Pain catastrophizing: as a clinician and/or researcher in the field of pain, this term may sound familiar to you. Pain catastrophizing is often broadly conceived as an exaggerated mental mindset during painful experiences (1). It has been identified as an important and consistent psychosocial predictor of almost every significant pain-related outcome. Notwithstanding its use in clinical and experimental studies, the concept of pain catastrophizing has frequently raised concerns about its definition, conceptualization and evaluation (2). Moreover, the terminology pain catastrophizing is considered stigmatizing by people with chronic pain (3,4). Different initiatives are being taken to refine the concept of pain catastrophizing and its assessment.
One of these is the Rename Pain Catastrophizing study, a patient-centered initiative that was started at Stanford University and is now being led by clinicians, pain researchers, patients, their caregivers, family members, and patient advocates from different countries and professional fields. The study's overarching goal was to comprehend how various stakeholders felt about the term pain catastrophizing and determine whether new, more patient-centered terminology might be necessary.Recently, study results regarding the perspectives of patients with ongoing or past chronic pain on the term pain catastrophizing were published in The Journal of Pain (5).
In this study, a survey asking about experiences with and opinions on the term pain catastrophizing was completed by a total of 2911 participants. Questions included: Have you heard of the term ‘pain catastrophizing’? Has a healthcare provider ever described you as being a ‘pain catastrophizer’ or said that you were ‘catastrophizing’ your pain, or used the term to discuss your pain care? What comes to mind when you hear the term ‘pain catastrophizing’? What would be a better term for ‘pain catastrophizing’? Forty-five percent of participants (n = 1295) had heard of the term pain catastrophizing and 12% (n = 349) reported being described as a pain catastrophizer by a clinician with associated feelings of being blamed, judged, and dismissed. Approximately 32% of participants (n = 588) reported negative experiences with the term pain catastrophizing or perceived the term to be problematic, while the remaining participants did not spontaneously report negative experiences with or responses to the term.
What did patients think about renaming pain catastrophizing? Many patients associated the meaning of pain catastrophizing with a lack of clinician empathy and care. The study reports that most respondents were less concerned with the term than with the effect it had on their experiences with clinicians. Some patients questioned the term's use and any replacement term, believing that any new name would be misapplied and would continue to carry the associated stigma and judgement.
The study's authors' main takeaway is the significance of terminology in patient care. Our use of language and words matters and it can have a direct impact on how open someone is to receiving a treatment or referral.
Lore Dams is postdoctoral researcher at the University of Antwerp and physiotherapist at the oncological department of the University Hospital Leuven.
2023Pain in Motion
References and further reading:
(1) Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001 Mar;17(1):52-64. doi: 10.1097/00002508-200103000-00008. PMID: 11289089.
(2) Petrini L, Arendt-Nielsen L. Understanding Pain Catastrophizing: Putting Pieces Together. Front Psychol. 2020 Dec 16;11:603420. doi: 10.3389/fpsyg.2020.603420. PMID: 33391121; PMCID: PMC7772183.
(3) Pearce L. Words can hurt - how the language of ‘pain catastrophisation’ has had its day. Nursing Standard. 2020 Sept 35;9:69-71. doi: 10.7748/ns.35.9.69.s21.
(4) Amtmann D, Liljenquist K, Bamer A, Bocell F, Jensen M, Wilson R, Turk D. Measuring Pain Catastrophizing and Pain-Related Self-Efficacy: Expert Panels, Focus Groups, and Cognitive Interviews. Patient. 2018 Feb;11(1):107-117. doi: 10.1007/s40271-017-0269-1. PMID: 28871427.
(5) Webster F, Connoy L, Longo R, Ahuja D, Amtmann D, Anderson A, Ashton-James CE, Boyd H, Chambers CT, Cook KF, Cowan P, Crombez G, Feinstein AB, Fuqua A, Gilam G, Jordan I, Mackey SC, Martins E, Martire LM, O'Sullivan P, Richards DP, Turner JA, Veasley C, Würtzen H, Yang SY, You DS, Ziadni M, Darnall BD. Patient Responses to the Term Pain Catastrophizing: Thematic Analysis of Cross-sectional International Data. J Pain. 2022 Oct 11:S1526-5900(22)00418-7. doi: 10.1016/j.jpain.2022.10.001. Epub ahead of print. PMID: 36241160.