Why is it important to understand catastrophization in persistent pain?


Edwards RR, Kronfli, T., Haythornthwaite JA, Smith MT, McGuire L, Page GG. (2008) Association of catastrophizing with interleukin-6 responses to acute pain. 1: Pain. 2008 Nov 15; 140(1): 135-44. Epub 2008 Sept



  • Describes a less than ideal coping style often used by patients with anxiety and depression
  • At the core of this coping style is the concept of an irrationally negative fore-cast of future events (the worst possible thing is going to happen with an overwhelming inability to cope with that event)
  • It is the tendency to magnify or exaggerate the threat value or seriousness of pain sensations
  • It emphasizes pain-related worry and fear, coupled with an inability to draw your attention away from your pain (always think about and focus on your pain)

How do you know if you have a tendency towards catastrophization?


There are three main characteristics:



  • I wonder whether something serious may happen
  • I become afraid that the pain will get worse
  • I keep thinking of other painful events


  • I anxiously want the pain to go away
  • I can’t seem to get it out of my mind
  • I keep thinking about how much it hurts
  • I keep thinking about how badly I want the pain to stop


  • I feel I can’t go on
  • I feel I can’t stand it anymore
  • There’s nothing I can do to reduce the intensity of the pain
  • It’s terrible and I think it’s never going to get any better
  • I worry all the time about whether it will end
  • It’s awful and I feel that it overwhelms me

The study that is referenced at the beginning of this section on catastrophization examined 42 generally healthy adults that underwent a series of testing procedures which assessed their response to painful mechanical pressure, heat and cold stimulation. Pain catastrophizing thoughts were assessed prior to and then immediately after the various pain producing procedures. Blood samples were taken at the beginning and then at several time points from the end of each pain testing procedure until one hour after the tests were completed. Samples were tested for blood levels of cortisol (stress hormone) and interleukin-6 (IL-6), one of the markers in the blood for inflammation. Both cortisol and IL-6 increased from baseline during the post-testing period, with cortisol returning to baseline by 1h post-testing and IL-6 remaining elevated. Pain catastrophizing, measured immediately after the pain procedures, was found to be unrelated to cortisol reaction levels, but was strongly related to IL-6 reaction levels. In their analysis, the relationship between catastrophizing and IL-6 reactivity was not related to the level of pain experienced, but directly related to each other. In other words, the increase of inflammatory indicators in the blood was more related to the person’s level of catastrophizing thoughts rather than the level of pain they were reporting. Collectively, these findings suggest that our coping style and emotional responses during the experience of pain may cause an increased inflammatory response to noxious stimulation. This pathway may represent one important way by which catastrophizing and other psychosocial factors shape the experience of both acute and chronic pain in a variety of settings.


So what does this all mean? Many research studies have shown that catastrophization is linked strongly to the development of persistent pain. Our thoughts and beliefs are strongly linked with the likelihood that our pain will become chronic, even though the tissues have healed. Therefore, catastrophization needs to be identified early to minimize the chance of injuries and/or physical problems becoming chronic, or persistent. Pain education is a very effective tool in helping patients who tend to catastrophize to understand what is happening in their bodies and why these things are happening. Pain Education helps to eliminate the threats of ongoing danger messages that are perceived by the brain.