Pain catastrophizing: a critical review.

Quartana, Phillip J; Campbell, Claudia M; Edwards, Robert R

doi:10.1586/ern.09.34

Cited by 1,405Musculoskeletal pain and rehabilitationPain Management and Placebo EffectPediatric Pain Management Techniques

Pain catastrophizing: a critical review.

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Quartana, Phillip J, Campbell, Claudia M, Edwards, Robert R·2009·Expert Review of Neurotherapeutics

DOI 10.1586/ern.09.34PMC PMC2696024

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Abstract

Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently.

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The Fear-Avoidance Model describes core cognitive-behavioural processes, including pain catastrophising, pain-related fear, pain hypervigilance and pain avoidance, which contribute to the transition from acute to persistent pain, including maintaining and exacerbating processes.
“The Fear-Avoidance Model (FAM)65–71 describes core cognitive–behavioural processes, including pain catastrophising, pain-related fear, pain hypervigilance and pain avoidance, which contribute to the transition from acute to persistent pain, including maintaining and exacerbating processes.”
From Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark (2023) · cites this paper as [70]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Pain catastrophizing is linked to pain intensity, depressive symptoms, disability, and delayed recovery in patients with chronic pain.
“a construct previously linked to pain intensity, depressive symptoms, disability, and delayed recovery in patients with chronic pain [56,57].”
From The bed nucleus of the stria terminalis as a brain correlate of psychological inflexibility in fibromyalgia (2020) · cites this paper as [57]
The section “Association of pain catastrophizing with pain-related outcomes” links catastrophizing to clinical pain severity, depression, and disability in chronic pain samples. It also reports adverse postsurgical outcomes, but does not specifically establish delayed recovery in patients with chronic pain. (LLM, conf=0.83)
Experimental — accuracy not yet measured
People with persistent pain often catastrophise, seen as exaggerated negative thoughts and feelings in response to actual or anticipated pain.
“Similarly, people with persistent pain often catastrophise. This is seen as exaggerated negative thoughts and feelings in response to actual or anticipated pain.10”
From Protocol for a feasibility and acceptability study using a brief ACT-based intervention for people from Southwest Wales who live with persistent pain (2018) · cites this paper as [10]
The ‘Pain catastrophizing: conceptual & measurement considerations’ section (page unavailable) defines it as exaggerated negative cognitive and emotional responses to actual or anticipated pain. The ‘Association of pain catastrophizing with pain-related outcomes’ section discusses people with chronic pain, but does not establish that they often catastrophise. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Pain acceptance addresses pain catastrophizing and kinesiophobia.
“pain acceptance addresses: (1) pain catastrophizing, which is an exaggerated cognitive or emotional response to actual or anticipated pain [51-53], and (2) kinesiophobia, which is the avoidance of activities or movements due to excessive anxiety that it will cause pain or injury [54].”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [53]
Catastrophizing has been linked to increased hypervigilance and heightened activity in brain regions involved in threat detection and affective processing.
“Additionally, catastrophizing has been linked to increased hypervigilance and heightened activity in brain regions involved in threat detection and affective processing.45,46”
From Acceptance and commitment therapy for prevention of chronic pain after total knee arthroplasty. (2026) · cites this paper as [46]

In patients with musculoskeletal pain, catastrophizing is the single most important pre-treatment risk factor that reduces the effectiveness of pain-relieving interventions.
“Studies in patients with musculoskeletal pain have indicated that catastrophizing is the single most important pre-treatment risk factor that impairs the effectiveness of pain-relieving interventions 300, 301”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [300]
Catastrophizing affects the effectiveness of pain-relieving interventions, including surgery.
“Catastrophizing also impacts treatment effectiveness for pain-relieving interventions 300, 301, 309, including surgery310–312.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [300]
Of all cognitive and psychological covariates commonly measured in experimental and clinical pain studies, pain catastrophizing is repeatedly identified as the one robust measure associated with indices of pain sensitivity, clinical outcomes, and behavioral expressions of pain.
“Of all the cognitive and psychological covariates commonly measured in experimental and clinical pain studies, pain catastrophizing (24) is repeatedly identified as the one robust measure associated with indices of pain sensitivity, clinical outcomes, and behavioral expressions of pain (25).”
From World Endometriosis Research Foundation Endometriosis Phenome and biobanking harmonization project: II. Clinical and covariate phenotype data collection in endometriosis research (2014) · cites this paper as [25]
The pain catastrophizing scale is valid and relevant for both patients and healthy controls, acceptable to patients/controls, and comprises only 13 questions.
“As the pain catastrophizing scale is valid and relevant for both patients and healthy controls (referring to any pain experienced rather than to pelvic pain specifically), acceptable to patients/controls, and comprises of only 13 questions”
From World Endometriosis Research Foundation Endometriosis Phenome and biobanking harmonization project: II. Clinical and covariate phenotype data collection in endometriosis research (2014) · cites this paper as [25]
Pain catastrophizing is considered a trait measure and thus should not be influenced by the preceding questions.
“Although pain catastrophizing is considered a trait measure (25) and thus should not be influenced by the preceding questions”
From World Endometriosis Research Foundation Endometriosis Phenome and biobanking harmonization project: II. Clinical and covariate phenotype data collection in endometriosis research (2014) · cites this paper as [25]

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Path Model of Psychological Antecedents to Pain Experience
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An experimental investigation on attentional interference by threatening fixations of the neck in patients with chronic whiplash syndrome
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Sex differences and construct redundancy of the Coping Strategies Questionnaire - catastrophizing Subscale
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[4]Beck AT Rush AJ Shaw BF Emery G Cognitive Therapy of Depression Guilford Press NY, USA 1979
[76]Edwards RR Kronfli T Haythornthwaite JA Association of catastrophizing with interleukin-6 responses to acute pain Pain 140 1 135 144 2008 18778895 PMC2659503

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Authors: Quartana, P. J., Campbell, C. M., & Edwards, R. R.
Affiliations: Johns Hopkins University (US)
Brigham and Women's Hospital (US)
ORCID: Quartana, Phillip J
Campbell, Claudia M
Edwards, Robert R
Venue: Expert Review of Neurotherapeutics
Publisher: Informa UK Limited
Published: 2009-05
Volume: 9
Issue: 5
Pages: 745-758
ISSN: 1473-7175 (ISSN-L)
1744-8360
DOI: 10.1586/ern.09.34
PMC: PMC2696024
OpenAlex: W2122400634
Semantic Scholar: 3bcf1a3b337d6163857552d6bc2e7278da5f2459
Cited by: 1,405
References: 111
Citations by year: 2026: 111 · 2025: 123 · 2024: 120 · 2023: 121 · 2022: 111 · 2021: 136 · 2020: 112 · 2019: 91 · 2018: 92 · 2017: 86 · 2016: 79 · 2015: 71 · 2014: 51 · 2013: 40 · 2012: 28
FWCI: 2.03
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Expert Review of Neurotherapeutics (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (7k23ar051315-05)
National Institute of Mental Health (T32MH075884)
National Institute of Neurological Disorders and Stroke (F32NS063624)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23-AR051315)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: pain catastrophizing, appraisal theory, attentional bias, information processing, communal coping, central sensitization, neural pathways, pain management, heuristic model
MeSH terms: Adaptation, Psychological, Attitude to Health, Humans, Pain

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