Chronic Pain and Catastrophizing: Treating Imagined Outcomes with Care

 The experience of pain is complex. It involves not only the physical but, as those with Chronic Pain know, also involves the social and psychological. One or more of these factors can lead to pain and living with Chronic Pain includes all of them, at different times and in varying degrees.

“Of all of the psychological factors that have been studied and shown to be associated with pain and its impact on our lives, the single most consistent factor (and to date – among the strongest) associated with pain is catastrophizing.” ~Dr, Mark Jensen, University of Washington;

Catastrophizing is defined by…

imagining the worst possible outcome of an action or event according to Merriam Webster. For those with living with pain it is considered “a maladaptive coping style that includes hopelessness, expanded rumination, and pain magnification.” ~ Claudia M. Campbell, PhD, Johns Hopkins University School of Medicine in Baltimore, Maryland

To determine for yourself if you are catastrophizing have a look at the Pain Catastrophizing Scale (the PCS). Developed by Dr. Michael Sullivan, it is the most widely used test-instrument of its kind.

“Our stories do not develop in isolation. They are shaped by years of social interaction – some positive, some negative. Humans tend to remember painful events more than pleasant ones…negative events are usually more salient, and remembered and recalled more accurately and in greater detail than positive ones….These negative experiences need not be traumatic to be impactful, but we tend to remember them in remarkable detail, and recall them more readily than positive events,” according to Dr. Grace Bullock.

Research has shown that because pain triggers fear and “fight-flight” signals and our minds automatically, with dedicated circuitry, give preferentially treatment to these based upon our evolution; they are “relatively impenetrable to our cognitive control”. These types of thoughts are typical of those experiencing pain, but when people with Chronic Pain think such thoughts, this is followed by increases in pain and suffering and simply makes things worse.

So what to do…

1. Schedule a “Worry Time” and create a “Worry Box”

Research out of Harvard has shown that if you schedule a once-a-day time, no more than 10 to 15 minutes, to “dedicate’  your thoughts and mind to your worries and utilize what is known as a worry box (a box you dedicate to your worries by writing them down and placing them in the box, contained) you can help yourself to address your fears, neither ignoring or obsessing on them. In the process you will train yourself not to repeatedly think of them and blow them out of proportion (catastrophizing) but to wait for the “correct” time to think of them and too, to not let them run away with you. Hopefully too you’ll address the ones that you can as, in a sense, you’ll get tired of them, the act of writing them over and over again for your worry box.

2. Practice Cognitive Behavioral Therapy –

CBT has been found to help with catastrophizing as well as the other psychological disturbances, such as depression, anxiety and insomnia, that can occur as a result of living in Chronic Pain. “It is a bit of the chicken and the egg. Which comes first? If we reduce pain, catastrophizing gets better. If we reduce the catastrophizing, pain gets better….CBT is the best option currently available,” according to Steven Z. George, PhD, University of Florida in Gainesville in the Clinical Pain Advisor.

3. Rewrite the Stories You Tell Yourself –

It is important to recognize that we are not what happens to us, that we create the stories of our lives by the tale we tell ourselves about our life’s events. Perspective is the key here. Learning to “see” our own thoughts and to see them objectively is a crucial take-away of practicing mindfulness. Once we can do that, we can then learn to practice listening to our stories and rewrite or edit them from a more positive, optimistic stance. Keeping a journal may be particularly helpful….and make a vested attempt to practice listing best-case scenarios and highlighting the positive.

“The key takeaway is that pain catastrophizing is not just a psychological experience…. (but) a real condition that needs to be recognized and managed. As we include it in more studies, we will learn more about how to treat it,” Campbell said.




Author: ChronicPainDailyReflections

I manage a web-site, Chronic Pain Daily, created for and in support of those living in chronic pain. The site helps with the day-to-day spiritual, mental, emotional and physical needs of those with constant pain, whatever its source.