Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation: A Prospective Study of Individuals With Subacute Pain After Whiplash Injury

Scott, Whitney; Wideman, Timothy H.; Sullivan, Michael J. L.

doi:10.1097/ajp.0b013e31828eee6c

Cited by 155Musculoskeletal pain and rehabilitationMedical Practices and RehabilitationPediatric Pain Management Techniques

Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation: A Prospective Study of Individuals With Subacute Pain After Whiplash Injury

Scott, Whitney, Wideman, Timothy H., Sullivan, Michael J. L.·2014·The Clinical Journal of Pain

DOI 10.1097/ajp.0b013e31828eee6c

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Abstract

OBJECTIVES: Pain catastrophizing has emerged as a significant risk factor for problematic recovery after musculoskeletal injury. As such, there has been an increased focus on interventions that target patients' levels of catastrophizing. However, it is not presently clear how clinicians might best interpret scores on catastrophizing before and after treatment. Thus, the purpose of this study was to provide preliminary guidelines for the clinical interpretation of scores on pain catastrophizing among individuals with subacute pain after musculoskeletal injury. METHODS: A sample of 166 occupationally disabled individuals with subacute pain due to a whiplash injury participated in this study. Participants completed a 7-week standardized multidisciplinary rehabilitation program aimed at fostering functional recovery. Participants completed the Pain Catastrophizing Scale (PCS) upon program commencement and completion. One year later, participants indicated their pain severity and involvement in employment activities. Separate receiver operating characteristic curve analyses were conducted to determine absolute pretreatment and posttreatment and percent change scores on the PCS that were best associated with clinically important levels of pain and employment status at the follow-up. RESULTS: An absolute pretreatment PCS score of 24 best identified patients according to follow-up clinical outcomes. Posttreatment PCS scores of 14 and 15 best identified patients with high follow-up pain intensity ratings and those who did not return to work, respectively. PCS reductions of approximately 38% to 44% were best associated with return to work and low pain intensity ratings at follow-up. DISCUSSION: The results indicate scores on catastrophizing before and after treatment that are clinically meaningful. These results may serve as preliminary guidelines to assess the clinical significance of interventions targeting pain catastrophizing in patients with subacute pain after musculoskeletal injury.

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Change scores have ranged from 30% to 60% across investigations depending on the outcomes and measures used, so the generalizability of findings should be taken with caution.
“However, change scores have ranged from 30% to 60% across investigations depending on the outcomes and the measures used [61], so the generalizability of our findings should be taken with caution.”
From Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms (2020) · cites this paper as [61]
A reduction of 30% in severity of symptoms is a useful benchmark representing at least moderate clinically significant changes for individuals.
“This analysis is recommended in guidelines for pain trials and a reduction in 30% of severity of symptoms is argued to be a useful benchmark, representing at least moderate clinically significant changes (CSC) for the individuals [61,62].”
From Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms (2020) · cites this paper as [61]

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Cervical radiofrequency neurotomy reduces psychological features in individuals with chronic whiplash symptoms.
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Pain, psychosocial tests, pain sensitization and laparoscopic pelvic surgery
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Knowing What We Are Talking About: The Case of Pain Catastrophizing
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The Relation Between Catastrophizing and Occupational Disability in Individuals with Major Depression: Concurrent and Prospective Associations
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Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan
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Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire
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Contextual modulation of pain sensitivity utilising virtual environments
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An adaptive role for negative expected pain in patients with neuropathic pain
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Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: a prospective case series
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Regenerative Peripheral Nerve Interface Surgery to Treat Chronic Postamputation Pain: A Prospective Study in Major Lower Limb Amputation Patients
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Manual therapy and neck-specific exercise are equally effective for treating non-specific neck pain but only when exercise adherence is maximised: A randomised controlled trial
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Serum C-reactive protein levels predict regional brain responses to noxious cold stimulation of the hand in chronic whiplash associated disorders
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The Sequential Relation Between Changes in Catastrophizing and Changes in Posttraumatic Stress Disorder Symptom Severity
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The association of demographic, psychological, social and activity factors with foot health in people with plantar heel pain
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Factors associated with high pain catastrophizing in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome
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A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.
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The Association Between Preoperative Pain Catastrophizing and Chronic Pain After Hysterectomy – Secondary Analysis of a Prospective Cohort Study
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Differences in dynamic balance control based on pain catastrophizing level in individuals with nonspecific chronic low back pain
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Fear of Movement in People With CRPS
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The Association Between Sleep Disturbance and Health Outcomes in Chronic Whiplash-associated Disorders
Smith, A. D., Andruski, B., Deng, G., & Burnham, R. S. (2022) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001066 · Cited by 7 · see citing works

Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation A Prospective Study of Individuals With Subacute Pain After Whiplash
Scott, W., Wideman, T. H., & Sullivan, M. J. L. (2015)
Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program
Moore, E., Thibault, P., Adams, H., & Sullivan, M. J. L. (2016) · PAIN Reports · doi:10.1097/pr9.0000000000000567 · Cited by 30 · see citing works
Pain Catastrophising and Rehabilitation Outcome: Screening Instruments and What to Do With a High Score
Csongradi, V., Alfaiate-Serodio, R., & Kaltenbrunner, I. (2023) · Journal of Sports Medicine and Pain Management · doi:10.5281/zenodo.22548758
Catastrophizing, pain, and disability in patients with soft-tissue injuries
Sullivan, M. J. L., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998) · Pain · doi:10.1016/s0304-3959(98)00097-9 · Cited by 593 · see citing works
A prospective sequential analysis of the fear-avoidance model of pain
Wideman, T. H., Adams, H., & Sullivan, M. J. L. (2009) · Pain · doi:10.1016/j.pain.2009.04.022 · Cited by 162 · see citing works

Authors: Scott, W., Wideman, T. H., & Sullivan, M. J. L.
Affiliations: McGill University (CA)
ORCID: Scott, Whitney
Wideman, Timothy H.
Sullivan, Michael J. L.
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2014-03
Volume: 30
Issue: 3
Pages: 183-190
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/ajp.0b013e31828eee6c
OpenAlex: W2101385374
Cited by: 155
References: 54
Citations by year: 2026: 4 · 2025: 10 · 2024: 9 · 2023: 18 · 2022: 13 · 2021: 23 · 2020: 20 · 2019: 17 · 2018: 6 · 2017: 12 · 2016: 6 · 2015: 10 · 2014: 4 · 2013: 3
FWCI: 5.63
Type: journal article
Language: en
Open access: closed
Locations: Clinical Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: pain catastrophizing, Pain Catastrophizing Scale, whiplash injury, subacute pain, multidisciplinary rehabilitation, return to work, clinically meaningful change, pain intensity, musculoskeletal injuries, work disability
MeSH terms: Adult, Employment, Female, Follow-Up Studies, Humans, Pain, Pain Measurement, Prognosis, Prospective Studies, Psychological Tests, ROC Curve, Whiplash Injuries, Treatment Outcome, Catastrophization

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Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation: A Prospective Study of Individuals With Subacute Pain After Whiplash Injury

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