Catastrophizing Scale (PCS) was completed 4 times interspersed with other assessments. First, with standard instructions, then with specific referent scenarios in a blocked order to minimize order effects. Anticipated scenario pain intensities were rated using a 0-10-cm scale. PCS cross-situational consistency was assessed with intraclass correlations. Mixed linear models evaluated the PCS-referent pain relationship, with and without covariate adjustment.
PCS cross-situational consistency was high, with ICCs = 0.79-0.84. However, total scores varied significantly across referent scenarios, where catastrophizing generally increased with referent pain intensity (
= 0.74,
< 0.0001), and pain explained 40% of PCS variability. The best fit model of \"high\" catastrophizing, using the 75th percentile, varied with referent pain intensity, underscoring the importance of contextual anchors, without notable sex differences.
Trait PCS scores should not be interpreted as context-free indices of catastrophizing. The wide range of published PCS cut points may in part reflect differences in referent pain, highlighting the need to contextualize catastrophizing scores for appropriate interpretation.
Journal Article
The Relationship Between Physical Activity and Pain, Pain-Related Cognitions, and Central Sensitization in Patients With Midportion Achilles Tendinopathy
Achilles tendinopathy is one of the most prevalent lower limb tendinopathies that, while commonly present in physically active people, can affect men and women of all ages and lifestyles. Although this condition can significantly affect patients' daily lives, not much is known regarding that which contributes to negative influences on patients' physical activity.
To explore the association between objectively measured physical activity behavior and pain, kinesiophobia, pain catastrophizing, and symptoms of central sensitization in patients with midportion Achilles tendinopathy.
Cohort study; Level of evidence, 2.
For 130 adult patients with midportion Achilles tendinopathy (mean age, 47; 55% female), physical activity was measured via wrist-worn actigraphy and assessed as daily step count and active minutes. The latter includes lightly, fairly, and very active minutes, as well as total active minutes. Linear regression analyses explored the relationship between physical activity behavior and pain intensity, pain interference, kinesiophobia, pain catastrophizing, and central sensitization. All analyses were controlled for age and sex.
A significant association was found between pain intensity and participants' daily step count scores (regression coefficient, -591; 95% CI, -994 to -187) and very active minutes (regression coefficient, -3.76; 95% CI, -5.86 to -1.67). Pain intensity was not significantly associated with patients' total, lightly, or fairly active minutes. Similarly, no significant associations were found between physical activity and pain interference, kinesiophobia, pain catastrophizing, and symptoms of central sensitization.
Only pain intensity of patients with midportion Achilles tendinopathy is significantly associated with their daily steps and time spent being very physically active, as determined via actigraphy.
Journal Article
Association of high kinesiophobia and pain catastrophizing with quality of life in severe hip osteoarthritis: a cross-sectional study
Background
While fear of movement is an important predictor of pain and disability in osteoarthritis (OA), its impact on patients with hip OA remains uncertain. This study aimed to determine whether fear of movement, evaluated by the Tampa Scale for Kinesiophobia (TSK)-11, and pain catastrophizing, evaluated by the Pain Catastrophizing Scale (PCS), were associated with quality of life (QOL) in patients with hip OA.
Methods
This cross-sectional study was conducted between November 2017 and December 2018. Ninety-one consecutively enrolled patients with severe hip OA were scheduled for primary unilateral total hip arthroplasty. The EuroQOL-5 Dimensions questionnaire was used to measure general QOL. The Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to assess disease-specific QOL. The covariates included age, sex, body mass index (BMI), pain intensity, high pain catastrophizing (PCS ≥ 30), and high kinesiophobia (TSK-11 ≥ 25). Variables were subjected to multivariate analysis using each QOL scale.
Results
In multiple regression analysis, pain intensity, high pain catastrophizing, and BMI were independently correlated with the disease-specific QOL scale. High pain catastrophizing, pain intensity, and high kinesiophobia were independently correlated with the general QOL scale.
Conclusions
High pain catastrophizing (PCS ≥ 30) was independently associated with disease and general QOL scales. High kinesiophobia (TSK-11 ≥ 25) was independently associated with the general QOL scale in preoperative patients with severe hip OA.
Journal Article
Walking speed is associated with postoperative pain catastrophizing in patients with lumbar spinal stenosis: a prospective observational study
Background
The purpose of this study was to investigate whether walking speed is associated with postoperative pain catastrophizing in patients with lumbar spinal stenosis.
Methods
In this prospective observational study, consecutive patients with clinically and radiologically defined lumbar spinal stenosis underwent surgical treatment (decompression, or posterolateral or transforaminal lumbar interbody fusion) at Tottori University Hospital, between October 2015 and April 2018. The pain catastrophizing scale, walking speed, leg and back pain (numerical rating scale), and Japanese Orthopaedic Association score were evaluated preoperatively and at 3, 6, and 12 months postoperatively. Correlations between the pain catastrophizing scale and each variable were analyzed at each evaluation time point. The effect of walking speed on the pain catastrophizing scale was analyzed using mixed-effect models for repeated measurements.
Results
Ninety-four patients were included at baseline, and 83, 88, and 82 patients were analyzed at 3, 6, and 12 months postoperatively, respectively. The pain catastrophizing scale was significantly correlated with walking speed, leg pain, back pain, and the Japanese Orthopaedic Association score at all evaluation time points. The pain catastrophizing scale was associated with walking speed at all evaluation time points.
Conclusions
Our results suggest that changes in postoperative pain catastrophizing after lumbar spine surgery are associated with walking speed. Thus, walking speed is a necessary assessment for the management of pain catastrophizing and associated pain and disability in patients after lumbar spine surgery.
Journal Article
The Combination of Preoperative Pain, Conditioned Pain Modulation, and Pain Catastrophizing Predicts Postoperative Pain 12 Months After Total Knee Arthroplasty
Abstract
Objectives
Approximately 20% of knee osteoarthritis patients undergoing total knee arthroplasty (TKA) report chronic postoperative pain. Studies suggest that preoperative variables such as impaired descending pain control, catastrophizing, function, and neuropathic pain–like symptoms may predict postoperative pain 12 months after TKA, but the combined prediction value of these factors has not been tested. The current prospective cohort study aimed to combine preoperative risk factors to investigate the predictive value for postoperative pain 12 months after TKA.
Design
Prospective cohort with follow-up 12 months after surgery.
Patients
A consecutive sample of 131 knee osteoarthritis patients undergoing TKA.
Methods
Pain intensity, Pain Catastrophizing Scale (PCS) scores, PainDETECT Questionnaire scores, conditioned pain modulation (CPM), and Oxford Knee Score (OKS) were obtained before and 12 months after TKA.
Results
TKA improved pain (P < 0.001), PCS scores (P < 0.001), PainDETECT Questionnaire scores (P < 0.001), and OKSs (P < 0.001). Preoperative pain correlated with preoperative PCS scores (r = 0.38, P < 0.001), PainDETECT scores (r = 0.53, P < 0.001), and OKSs (r = –0.25, P = 0.001). Preoperative PainDETECT scores were associated with preoperative PCS scores (r = 0.53, P < 0.001) and OKSs (r = –0.25, P = 0.002). Higher postoperative pain was correlated with high preoperative pain (r = 0.424, P < 0.001), PCS scores (r = 0.33, P < 0.001), PainDETECT scores (r = 0.298, P = 0.001), and lower CPM (r = –0.18, P = 0.04). The combination of preoperative pain, PCS score, and CPM explained 20.5% of variance in follow-up pain. PCS scores had a significant effect on pain trajectory when accounting for patient variance (t = 14.41, P < 0.0005).
Conclusion
The combination of high preoperative clinical pain intensity, high levels of pain catastrophizing thoughts, and impaired CPM may predict long-term postoperative pain 12 months after surgery.
Journal Article
Prevalence and Impact of Dysmenorrhea Among University Students in Ireland
Abstract
Objective
Primary dysmenorrhea (PD), or painful menstruation, is a common gynecological condition that can cause intense pain and functional disability in women of reproductive age. As a nonmalignant condition, PD is relatively understudied and poorly managed. The purpose of this study was to estimate the prevalence and impact of PD among third-level students in Ireland.
Design
A cross-sectional observational design was used.
Methods
Students (n = 892; age range = 18–45 years) completed an online survey on menstrual pain characteristics, pain management strategies, pain interference, and pain catastrophizing.
Results
The prevalence of PD was 91.5% (95% confidence interval = 89.67–93.33). Nonpharmacological management strategies were most popular (95.1%); of these, heat application (79%), rest (60.4%), hot shower/bath (40.9%), and exercise (25.7%) were most common. Perceived effectiveness of these methods varied between participants. Analgesic use was also common (79.5%); of these, paracetamol was most used (60.5%) despite limited perceived effectiveness. Pain catastrophizing was a significant predictor of variance in both pain intensity and pain interference scores such that those with higher pain catastrophizing scores reported more intense pain and greater interference with daily activities and academic demands.
Conclusions
This article presents the first investigation into PD among third-level students in Ireland. Poorly managed menstrual pain may impact functional ability across several domains. Future research should focus on improving menstrual pain management education and support and promoting menstrual health literacy for women affected by PD.
Journal Article
Predictors of disability in patients with chronic low back pain
Chronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.
Seventy-six patients diagnosed with CLBP (age range 25-77 years; 73.7% female) participated in the study. Participants' socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).
The mean group scores revealed moderate CLBP complaints (VAS - 4 [3-6]), mild depression (BDI - 10 [5-16]), a moderate level of catastrophizing (PCS total score 20.5 [10-34]) and moderate disability (Oswestry Disability Index [ODI] - 31 [14-38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (
= 0.851, adjusted
= 0.843).
A multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.
Journal Article
Low-Intensity Physical Exercise Improves Pain Catastrophizing and Other Psychological and Physical Aspects in Women with Fibromyalgia: A Randomized Controlled Trial
Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain and other physical and psychological features. In this study, we aimed to analyze the effect of a low-intensity physical exercise (PE) program, combining endurance training and coordination, on psychological aspects (i.e., pain catastrophizing, anxiety, depression, stress), pain perception (i.e., pain acceptance, pressure pain threshold (PPT), and quality of life and physical conditioning (i.e., self-perceived functional capacity, endurance and functional capacity, power and velocity) in women with FM. For this purpose, a randomized controlled trial was carried out. Thirty-two women with FM were randomly allocated to a PE group (PEG, n = 16), performing an eight-week low-intensity PE program and a control group (CG, n = 16). Pain catastrophizing, anxiety, depression, stress, pain acceptance, PPT, quality of life, self-perceived functional capacity, endurance and functional capacity, power, and velocity were assessed before and after the intervention. We observed a significant improvement in all studied variables in the PEG after the intervention (p < 0.05). In contrast, the CG showed no improvements in any variable, which further displayed poorer values for PPT (p < 0.05). In conclusion, a low-intensity combined PE program, including endurance training and coordination, improves psychological variables, pain perception, quality of life, and physical conditioning in women with FM.
Journal Article
Pain catastrophizing mediates the negative influence of pain and trait-anxiety on health-related quality of life in fibromyalgia
Background
Patients with fibromyalgia syndrome (FMS) usually display a decrease in health-related quality of life (HRQoL). This decrease in HRQoL is related to clinical pain, anxiety, and depression. This cross-sectional study analyzes the mediating role of pain-coping strategies (especially catastrophizing) in the negative relationships of pain, anxiety, depression, and HRQoL in FMS.
Methods
One hundred and thirteen women with FMS and 63 healthy women were assessed using the Short-Form Health Survey (SF-36). Participants completed self-report questionnaires to evaluate clinical pain, anxiety, depression, and pain-coping strategies.
Results
Pain catastrophizing was inversely associated with the physical function, general health perception, vitality, emotional role, mental health, the physical and mental general components, and the global index of HRQoL, with percentages of variance explained ranging between 9 and 18%. Cognitive distraction showed a positive association with the physical function, general health perception, vitality, emotional role, mental health, physical component, and global index of HRQoL, with percentages of variance explained ranging between 4 and 7%. Mediation analysis showed that catastrophizing mediates the negative influence of clinical pain and trait-anxiety on the physical function, general health perception, vitality, mental health, and global index of HRQoL. No mediating effect of pain catastrophizing on the relation between depression and HRQoL was observed.
Conclusions
Patients with FMS exhibited markedly lower HRQoL than healthy individuals. While pain catastrophizing was inversely related to several domains of HRQL, associations were positive for cognitive distraction. Catastrophizing mediates the negative influence of clinical pain and trait-anxiety on HRQoL. Therefore, cognitive behavioral treatments focused on adaptive management and control of catastrophizing and negative emotional states may be helpful.
Journal Article