Pain catastrophizing predicts poor response to topical analgesics in patients with neuropathic pain
Open accessAbstract
The prevalence of neuropathic pain approaches 10% in Canada and the United States. Given the aging population and the increasing survival rates following interventions for neuropathic pain, the prevalence of neuropathic pain conditions is expected to rise significantly over the next 20 years. Although pharmacological interventions represent the dominant treatment approach for neuropathic pain, as many as 50% of patients are partially or completely refractory to the available treatments. Pain catastrophizing has been associated with heightened pain experiences in patients with neuropathic pain conditions; however, the clinical relevance of the relationship between catastrophizing and poor treatment outcomes is, to date, unclear. Accordingly, using a numerical rating scale, this study aimed to examine this relationship in patients with varied neuropathic pain conditions who completed a measure of catastrophizing before initiating a course of topical analgesic. BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain. OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end‐of‐treatment pain ratings were below 4/10. METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three‐week trial examining the efficacy of topical analgesics for neuropathic pain. RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (≥2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end‐of‐treatment pain ratings below 4/10. CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication.
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“catastrophizing predicts poorer treatment outcome in various chronic pain conditions [75,76].”
BackgroundPhilpott, R., Gulabivala, K., Leeson, R., & Ng, Y. ‐. (2018) · International Endodontic Journal · doi:10.1111/iej.13029 · Cited by 33 · see citing works
An amygdala-to-cingulate cortex circuit for conflicting choices in chronic pain
Valentinova, K., Acuña, M. A., Ntamati, N. R., Nevian, N. E., & Nevian, T. (2023) · Cell Reports · doi:10.1016/j.celrep.2023.113125 · Cited by 32 · see citing works
Climent‐Sanz, C., Hamilton, K. R., Martínez-Navarro, O., Briones‐Vozmediano, E., Gracia-Lasheras, M., Fernández‐Lago, H., Valenzuela‐Pascual, F., & Finan, P. H. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2280057 · Cited by 25 · see citing works
“In adults diagnosed with chronic pain, brain connectivity phenotypes [63], pretreatment levels of anxiety and depression [64–66], pain catastrophizing [67,68], pain variability [69], and treatment expectations [70] all prospectively predict treatment outcomes.”
Alcon, C. A., Bergman, E., Humphrey, J., Patel, R. M., & Wang-Price, S. S. (2023) · Pain Research and Management · doi:10.1155/2023/5851450 · Cited by 24 · see citing works
İlçin, N., GÜRPINAR, B., Bayraktar, D., Savcı, S., Cetin, P., Sarı, İ., & Akkoç, N. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.298 · Cited by 22 · see citing works
Abu‐Saad, H. H., Fares, S. A., & French, D. J. (2017) · Pain Research and Management · doi:10.1155/2017/1472792 · Cited by 22 · see citing works
“Furthermore, treatment outcome studies have demonstrated that high levels of pain catastrophizing are associated with poor responses to pharmacological intervention [16], surgical treatment [17], physical therapies [18, 19], andpsychological interventions for pain conditions [20].”
BackgroundTerradas‐Monllor, M., Ruiz, M. Á., & Ochandorena‐Acha, M. (2023) · Physical Therapy · doi:10.1093/ptj/pzad141 · Cited by 22 · see citing works
Pain Catastrophizing and EEG-α Asymmetry
Jensen, M. P., Gianas, A., Sherlin, L. H., & Howe, J. D. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000182 · Cited by 20 · see citing works
Ramírez‐Maestre, C., Reyes-Pérez, Á., Esteve, R., López-Martínez, A. E., Bernardes, S. F., & Jensen, M. P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17176428 · Cited by 20 · see citing works
Pain patterns in chronic pancreatitis and chronic primary pain
Tuck, N. L., Teo, K., Kuhlmann, L., Olesen, S. S., Johnson, M., Bean, D. J., Rashid, U., MacCormick, A. D., Srikumar, G., Drewes, A. M., et al. (2022) · Pancreatology · doi:10.1016/j.pan.2022.04.016 · Cited by 20 · see citing works
Muere, A., Tripp, D. A., Nickel, J. C., Kelly, K.-L., Mayer, R., Pontari, M., Moldwin, R., Carr, L. K., Yang, C. C., & Nordling, J. (2018) · Pain Management Nursing · doi:10.1016/j.pmn.2017.11.001 · Cited by 18 · see citing works
Katastrofiziranje u bolesnika sa sindromom pekućih usta
Rogulj, A. A., Richter, I., Brailo, V., Krstevski, I., & Boras, V. V. (2014) · Acta Stomatologica Croatica · doi:10.15644/asc48/2.109 · Cited by 18 · see citing works
Grosen, K., Olesen, A. E., Gram, M., Jonsson, T., Kamp-Jensen, M., Andresen, T., Nielsen, C., Požlep, G., Pfeiffer‐Jensen, M., Morlion, B. J., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0171723 · Cited by 18 · see citing works
“As such, catastrophizers are more likely than non-catastrophizers to continue to suffer from high levels of persistent pain in spite of treatment [27].”
BackgroundSpinoni, M., Capano, A. U., Porpora, M. G., & Grano, C. (2024) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2024.12.027 · Cited by 15 · see citing works
Ramírez‐Maestre, C., Esteve, R., López-Martínez, A. E., Miró, J., Jensen, M. P., & de la Vega, R. (2020) · European Journal of Pain · doi:10.1002/ejp.1583 · Cited by 15 · see citing works
“According to Martin (2007), humour is anything that people say or do that is perceived as funny and makes others laugh.”
BackgroundPain referents used to respond to the P ain C atastrophizing S cale
Kapoor, S., Thorn, B. E., Bandy, O., & Clements, K. L. (2014) · European Journal of Pain · doi:10.1002/ejp.561 · Cited by 15 · see citing works
“The detrimental role of catastrophizing in managing and coping with pain is well documented and catastrophizing is widely acknowledged as an important predictor of pain experience (Campbell et al., 2010a,b; Khan et al., 2011; Mankovsky et al., 2012).”
BackgroundKeter, D. L., Esteves, J. E., Loghmani, M. T., Rossettini, G., & Cook, C. E. (2025) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2025.100750 · Cited by 14 · see citing works
Elphinston, R. A., Sullivan, M. J. L., Sterling, M. M., Connor, J. P., Baranoff, J. A., Tan, D. H. T., & Day, M. A. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.08.009 · Cited by 14 · see citing works
Self-citationFrontal alpha asymmetry: A potential biomarker of approach-withdrawal motivation towards pain
Silva-Passadouro, B., Delgado-Sánchez, A., Henshaw, J., Lopez-Diaz, K., Trujillo‐Barreto, N. J., Jones, A. K. P., & Sivan, M. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.962722 · Cited by 11 · see citing works
Linguistic Indicators of Pain Catastrophizing in Patients With Chronic Musculoskeletal Pain
Junghaenel, D. U., Schneider, S., & Broderick, J. E. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.01.001 · Cited by 12 · see citing works
“impaired social relations (1,2,22), and suboptimal treatment outcomes (25,52).”
BackgroundThe utility/futility of medications for neuropathic pain – an observational study
Butler, S. H., Eek, D., Ring, L., Gordon, A., & Karlsten, R. (2018) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2018-0317 · Cited by 11 · see citing works
“Similarly, two recent studies showed that patients with peripheral neuropathy who are “catastrophizers” are less responsive to first line pharmacotherapy [38, 39].”
BackgroundChao, P.-K., Chang, H.-F., Ou, L.-C., Chuang, J., Lee, P.-T., Chang, W., Chen, S.-C., Ueng, S., Hsu, J. T.-A., Tao, P., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-39555-x · Cited by 12 · see citing works
Dimova, V., Oertel, B. G., Kabakci, G., Zimmermann, M., Hermens, H., Lautenbacher, S., Ultsch, A., & Lötsch, J. (2015) · Journal of Pain · doi:10.1016/j.jpain.2015.05.004 · Cited by 10 · see citing works
“For instance, pain anxiety and catastrophizing contribute negatively to neuropathic pain and its treatment.(43,51,59,61,65) Pain vigilance, ie, a tendency to focus on pain-related bodily sensations,”
BackgroundLi, X., Lin, X., Yao, J., Chen, S., Hu, Y., Liu, J., & Jin, R. (2022) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2022.853509 · Cited by 9 · see citing works
“The Pain Vigilance and Awareness Questionnaire (PVAQ) was used to measure awareness, consciousness, vigilance, and observation of pain (McCracken, 1997).”
MethodPsychobehavioral and psychosocial aspects of neuropathic pain patients
Perissinotti, D. M. N., & Portnoi, A. G. (2016) · Revista Dor · doi:10.5935/1806-0013.20160055 · Cited by 9 · see citing works
Zimmers, S., Robieux, L., & Bungener, C. (2023) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887231154932 · Cited by 9 · see citing works
“Moreover, as previous research in non-parkinsonian chronic pain showed high scores on pain catastrophizing prospectively predicted poorer response to pain treatment.(78) Our results show that pain relief from pain killers is moderate.”
ResultMampel, J. V., Bautista, I. J., Salvat, I., Maroto‐Izquierdo, S., Girbés, E. L., & Ros‐Bernal, F. (2024) · PM&R · doi:10.1002/pmrj.13289 · Cited by 9 · see citing works
“57 Likewise, several studies have confirmed that the efficacy of surgical and pharmacological treat-ment 58,59 was diminished in individuals with high levels of catastrophism.”
Whole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility Trial
Fitzmaurice, B. C., Heneghan, N. R., Rayen, A. T. A., Grenfell, R. L., & Soundy, A. (2023) · Behavioral Sciences · doi:10.3390/bs13090717 · Cited by 8 · see citing works
“Pain catastrophizing was not controlled for; however, it is a factor that maintains chronic pain and predicts a poorer response to treatment [126,127].”
BackgroundTodorovic, M. S., Frey, K., Swarm, R. A., Bottros, M. M., Rao, L. K., Tallchief, D., Kraus, K., Meacham, K., Bakos, K., Zang, X., et al. (2021) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001001 · Cited by 7 · see citing works
“Tricyclic antidepressants (eg, amitriptyline) 2 (12) 0 (0) 2 (6) Anticonvulsants (eg, gabapentin) 9 (53) 8 (47) 17 (50) Topical agents (eg, lidocaine patch, topical steroids) 1 (6) 1 (6) 2 (6) Antispasmodics (cyclobenzaprine) 0 (0) 2 (12) 2 (6) Duration of painful symptoms before study, n (%)”
InfluentialLetzen, J. E., Dildine, T. C., Mun, C. J., Colloca, L., Bruehl, S. P., & Campbell, C. M. (2020) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa032 · Cited by 6 · see citing works
“Second, pain coping systematically differs between NHW and Black adults, with the latter ethnic group reporting greater situational pain catastrophizing [12, 29, 30]; greater situational pain catastrophizing, in turn, is associated with reduced placebo or increased nocebo responses [31, 32].”
BackgroundStokholm, R. N., Handberg, C., & Knudsen, L. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1998669 · Cited by 7 · see citing works
Dwyer, C. L., Craft, W. H., Yeh, Y., Cabral, D. A. R., Athamneh, L. N., Tegge, A. N., Stein, J. S., & Bickel, W. K. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209573 · Cited by 4 · see citing works
Whole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility TrialPreprint
Fitzmaurice, B. C., Heneghan, N. R., Rayen, A. T. A., Grenfell, R. L., & Soundy, A. (2023) · medRxiv · doi:10.1101/2023.03.03.23286452 · Cited by 4 · see citing works
Jin, Q., Li, W., Chu, X., & Huang, L. (2022) · Cellular and Molecular Biology · doi:10.14715/cmb/2021.67.6.18 · Cited by 3 · see citing works
Perspectives on Pain: A Narrative Review of Pain Beliefs, Coping, and Clinical Implications
Pugh, C., Snoddy, K., Boyett, R., Bakir, H., Cawley, D., & Piscura, M. K. (2026) · Journal of Pain Research · doi:10.2147/jpr.s603074 · Cited by 2 · see citing works
“51 Similarly, human immunodeficiency virus (HIV)-related neuropathy commonly manifests as distal sensory neuro-pathy resulting from small-fiber demyelination.”
Pain catastrophizing and fear of movement: detection and intervention
Paré, C., & Sullivan, M. J. L. (2022) · doi:10.1002/9781119701170.ch27 · Cited by 2 · see citing works
Self-citationWhole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility TrialPreprint
Fitzmaurice, B. C., Heneghan, N. R., Rayen, A. T. A., Grenfell, R. L., & Soundy, A. (2023) · Research Square · doi:10.21203/rs.3.rs-2777152/v1 · Cited by 2 · see citing works
Catastrophization, pain and disability in patients with chronic low back pain
Berković-Šubić, M., Karšaj, J. M., Hofmann, G., & Grazio, S. (2025) · Balneo and PRM Research Journal · doi:10.12680/balneo.2025.824 · Cited by 1 · see citing works
Moore, T. B. (2016) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/p1z0-ja31 · Cited by 1 · see citing works
“Additionally, they found that catastrophizers were less likely to report moderate to substantial reductions in pain ratings over the course of treatment than non-catastrophizers (Mankovsky et al., 2012).”
BackgroundDrug discovery to counteract antinociceptive tolerance with mu-opioid receptor endocytosisPreprint
Chao, P., Ke, Y., Chang, H.-F., Huang, Y., Ou, L.-C., Chuang, J., Lin, Y., Lee, P.-T., Chang, W., Chen, S., et al. (2017) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/182360
“previous studies showing that MOR agonists are highly effective in acute pain, but less so in chronic inflammatory and neuropathic pain (Fernández-Dueñas et al., 2007; Mankovsky et al., 2012; Rowbotham et al., 2003).”
BackgroundResultLin, C., Lane, H., Sun, C., Chen, M., Lee, C., Li, L., Lee, J., & Yeh, P. (2024) · European Journal of Pain · doi:10.1002/ejp.2270
“Consistently, unresponsiveness to medication could enhance pain catastrophizing (Mankovsky et al., 2012) that triggers depression and anxiety, which have been reported to be associated with a reduction in grey matter volume (Rhudy & Meagher, 2000; Wiech et al., 2014; Zhang et al., 2012).”
Vora, A. J., Kennedy-Spaien, E., Gray, S., Estudillo‐Guerra, M. A., Phillips, G., Mesia-Toledo, I., Glenn, M. B., Chin, B. S., & Morales-Quezada, L. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1448117
Sendel, M., Ehmke, L., Dunst, A., Vollert, J., Bruckmueller, H., Brügge, S., Rehm, S., Gierthmühlen, J., Kersebaum, D., Cascorbi, I., et al. (2026) · European Journal of Pain · doi:10.1002/ejp.70200
“Our findings are not in line with a study showing poor response of patients who exhibit high pain catastrophizing to topical amitriptyline and/or ketamine cream (Mankovsky et al. 2012), but in the study mentioned, the patients had to apply the cream themselves several times a day.”
Douleur et détresse psychologique dans la maladie de Parkinson
Zimmers, S. (2022) · theses.fr (ABES) · doi:10.70675/4ee56062z2f4bz4814z99c6z5f4b7eb80571
The Effect of Pain Catastrophizing on Acupuncture Treatment for Chronic Pain in Cancer Survivors
Jyung, H., Sun, L., Li, Q., Chimonas, S. C., Li, X., Liou, K. T., & Mao, J. J. J. (2026) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2026.06.008
- Authors
- Mankovsky, T., Lynch, M. E., Clark, A., Sawynok, J., & Sullivan, M. J.
- Affiliations
- Dalhousie University (CA)
- Calgary Health Region (CA)
- McGill University (CA)
- Corresponding author
- Sullivan, Michael JL
- Venue
- Pain Research and Management
- Publisher
- Wiley
- Published
- 2012-01
- Volume
- 17
- Issue
- 1
- Pages
- 10-14
- ISSN
- 1203-6765 (ISSN-L)
- 1918-1523
- PMC
- PMC3299037
- OpenAlex
- W5793289
- Cited by
- 72
- References
- 48
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 9 · 2022: 7 · 2021: 7 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 4 · 2014: 6 · 2013: 2 · 2012: 1
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Pain Research and Management (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes for Health Research
- EpiCept Corporation
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- pain catastrophizing, neuropathic pain, topical analgesics, treatment response prediction, analgesic efficacy, pain intensity, catastrophic thinking, brief intervention
- MeSH terms
- Administration, Topical, Adult, Aged, Aged, 80 and over, Analgesics, Double-Blind Method, Female, Humans, Male, Middle Aged, Neuralgia, Pain Measurement, Psychiatric Status Rating Scales, Logistic Models, Young Adult, Catastrophization
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