Few things are more infuriating to a chronic pain patient than having someone – a doctor, a loved one, a friend – tell them that the pain is all in their head. For the approximately 100 million people in the U.S., this is a statement that underscores how little chronic pain is understood. In some cases, this dismissive attitude can swing the pendulum the other way to pain catastrophizing.
Pain catastrophizing is when a chronic pain patient focuses increasingly on their pain. This may be accompanied by feelings of helplessness, hopelessness, and an increase in thoughts about and perceptions of the pain itself.
Pain catastrophizing is not present in all chronic pain cases, and there are some ways to lessen the impact or avoid it all together.
Pain catastrophizing was first named in 1962 by an American psychologist and then defined in 1987 by Aaron T. Beck, PhD as “a maladaptive cognitive style originally seen in patients with anxiety and depressive disorders with an irrational negative forecast of future events. (Beck, 1987).” Those patients suffering from pain catastrophizing are “maladaptive” in the sense that they are not able to develop additional coping skills that might afford them a more optimistic outlook for the future.
One of the best examples of pain catastrophizing might be Frida Kahlo. Kahlo was an artist who suffered a horrific bus crash in her childhood where she was impaled on a wooden pole. She spent the rest of her life undergoing surgery and in terrible pain, documenting her experience in her artwork, much of which was painted as she laid in bed. Kahlo’s entire life centered on her pain, and her art magnified and made it larger than any other part of her life, including her activism. She died at 47, officially of a pulmonary embolism, but some suggest that she may have suffered a potentially self-inflicted overdose. While there is no doubt that the physical pain Kahlo suffered was tremendous, her mental anguish may have enlarged it even further.
Pain catastrophizing goes hand-in-hand with depressive disorders and can predict a poor outcome for chronic pain patients.
A 2011 study of 297 patients with musculoskeletal pain found that pain catastrophizing and depressed mood related to lack of significant improvement in pain symptoms, regardless of intervention. This suggests that pain treatments that simply treat pain do not go far enough in addressing the totality of the issue.
Research presented at the 2014 annual meeting of the American Society of Anesthesiologists (ASA) found that pain catastrophizing could also influence the development of chronic pain after surgery. Researchers reviewed seven studies of over 660 patients who underwent knee surgery (considered low-risk for the development of chronic pain) and found that those with higher levels of pain catastrophizing prior to surgery were more likely to develop chronic pain after.
Asokumar Buvanendran, M.D., lead author and professor in the department of anesthesiology at Rush University Medical Center in Chicago, believes that one of the keys to this is thinking about a patient’s mental state prior to surgery:
“There has been considerable evidence that psychological factors can lead to the development of persistent post-surgical pain. Pre-surgical evaluation of these factors, including catastrophizing, could help to identify patients having elective surgery who might benefit from treatment of this cognitive disorder to prevent the development of chronic pain.”
For people with chronic pain, even discussing pain catastrophizing can feel like a slap in the face. It can seem as if medical professionals and loved ones are dismissing the pain or diminishing it. The fact remains that pain catastrophizing is a real phenomenon that occurs, with sometimes disastrous effects. There are ways to avoid of minimize the effects of pain catastrophizing while still acknowledging all of the challenges that exist with chronic pain.
Mindfulness meditation is a technique whereby the meditator learns to accept what is happening without judgment, interpretation, or analysis. Those who experience pain catastrophizing often experience their pain in terms of the future and how it will affect them, not in terms of what is occurring in the present. This futuristic focus can result in a negative outlook, which can deepen the perception of pain or cause resistance to what is occurring. Mindfulness promotes acceptance of what is, not exaggeration of what might be.
Talk to someone
Cognitive behavior therapy (CBT) has been shown to be remarkably effective for a number of mental conditions, including pain catastrophizing. CBT helps patients to recognize and change negative thought patterns so that they are able to shift their focus to other things, away from the pain. Cognitive behavioral therapy is a structured way to approach negative thoughts, and many of the gains achieved from just a few sessions can continue to be applied to new situations in the future.
Those in chronic pain may laugh at this suggestion, but in some cases, just not giving chronic pain any space in your head can be a good way to cope in the short term. This does not mean to ignore obvious warning signs of a serious issue, but on days when pain is at a regular level, meaning neither extraordinarily bad or good, simply going about the day deliberately and focusing on other things that matter without giving the pain too much time can be a good way to avoid ultra-negative thinking that can lead to pain catastrophizing.
One prominent feature of pain catastrophizing is a focus on and magnification of the negative. One way to combat this negative thinking is to maintain a gratitude journal. At the end of each day, write down five things that you are grateful for. It may be challenging to find five things to be grateful for on the most painful days. When that happens, flipping through the journal can help to remind you just how much more there is to life than pain.
Seek help when you need it
While pain catastrophizing can create a climate where recovery and treatment is difficult, so can the opposite: ignoring warning signs of worsening pain. If you are not getting the help you need or feel that your doctor isn’t listening to you, it may be time to switch healthcare providers or bring along a friend to help advocate for you. There are a variety of treatments available for chronic pain. Taking steps towards proper treatment can be an empowering and vital part of the treatment itself.
How do you stay positive when the pain gets harder to handle?
Image by Xu-Gong via Flickr