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Pain catastrophizing: a critical review.
Open accessAbstract
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 (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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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].”
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“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]
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“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]
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“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]
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“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).”
In the citing paper
“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”
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“Although pain catastrophizing is considered a trait measure (25) and thus should not be influenced by the preceding questions”
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Metadata
- Authors
- Quartana, P. J., Campbell, C. M., & Edwards, R. R.
- Affiliations
- Johns Hopkins University (US)
- Brigham and Women's Hospital (US)
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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