Cited by 596Musculoskeletal pain and rehabilitationPsychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome Research

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Pain, catastrophizing, and depression in the rheumatic diseases

Edwards, Robert R., Cahalan, Christine, Mensing, George, Smith, Michael, Haythornthwaite, Jennifer A.·2011·Nature Reviews Rheumatology

DOI 10.1038/nrrheum.2011.2

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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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Neural representations of aversive value encoding in pain catastrophizers
Brown, C. A., Almarzouki, A. F., Brown, R. J., & Jones, A. K. P. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2018.09.052 · Cited by 9
“PC predicts the severity of chronic pain (Edwards et al., 2011) and physical dysfunction above and beyond the effects of concurrent depression (Arnow et al.”
Effect of Coping Strategies on Patient and Physician Perceptions of Disease Severity and Disability in Systemic Sclerosis
DiRenzo, D., Smith, T. R., Frech, T., Shah, A. A., & Pauling, J. D. (2021) · The Journal of Rheumatology · doi:10.3899/jrheum.201612 · Cited by 9
“Pain catastrophizing has similarly been associated with patient-reported severity of pain, disability, and poor treatment outcomes in other rheumatic diseases (20,21).”
Background
Pain‐Related Risk Factors Among Radiologic Stages of Knee Osteoarthritis: Data From the Osteoarthritis Initiative
He, Z., Li, S., Zou, J., Gong, Z., He, L., Zhang, Z., Lu, P., Fan, T., Chen, R., Chen, Z., et al. (2022) · Arthritis Care & Research · doi:10.1002/acr.24997 · Cited by 9
“Chronic pain has been reported to cause depression (40,41), and depression is associated with reduced pain threshold and feeling increased severity of pain (30).”
Background
The Need for an Integrated Cognitive-Behavioral Model for Co-occurring Chronic Pain and Insomnia
Bryson, W. J., Read, J. B., Bush, J. P., & Edwards, C. L. (2015) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-015-0213-z · Cited by 9
“Catastrophizing is also recognized as a common mechanism in those with both chronic pain (Edwards et al. 2011) and”
Background
Pain in the Elderly
Fillingim, R. B., Turk, D. C., & Yezierski, R. P. (2015) · Springer eBooks · doi:10.1007/978-3-319-23246-1_18 · Cited by 9
The roles of race, sex and cognitions in response to experimental pain
Day, M. A., Ward, L. C., Grover, M. P., Ehde, D. M., Illingworth, O. R., & Jensen, M. P. (2020) · European Journal of Pain · doi:10.1002/ejp.1552 · Cited by 10
“Somewhat unexpectedly, despite the wealth of research suggesting that pain catastrophizing is a robust predictor of pain outcomes (Day & Thorn, 2010; Drahovzal et al., 2006; Edwards et al., 2011; Fillingim, 2015, 2017; Flor et al., 1993; Geisser et al., 1994; Keefe et al., 2004; Martinez-Calderon et al., 2019; Quartan…”
Nocturnal Delta Power is Associated With Lower Next-Day Pain But Not Pain Catastrophizing: Results From a Cohort of Female Participants With Temporomandibular Joint Pain
Reid, M. J., Dave, A., Rojo‐Wissar, D. M., Mun, C. J., Lerman, S. F., Buenaver, L. F., Tennen, H. A., Haythornthwaite, J. A., Campbell, C. M., Finan, P. H., et al. (2022) · Journal of Pain · doi:10.1016/j.jpain.2022.10.002 · Cited by 9
Self-citation
Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions
Alcon, C. A., & Wang-Price, S. S. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.959609 · Cited by 10
Somatic symptoms are sensitive in predicting interstitial cystitis/bladder pain syndrome
Chen, I., Lee, M., Wu, S.-L., Lin, H., Chang, K., & Lin, H. (2017) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217417703286 · Cited by 9
Chemical Mediators’ Expression Associated with the Modulation of Pain in Rheumatoid Arthritis
Cortes-Altamirano, J. L., Morraz-Varela, A., Reyes-Long, S., Gutiérrez, M., Bandala, C., Clavijo‐Cornejo, D., & Alfaro-Rodríguez, A. (2019) · Current Medicinal Chemistry · doi:10.2174/0929867326666190816225348 · Cited by 8
A new biopsychosocial questionnaire (BETY-BQ) for patients with ankylosing spondylitis
Verep, U., Ünal, E., Öksüz, S., Soy, M., Önen, F., & Kiraz, S. (2023) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2023.102267 · Cited by 8
Catastrophizing Mediates the Relationship Between the Personal Belief in a Just World and Pain Outcomes Among Chronic Pain Support Group Attendees
McParland, J. L., & Knussen, C. (2016) · Psychological Injury and Law · doi:10.1007/s12207-015-9246-y · Cited by 9
“…pain in general (Severeijns, Vlaeyen, Van Den Hout, & Weber, 2001) and a critical factor in explaining the experience of pain in rheumatic diseases and fibromyalgia (Edwards, Bingham, Bathon, & Haythornthwaite, 2006; Edwards et al., 2010; Edwards, Cahalan, Mensing, Smith, & Haythornthwaite, 2011).”
Background
Relationships between components of emotional intelligence and physical pain in alcohol-dependent patients
Kopera, M., Brower, K. J., Suszek, H., Jakubczyk, A., Fudalej, S., Krasowska, A., Klimkiewicz, A., & Wojnar, M. (2017) · Journal of Pain Research · doi:10.2147/jpr.s134019 · Cited by 8
“68 Meta-analytic data confirmed the pain-reducing properties of antidepressants (vs placebo) in chronic back pain patients.”
Social support, social undermining, and acute clinical pain in women: Mediational pathways of negative cognitive appraisal and emotion
Gaffey, A. E., Burns, J. W., Aranda, F., Purim-Shem-Tov, Y. A., Burgess, H. J., Beckham, J. C., Bruehl, S. P., & Hobfoll, S. E. (2018) · Journal of Health Psychology · doi:10.1177/1359105318796189 · Cited by 10
“In chronic pain patients, catastrophizing has been linked to greater pain intensity for individuals with more limited social support (Edwards et al., 2011).”
The Feasibility and Acceptability of a Smartphone-Based Music Intervention for Acute Pain
Chai, P. R., Schreiber, K. L., Taylor, S. W., Jambaulikar, G. D., Kikut, A., Hasdianda, M. A., & Boyer, E. W. (2019) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2019.475 · Cited by 8
“and maybe at greater risk for opioid use.[8,23,24] There is some evidence that individuals with higher catastrophizing scores may in fact respond to a distracting stimulus with greater pain reduction.”
Background
Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial
Alshehri, M. M., Alenazi, A. M., Hoover, J. C., Alothman, S., Phadnis, M. A., RUCKER, J. L., Befort, C. A., Miles, J. M., Kluding, P. M., & Siengsukon, C. F. (2019) · JMIR Research Protocols · doi:10.2196/14647 · Cited by 8
“Pain, fatigue, and poor sleep quality are common symptoms in people with fibromyalgia and rheumatic diseases [86-90].”
The Impact of Childhood Emotional Abuse on Pain Interference Among People with Chronic Pain who Inject Drugs in Vancouver, Canada
Prangnell, A., Shoveller, J., Voon, P., Shulha, H. P., Grant, C. C., Milloy, M., Kerr, T. H., & Hayashi, K. (2019) · Pain Medicine · doi:10.1093/pm/pnz233 · Cited by 10
“, the neurotransmitters serotonin and norepinephrine) [31,56,57].”
Facial Emotion Recognition in Obesity and in Fibromyalgia: A Systematic Review
Vaioli, G., & Scarpina, F. (2021) · NeuroSci · doi:10.3390/neurosci2040025 · Cited by 8
Impact of psoriatic arthritis and comorbidities on ustekinumab outcomes in psoriasis: a retrospective, observational BADBIR cohort study
Tillett, W. L., Ogdie, A., Passey, A., & Gorecki, P. C. (2023) · RMD Open · doi:10.1136/rmdopen-2022-002533 · Cited by 8
"The Effectiveness of Cognitive Behavioral Therapy in Chronic Low Back Pain"
Trevlaki, E. (2023) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2023.48.007643 · Cited by 7
Fibromyalgia as a Disorder Related to Distress and its Therapeutic Implications
Schweinhardt, P., Fitzcharles, M., Boomershine, C. S., Vierck, C. J., & Yunus, M. B. (2012) · Pain Research and Treatment · doi:10.1155/2012/950602 · Cited by 8
Insomnia and cognitive behavioral therapy for chronic back pain
Parfenova, E. V. (2020) · Neurology neuropsychiatry Psychosomatics · doi:10.14412/2074-2711-2020-4-119-124 · Cited by 8
Rheumatoid arthritis patients with predominantly tender joints rarely achieve clinical remission despite being in ultrasound remission
Hammer, H. B., Hansen, I. M. J., Järvinen, P., Leirisalo‐Repo, M., Ziegelasch, M., Agular, B., & Terslev, L. (2021) · Rheumatology Advances in Practice · doi:10.1093/rap/rkab030 · Cited by 8
“Catastrophizing has been found to be a crucially important variable in understanding the experience of pain in patients with rheumatological disorders [19].”
Background
Pain Appraisals in Patients with Physical Injury: Assessing the Role of Distress Tolerance in the Relationship between Depression and Pain Catastrophizing
Hruschak, V., Yuan, Y., Ringwald, W. R., Beaugard, C. A., Repine, M. J., Pacella‐LaBarbara, M. L., Rosen, D., & Cochran, G. (2021) · Health & Social Work · doi:10.1093/hsw/hlab021 · Cited by 7
Mediating Effect of Pain Sensitization on the Paradoxical Relation of Taking Opioids to Pain Severity in Knee Osteoarthritis: The Multicenter Osteoarthritis Study
Aoyagi, K., Jafarzadeh, S. R., Carlesso, L. C., Frey‐Law, L., Lewis, C. E., Nevitt, M. C., & Neogi, T. (2023) · Arthritis Care & Research · doi:10.1002/acr.25244 · Cited by 7
“17,36,37 Biologically, negative effects can impair opioid-mediated pain inhibition in the central nervous system 38 because of functional connectivities between brain regions responsible for those biopsychosocial symptoms and the mid-brain that controls opioid-mediated pain inhibition.”
Background
A preliminary validation of the Swedish version of the Pain Catastrophizing Scale for Children (PCS-C) for children and adolescents with cancer
Cederberg, J. T., Weineland, S., Dahl, J. C., & Ljungman, G. (2019) · Journal of Pain Research · doi:10.2147/jpr.s191378 · Cited by 8
“The PCS has shown good internal consistency and temporal stability and correlates with measures of psychological distress, functional disability and pain intensity.(21,22,25,37) The child version of the Pain Catastrophizing Scale, the PCS for children (PCS-C) was developed in 2003(38)”
Method
Depression According to ICD-10 Clinical Interview vs. Depression According to the Epidemiologic Studies Depression Scale to Predict Pain Therapy Outcomes
Fiegl, S., Lahmann, C., O’Rourke, T., Probst, T., & Pieh, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01862 · Cited by 7
“It refers to the past 4 weeks and rates minimum, average, and maximum pain (Ferraz et al., 1990).”
Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients
Feingold, D., Brill, S., Goor‐Aryeh, I., Delayahu, Y., & Lev‐Ran, S. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110130 · Cited by 7
Depression in patients with ankylosing spondylitis
Ma, T., Geng, Y., & Li, P. (2022) · Rheumatology & autoimmunity · doi:10.1002/rai2.12020 · Cited by 7
The relationship between experience of knee pain and physical activity participation: A scoping review of quantitative studies
Yang, L., Wang, P., & McGill, B. (2023) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2023.03.010 · Cited by 8
“Contrary to the findings in our review and two additional studies (pain catastrophizing intensified pain) [70,71], another study suggested that pain catastrophizing was associated with PA after adjusting for pain levels, which means that one’s personal attitude toward pain is not related to pain severity, but related…”
The efficacy of a brief acceptance-based group intervention in a sample of female patients with fibromyalgia and comorbid obesity: a randomised controlled trial
Varallo, G., Cattivelli, R., Giusti, E. M., Landi, G., Spatola, C. A. M., Ruggiero, G. M., Franceschini, C., Tossani, E., Grandi, S., Capodaglio, P., et al. (2023) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/7hvaya · Cited by 7
Biopsychosocial Typologies of Pain in a Cohort of Patients With Systemic Sclerosis
Merz, E. L., Malcarne, V. L., Assassi, S., Nair, D. K., Graham, T. A., Yellman, B. P., Estrada-Y-Martin, R. M., & Mayes, M. D. (2013) · Arthritis Care & Research · doi:10.1002/acr.22171 · Cited by 7
“Real-life” treatment of chronic pain: Targets and goals
Ablin, J. N., & Buskila, D. (2015) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2015.04.020 · Cited by 7
Association learning of Chinese herbal medicines and disease treatment efficacy
Xie, J., Wang, N., Ding, R., Guo, J., Xin, L., & Liu, J. (2018) · International Journal of Production Research · doi:10.1080/00207543.2018.1480841 · Cited by 7
“Patients with RA not only suffer from joint pain and other physical damage but also are accompanied by emotional disorder and depression, which may lead to labour incapacity, lower working efficiency and poor quality of life (Edwards et al. 2011).”
Background
Early optimized pharmacological treatment in patients with depression and chronic pain
Oluboka, O. J., Katzman, M. A., Habert, J., Khullar, A., Oakander, M. A., McIntosh, D., McIntyre, R. S., Soares, C. N., Lam, R. W. M., Klassen, L. J., et al. (2022) · CNS Spectrums · doi:10.1017/s1092852922000128 · Cited by 7
“Neuromodulation of pain via descending efferent pathways may also be impaired in depression, as a negative emotional state increases the perceived unpleasantness of pain via anterior cingulate cortex—PFC—periaqueductal gray circuitry,(51) and cognitive variables such as pessimism and catastrophizing has been found to…”
Circulating Inflammatory Biomarkers Predict Pain Change Following Exercise-Induced Shoulder Injury: Findings From the Biopsychosocial Influence on Shoulder Pain Preclinical Trial
Simon, C. B., Bishop, M. D., Wallace, M. R., Staud, R. M., DelRocco, N. J., Wu, S. S., Dai, Y. E., Borsa, P. A., Greenfield, W. H., Fillingim, R. B., et al. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.04.001 · Cited by 6
The mediating role of psychological resilience on the negative effect of pain in patients with rheumatoid arthritis: A cross-sectional study
Xu, S., Zhang, Q., & Zhou, J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0295255 · Cited by 6
Biopsychosocial influence on shoulder pain: results from a randomized preclinical trial of exercise-induced muscle injury
George, S. Z., Bishop, M. D., Wu, S. S., Staud, R. M., Borsa, P. A., Wallace, M. R., Greenfield, W. H., Dai, Y. E., & Fillingim, R. B. (2022) · Pain · doi:10.1097/j.pain.0000000000002700 · Cited by 6
Coping With Chronic Pain After Traumatic Brain Injury: Role of Race/Ethnicity and Effect on Participation Outcomes in a TBI Model Systems Sample
Sander, A. M., Christensen, K., Loyo, K. T., Williams, M., León‐Novelo, L., Ngan, E., Agtarap, S., Martin, A. M., Neumann, D. M., Hammond, F. M., et al. (2023) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2023.03.003 · Cited by 6
Mental health status can reflect disease activity in rheumatoid arthritis
Sokolović, Š., Vedina, D., & Fišeković, S. (2014) · European Journal of Rheumatology · doi:10.5152/eurjrheumatol.2014.020 · Cited by 6
Differences in Pain Intensity in Anti- and Pro-Nociceptive Pain Profile Subgroups in Patients with Knee Osteoarthritis
Bossmann, T., Brauner, T., & Horstmann, T. (2017) · Pain Management · doi:10.2217/pmt-2017-0039 · Cited by 6
A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study
Arends, R., Bode, C., Taal, E., & van de Laar, M. A. F. J. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1513086 · Cited by 6

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.
ORCID: Edwards, Robert R.
Smith, Michael
Haythornthwaite, Jennifer A.
Venue: Nature Reviews Rheumatology
Publisher: Springer Science and Business Media LLC
Published: 2011-02-01
Volume: 7
Issue: 4
Pages: 216-224
ISSN: 1759-4790 (ISSN-L)
1759-4804
DOI: 10.1038/nrrheum.2011.2
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
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Nature Reviews Rheumatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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Pain, catastrophizing, and depression in the rheumatic diseases

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