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The implications of pain catastrophizing

www.sentinelassam.com | December 15, 2023

Though individuals may rue pain, it is an important contributor to their health and well-being (Santiago, 2021).

Though individuals may rue pain, it is an important contributor to their health and well-being (Santiago, 2021). The evidence, or lack of pain, is what provides insight into the functioning of the human body. Due to how crucial pain is for human survival, research conducted on it has yielded different classifications of the same, and this commonly includes acute and chronic pain. Commonly understood as pain that persists for three months, chronic pain can have multiple causative factors (Anaesth, 2019). These include, but are not limited to, genetic disorders, injuries, or psychological problems (Anaesth, 2019). Though chronic pain can be understood in such a manner, the pain that is experienced is not uni-dimensional; rather, it is a combination of factors such as tolerance, perception, and catastrophization (to name a few). None of these factors work independently but instead work together to present unique sensations of pain experienced by individuals.

Based on research conducted, the amount of pain that is considered to be most bearable by an individual is their level of tolerance, and the negative schemas (both cognitive and emotional) that an individual experiences due to their fear or perception of pain can be considered as their rate of pain catastrophization (Cimpean & David, 2019). Both of these factors are extremely subjective and can differ based on ethnic differences, past experiences, and perceived sensitivity to painful stimuli.

Due to the subjective nature of pain catastrophization in particular and how it is actively influenced by an individual’s perceptions and experiences, fear of pain may become overwhelming. It, therefore, becomes imperative to encourage a change in the internal narrative that the individual possesses. One of the most direct ways in which this can be done is through cognitive behavioural therapy (CBT). As CBT assists in challenging unhealthy thoughts, behaviours, and emotions when used as an added treatment plan, it may aid in reducing pain-catastrophizing levels while simultaneously addressing any underlying psychological triggers that the individual may be facing (Fenn et al., 2013).

With unique experiences of chronic pain, it is noted that different ethnic groups may experience pain at different levels. For example, Campbell & Edwards (2012) note that Indians have been found to present lower levels of pain severity as compared to Malay and Chinese individuals; there has also been mention that pain prevalence may be different in the US population between natives and the general population. Terry et al. (2022) add to this by noting that levels of pain catastrophizing are different among different ethnicities. (Terry et al., 2022) move on to mention how non-Hispanic blacks catastrophize pain at higher levels than other groups that were tested.

Due to the potential of pain catastrophization affecting the care provision that individuals are engaged with, there needs to be research conducted on methods that can be used to reduce the same. With researchers such as (Meints & Edwards, 2018) providing insight into the mental contributors to pain catastrophization, solutions other than medical ones need to be taken into consideration. This is where mental health therapy techniques, such as CBT, that affect the psychological state of an individual come into play. As pain catastrophization is now being found to contribute towards suicidal ideation, the usage of CBT adds to the necessity of having techniques that can be used by those affected so that psychologically associated factors can be better cared for. An added benefit would be the individual’s perception of being more in charge of their treatment than they were before.

Moreover, as CBT has been noted to reduce anxiety and fear of pain, it has been considered a potential non-medical treatment for fibromyalgia (Aman et al., 2018). The researchers also mention that such an addition to medical treatment may lead to better long-term results (Aman et al., 2018). Therefore, with CBT aiding in multiple areas of care provision, there exists immense potential in not only treating pain catastrophizing but also other mental health disorders that may arise due to the same. 

As pain catastrophizing can be affected by factors such as increased rates of rumination, fear and general and focused catastrophic thinking, CBT may prove to be a beneficial add-on to medical treatment (Thorn et al., 2002). Apart from this, a meta-analysis conducted by Astin et al., 2002) notes that though there are positive changes in pain coping and perception, there needs to be further research conducted on the topic of CBT to know if it is the most applicable form of therapy. Moreover, there needs to be research on techniques that can be added to the pre-existing treatment model provided by CBT to understand if there is potential for unique outcomes.

On one hand, (Smeets et al., 2005) have highlighted the impact of physical treatment providing results similar to that of post-CBT intervention. On the other, (Day & Thorn, 2016) make note of the impact that mindfulness-based cognitive therapy (a form of therapy that integrates CBT and mindfulness principles) has on encouraging pain acceptance as a form of mediation. Similar results were found when administering mindfulness-based therapy techniques to reduce pain catastrophizing (Williams et al., 2012). This raises questions about the potential results that can be gathered in cases where various treatment styles are combined. 

Based on the current research, longitudinal studies - that span more than 2 years - that can provide insight into the implications of CBT may be best suited for data gathering and analysis. Doing so is likely to encourage better tracking of pain levels, perception and rates of catastrophizing which can later be used as a strong argument in and out of hospital administration. As therapy will provide individuals with a toolkit of resources that they can use for problems outside of pain catastrophizing regarding chronic pain, individuals will have the ability to adapt the technique that they have been exposed to for personalized care.

Moreover, a few papers address the impact of CBT on pain catastrophizing among those in non-urban locales. Regarding India in particular, research around rural groups, particularly around the theme of mental health and therapy, is necessary to encourage the growth of care that is not limited to the medical. In the case of active application of therapy techniques for care provision, there is also likely to be a positive move towards understanding mental health and reducing the stigma associated with it. As mentioned earlier, adding CBT to the medication provided by doctors may aid in reduced medication dependence while also increasing the individual’s accountability towards their care. Based on the above-mentioned points, CBT can be considered a beneficial method of care provision for pain catastrophizing. The technique addressing problems such as anxiety, depression and pain severity, CBT can assist in more than reduced pain catastrophizing, thereby providing a more holistic form of care.

This article has been co-authored by Liz George, Undergraduate Student, FLAME University and Prof. Moitrayee Das, Faculty of Psychology, FLAME University.

(Source:- https://www.sentinelassam.com/editorial/the-implications-of-pain-catastrophizing-681073 )