The importance of catastrophizing for successful pharmacological treatment of peripheral neuropathic pain
Open accessAbstract
OBJECTIVE: Catastrophizing may be a negative predictor of pain-related outcomes. We evaluated the impact of catastrophizing upon success of first-line pharmacotherapy in the management of neuropathic pain (NeP) due to peripheral polyneuropathy. METHODS: Patients with confirmed NeP with NeP Visual Analog Scale (VAS) pain severity score ≥4 (0-10 scale) completed the Coping Strategies Questionnaire (CSQ) catastrophizing subscale at baseline. Pharmacological therapy consisting of first-line agents gabapentin, pregabalin, or a tricyclic antidepressant was initiated. Other measures examined included the Karnofsky Performance Scale, Beck Depression Inventory, EuroQol Quality of Life Health Questionnaire, and Modified Brief Pain Inventory. At 3 and 6 months, questionnaires were repeated and adverse effect reporting was completed. Outcome measures assessed were pharmacotherapy success (≥30% relief of NeP) and tolerability over 6 months of follow-up. Bivariate relationships using Pearson product-moment correlations were examined for baseline CSQ catastrophizing subscale score and the change in the NeP VAS scores and medication discontinuation. RESULTS: Sixty-six patients were screened, 62 subjects participated, and 58 subjects (94%) completed the final follow-up visit. Greater catastrophizing was associated with poor pain relief response and greater likelihood of discontinuation of pharmacotherapy, reports of greater disability, and impaired quality of life. Duration of pain was negatively associated with likelihood of pharmacotherapy success. CONCLUSION: Catastrophizing exerts maladaptive effects on outcomes with pharmacotherapy in NeP patients. Detection of catastrophizing during clinical visits when pharmacological therapy is being considered can be a predictive factor for patient outcomes.
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In a recent analysis of large acupuncture trials, both patient and provider expectations for treatment success were strong predictors of response, with better pre-treatment expectations predicting improved post-treatment pain and physical functioning.
“in a recent analysis of large acupuncture trials revealed that both patient and provider expectations for treatment success were strong predictors of response, with better pretreatment expectations predicting improved post-treatment pain and physical functioning 362, 364.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [364]
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- Authors
- Toth, C., Brady, S., & Hatfield, M.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Toth, Cory
- Venue
- Journal of Pain Research
- Publisher
- Informa UK Limited
- Published
- 2014-06
- Volume
- 7
- Pages
- 327
- ISSN
- 1178-7090 (ISSN-L)
- PMC
- PMC4077695
- OpenAlex
- W1991328012
- Cited by
- 37
- References
- 60
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 4 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 5
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pain Research (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- 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, peripheral neuropathic pain, first-line pharmacotherapy, gabapentin, pregabalin, tricyclic antidepressants, treatment response prediction, drug tolerability, drug discontinuation, disability, quality of life, pain duration, coping strategies
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