Pain, catastrophizing, and depression in the rheumatic diseases
Abstract
Persistent and disabling pain is the hallmark of osteoarthritis, rheumatoid arthritis, fibromyalgia, and various other rheumatologic conditions. However, disease severity (as measured by 'objective' indices such as those that employ radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely between individuals with ostensibly similar conditions (for example, grade 4 osteoarthritis of the knee). Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This Review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae across a number of rheumatic diseases. Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity, and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with rheumatologic disorders. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions.
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Pain catastrophising occurs at higher rates in people with fibromyalgia compared with other rheumatologic populations.
“PC occurs at higher rates in people with FM compared with other rheumatologic populations.”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [22]
In people with fibromyalgia, there is often an even stronger relationship between pain catastrophising and key clinical outcomes, such as pain intensity and pain sensitivity, compared with other rheumatologic diseases.
“Moreover, there is often an even stronger relationship between PC and key clinical outcomes, such as pain intensity and pain sensitivity, in comparison with other rheumatologic diseases [20-22].”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [22]
Having a supportive partner is associated with reduced symptom burden including less pain, improved quality of life, and fewer distress symptoms in patients with chronic lymphocytic leukemia, metastatic breast cancer, and colorectal cancer.
“the presence of a supportive partner has been associated with reduced symptom burden (including less pain), improved quality of life, and fewer symptoms of distress in patients with chronic lymphocytic leukemia 92, metastatic breast cancer 93, 94, and other cancer types such as colorectal cancer95, 96.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [92]
Catastrophizing is linked to the intensity of pain and the severity of depression, which are markers of maladjustment.
“Catastrophizing is linked to the intensity of pain and the severity of depression, which are markers of maladjustment (34, 40).”
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Catastrophizing delays the analgesic effect of distraction
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A new episode of low back pain: Who relies on bed rest?
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Is one question enough to screen for depression?
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Back and Neck Pain and Psychopathology in Rural Sub-Saharan Africa
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Pathophysiology and Clinical Implications
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Gender and Exercise Behavior Among Women and Men with Osteoarthritis
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Developing Biologically-Based Assessment Tools for Physical Therapy Management of Neck Pain
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Cognitive bias in systemic lupus erythematosus
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The Corneal Pain System. Part I: The Missing Piece of the Dry Eye Puzzle
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Self-citationPain Catastrophizing and Function In Individuals With Chronic Musculoskeletal Pain
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Psychological Interventions for the Treatment of Chronic Pain in Adults
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Self-citationDistraction Analgesia in Chronic Pain Patients
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Self-citationCognitive Behavior Therapy, Exercise, or Both for Treating Chronic Widespread Pain
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Non-inflammatory Causes of Pain in Patients with Rheumatoid Arthritis
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Cognition in the Chronic Pain Experience: Preclinical Insights
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Self-citationLet’s talk about pain catastrophizing measures: an item content analysis
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“painmay be responsible for avoidance behavior (eg, avoidance of work, physical activity, and social activity).(5,8,47) Particularly, the”
Study on Pain Catastrophizing From 2010 to 2020: A Bibliometric Analysis via CiteSpace
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Self-citationLarsen, D. B., Laursen, M. B., Edwards, R. R., Simonsen, O. H., Arendt‐Nielsen, L., & Petersen, K. K. (2020) · Pain Medicine · doi:10.1093/pm/pnaa402 · Cited by 85 · see citing works
Self-citationThompson, E. L., Broadbent, J., Bertino, M. D., & Staiger, P. K. (2016) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000235 · Cited by 84 · see citing works
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Chronic Pain After Breast Surgery: A Prospective, Observational Study
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Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic
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Relationship of Negative Affect and Outcome of an Opioid Therapy Trial Among Low Back Pain Patients
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Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms
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Self-citationEncoding of Self‐Referential Pain Catastrophizing in the Posterior Cingulate Cortex in Fibromyalgia
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Self-citationA prediction model for length of stay after total and unicompartmental knee replacement
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- Authors
- Edwards, R. R., Cahalan, C., Mensing, G., Smith, M., & Haythornthwaite, J. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Johns Hopkins University (US)
- Corresponding author
- Edwards, Robert R.
- Venue
- Nature Reviews Rheumatology
- Published
- 2011-02-01
- Volume
- 7
- Issue
- 4
- Pages
- 216-224
- ISSN
- 1759-4790 (ISSN-L)
- 1759-4804
- OpenAlex
- W1986268428
- Cited by
- 596
- References
- 123
- Citations by year
- 2026: 25 · 2025: 29 · 2024: 30 · 2023: 44 · 2022: 48 · 2021: 55 · 2020: 47 · 2019: 54 · 2018: 48 · 2017: 42 · 2016: 30 · 2015: 35 · 2014: 39 · 2013: 31 · 2012: 29
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Update notices
- correction (2011-06-03)
- Open access
- closed
- Locations
- Nature Reviews Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- pain catastrophizing, depression, rheumatic diseases, chronic pain, biopsychosocial model of pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, pain sensitivity, disability, treatment outcomes, inflammatory disease activity, mortality, multimodal pain management
- MeSH terms
- Depression, Disability Evaluation, Helplessness, Learned, Humans, Pain, Rheumatic Diseases, Treatment Failure, Pain Threshold
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