Theoretical perspectives on the relation between catastrophizing and pain
Abstract
The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
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Pain catastrophising is associated with increased use of healthcare services and longer hospital stays.
“increased use of healthcare services and longer hospital stays [15,16]”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [16]
Pain catastrophizing has emerged as one of the most important predictors of pain, accounting for 7% to 31% of the variance in pain ratings.
“Pain catastrophizing, the tendency to focus on pain and negatively evaluate one's ability to deal with pain, has emerged as one of the most important predictors of pain, accounting for 7% to 31% of the variance in pain ratings.27,119”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [119]
These findings fit with a communal model of catastrophizing that maintains that catastrophizing represents an interpersonal form of coping whose aim is to maintain proximity to and support from others.
“These findings fit with a communal model of catastrophizing that maintains that catastrophizing represents an interpersonal form of coping whose aim is to maintain proximity to and support from others.119”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [119]
Pain-related catastrophizing is associated with heightened pain intensity, emotional distress, disability and pain-related behaviour.
“Pain-related catastrophizing has been defined as a negative mental set activated by actual or anticipated pain, and is associated with heightened pain intensity, emotional distress, disability and pain-related behaviour (Sullivan et al., Citation2001).”
From The association between pain-related factors and psychological distress in patients with temporomandibular disorder. (2023) · cites this paper as Sullivan et al., 2001
Generalized positive outcome expectancy, or dispositional optimism, is related to increased feelings of control, use of more active coping strategies, and better functional performance.
“Generalized positive outcome expectancy, or dispositional optimism 348–350, is related to increased feelings of control, the use of more active coping strategies, and better functional performance 91, 351–353.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [351]
Some forms of clinical pain may be caused by enhanced aversive valuation of pain, rather than resulting from dysregulation of nociceptive brain processes.
“For example, some forms of clinical pain may be caused by enhanced aversive valuation of pain, rather than resulting from dysregulation of nociceptive brain processes (e.g., [92],[93]).”
From Distinct Brain Systems Mediate the Effects of Nociceptive Input and Self-Regulation on Pain (2015) · cites this paper as [92]
The PCS total score can range from 0 to 52 and has excellent reliability (Cronbach's alpha = 0.87).
“The PCS total score can range from 0 to 52 and has been shown to have excellent reliability (Cronbach's alpha = 0.87; Sullivan et al., 2001).”
From Effects of mindfulness-based cognitive therapy on body awareness in patients with chronic pain and comorbid depression (2016) · cites this paper as Sullivan et al., 2001
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- Authors
- Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Sullivan, Michael J. L.
- ORCID
- Venue
- The Clinical Journal of Pain
- Published
- 2001-03
- Volume
- 17
- Issue
- 1
- Pages
- 52-64
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2099493839
- Cited by
- 2,472
- References
- 121
- Citations by year
- 2026: 79 · 2025: 98 · 2024: 113 · 2023: 115 · 2022: 112 · 2021: 127 · 2020: 141 · 2019: 134 · 2018: 123 · 2017: 117 · 2016: 129 · 2015: 124 · 2014: 112 · 2013: 140 · 2012: 117
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- pain catastrophizing, pain perception, evaluation model, attention-based models, emotional distress, social factors in pain, levels of analysis
- MeSH terms
- Adaptation, Psychological, Attention, Persons with Disabilities, Humans, Models, Psychological, Pain, Sex Characteristics, Stress, Psychological
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