Perils of Catastrophizing Pain
We all experience pain from time to time and it’s never a pleasant thing. However, there are some ways that we can make it better or worse for ourselves. One of the things we can do to make it worse is to catastrophize it. What does that mean exactly? Catastrophize in pain intensifies it by focusing on it and tell oneself how awful it is. This is very easy to do when we are feeling helpless and in the throes of deep suffering, but it would be helpful to recognize that by doing so, we only contribute to greater suffering. Furthermore, catastrophizing pain magnifies the “threat value” of pain and promotes a pessimistic view of any possible alleviation of suffering.[i] When we have acute pain, in other words pain that is time-limited in nature and comes from a recent injury or tissue damage, there is more hope for alleviation than with chronic pain. However, both acute and chronic pain can be subject to psychological factors that amplify it or lessen it.
When we experience pain, we tend to engage in certain behaviors, which may take the form of seeking help for being very preoccupied with managing the pain symptom. Catastrophizing has also been linked in research to more illness behaviors, like longer stays in the hospital, using more prescribed and over-the-counter analgesics, and more frequent visits to healthcare professionals. That can be helpful in some cases, but sometimes these outside resources are either unavailable or very costly. If there is a way to take care of the pain on one’s own, it may be helpful to use those methods first. If a person knows that focusing on the pain and catastrophizing about it worsening, it would make sense to decrease such behavior.
When people suffer pain for longer time, it is associated with greater disability as well. Pain can result in more downtime, time off work, poor dexterity and mobility, and more difficulty taking care of activities of daily living. All this is referred to as functional impairment, and is worsened with catastrophizing pain in people with fibromyalgia, knee replacement surgery, and rheumatoid arthritis. Women tend to report pain more often than men and use healthcare more frequently than men, especially when in pain. Catastrophizing pain may change with age, in which older patients report greater pain than younger patients.
Cognitive distortions are the bailiwick of cognitive behavior therapy (CBT), and until catastrophizing was associated with pain, it was used more in depression. Interestingly, there is an overlap between depression, anxiety, and psychological stress with physical pain, other which came first is not always clear. Rumination, in other words thinking about the same thing over and over, is a common feature of depression, and one that lends itself to only thinking of the worst things that can happen. It appears that doing the same about one’s physical pain can also lead to a worsening of symptoms.
However, research has shown that catastrophizing worsens pain even when depression is not present. If one predicts that they are going to be in pain, that the pain will last a long time, and that they’ll be unable to cope with the pain, these pain schemas contribute to worsening of the pain. Therefore, certain ways of thinking activate the schemas and thinking is within our control, fortunately. When we appraise pain in certain ways, it adds to the stress of the pain. It also influences which coping strategies we use today with the pain. Therefore, if you notice that your magnifying the pain, ruminating on it a lot, or that you feel helpless in relation to it, you might want to stop yourself from making the pain worse with your cognitive appraisals. Your beliefs about pain have been found to influence how you experience the pain. Pain also is influenced by how much attention we pay to it. If you exaggerate how threatening the pain is to you, the sensation of pain will increase. By paying more attention to pain, it disrupts your ability to pay attention to other things that you need to do.
So how do we cope with pain effectively? Some people seek help from other people, whether psychological or instrumental (with such tasks as driving, help with housework, or errands). By decreasing emotional distress, perhaps being with someone else might help lessen one’s experience of pain. However, some researchers think that “increased attention to their pain and the exaggerated display of pain behavior shown by catastrophizers may become maladaptive to contributing to heightened pain experience. In addition, solicitous or reinforcing responses from others they serve to trigger, or maintain, or to reinforce the exaggerated pain expression of catastrophizers” (p. 60, Sullivan et al, 2001). Therefore, it may be wise to try to cope with pain somewhat on your own so as not to develop too much dependence on other people and increase or perpetuate your helplessness.
Some of the ways that I know of dealing with pain include mindfulness-based stress reduction, meditation, hypnosis, some types of yoga, aromatherapy, and Quantum Biofeedback. I think it is worth exploring what works for you and to remember that not everyone responds to interventions the same way. Certainly, acceptance of the pain that does not yield to analgesics or medical intervention would save a lot of stress on the mind and body.
Removing stress by developing healthier attitudes toward it will not necessarily make the pain go away, but as we’ve seen, it can have a big impact on one’s experience of pain. I will talk about mindfulness-based stress reduction and hypnosis, as well as aromatherapy, in future posts. I hope that this exploration of pain has been helpful and eye-opening to your understanding of the mind-body connection in pain control.
[i] Sullivan, M., Thorne, B., Haythornthwaite, J., Keefe, F., Martin, M., Bradley, L., And Lefebvre, J. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17 (1), 52-64.