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Understanding Pain Catastrophizing: Putting Pieces Together
Open accessAbstract
The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.
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“A recent review of the literature has demonstrated that catastrophizing thoughts about pain are associated with increased pain intensity and severity, disability, emotional distress, healthcare utilization, pain medication use, and poorer outcomes following surgery (Petrini & Arendt-Nielsen, 2020).”
From Increasing Occupational Engagement by Addressing Psychosocial and Occupational Factors of Chronic Pain: A Case Report. (2022) · cites this paper as Petrini & Arendt-Nielsen, 2020
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“Furthermore, the fact that these results were not found in relation to helplessness shows how complex catastrophism truly is [52] and the possibility that the different components involved do not have the same role [25,52–54] as has been suggested in recent studies [24].”
ResultPeñacoba, C., Pastor-Mira, M. D. L. Á., Suso‐Ribera, C., Catalá, P., Nardi-Rodríguez, A., & López-Roig, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105394 · Cited by 9
“As has been pointed out, although pain catastrophizing has been considered as one of the most relevant psychological predictors of chronicity and disability related to pain, there are important problems still remaining in relation to its conceptualization [72].”
BackgroundInfluentialThe complexity of pain in osteoarthritis
Petersen, K. K., de Andrade, D. C., Pickering, G., Giordano, R., Hertel, E., Edwards, R. R., Pogatzki-Zahn, E., Mobasheri, A., & Arendt-Nielsen, L. (2026) · Nature Reviews Rheumatology · doi:10.1038/s41584-026-01372-8 · Cited by 8
“Catastrophizing is associated with increased pain intensity and disability 102 , and is one of the most important pre-treatment risk factors that impairs the effectiveness of pain-relief interventions for musculoskeletal pain 113–115 and management of chronic pain in general 102 .”
Self-citationCarvajal-Parodi, C., Rossel, P. O., Rodríguez-Alvarado, A., Guede-Rojas, F., & Ponce‐González, J. G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14113782 · Cited by 7
“Various models have been proposed to explain the chronification of musculoskeletal pain conditions [5–7].”
Factors influencing the hypoalgesic effects of virtual reality
Shafir, R., Watson, L., Felix, R. B., Muhammed, S., Fisher, J. P., Hu, P. F.-M., Wang, Y., & Colloca, L. (2025) · Pain · doi:10.1097/j.pain.0000000000003549 · Cited by 6
Stamp, G. E., Wadley, A. L., & Iacovides, S. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104619 · Cited by 7
Strigo, I. A., Kadlec, M., Mitchell, J., & Simmons, A. N. (2024) · Pain · doi:10.1097/j.pain.0000000000003207 · Cited by 7
Cognitive, behavioral, and psychological phenotypes in small fiber neuropathy: A case–control study
Telesca, A., Soldini, E., Devigili, G., Cazzato, D., Bella, E. D., Grazzi, L., Usai, S., Lauria, G., & Consonni, M. (2024) · Cortex · doi:10.1016/j.cortex.2024.01.012 · Cited by 10
Pain catastrophizing in the elderly: An experimental pain study
Petrini, L., & Arendt‐Nielsen, L. (2024) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2023-0035 · Cited by 9
Self-citationCioffi, I. (2023) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12688 · Cited by 7
“…multiple studies has shown that pain catastrophising, a personality trait characterized by negative emotional and cognitive responses to pain, 38,39 is one of the strongest contributors to pain, as it significantly heightens an individual's pain experience and contributes to pain chronicity and…”
Cundiff-O'Sullivan, R. L., Wang, Y., Thomas, S. P., Zhu, S., Campbell, C., & Colloca, L. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.04.010 · Cited by 7
Dysmenorrhea catastrophizing and functional impairment in female pelvic pain
Li, R., Kreher, D. A., Gubbels, A. L., Palermo, T., Benjamin, A., Irvine, C. S., Hart, A., Jusko, T., & Seplaki, C. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2022.1053026 · Cited by 7
“Pain catastrophizing has been conceptualized as a cognitive schemata (49), a coping strategy (50), a personality trait or situational state (51), a communal coping strategy (51), and most recently, as a broader concept incorporating emotional regulation, catastrophic worry, rumination, behavioral inhibition and behavi…”
BackgroundMoline, R. L., Constantin, K. L., Chambers, C. T., Powell, D. M., Lewis, S. P., Laurignano, L., & McMurtry, C. M. (2022) · Children · doi:10.3390/children9121869 · Cited by 10
“Mindfulness decouples sensations and automatic evaluations [15]; this is argued to buffer against reflexive reactions such as catastrophizing, suppression, magnification, or experiential avoidance (avoiding and fighting internal experiences), which are prone to exacerbating distress and pain [16].”
BackgroundAvoidance-Endurance Model in Older Black Men with Low Back Pain: Exploring Relationships
Fullwood, D., Means, S., Paxton, R. J., Wells, B., Riley, J. L., Stickley, Z. L., Tucker, C. M., You, L., Elie-Turenne, M.-C., Thomas, C., et al. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01316-4 · Cited by 7
Wang, X., Becker, B., & Tong, S. X. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121148 · Cited by 8
White, G., Bright, F., Rio, E. K., Chimenti, R. L., & Murphy, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14020473 · Cited by 6
“Psychological constructs that have been proposed to be important include the fear of pain [56,57] and pain catastrophizing [58–60], which may provide novel insights into the management of Achilles tendinopathy.”
Sensory and affective dimensions in loudness perception: Insights from young adults
Bigras, C., Duda, V., & Hébert, S. (2024) · Hearing Research · doi:10.1016/j.heares.2024.109147 · Cited by 7
Bavali‐Gazik, A., Vagharseyyedin, S. A., Saremi, Z., & Shafiee, F. (2024) · Musculoskeletal Care · doi:10.1002/msc.1923 · Cited by 7
Mikkelsen, M. B., Neumann, H., Buskbjerg, C. R., Johannsen, M., O’Toole, M. S., Arendt‐Nielsen, L., & Zachariae, R. H. (2023) · Pain · doi:10.1097/j.pain.0000000000003073 · Cited by 9
Self-citationKusumastuti, R., Andriana, R. M., Prawitri, Y. D., Tinduh, D., Sugianto, P., & Melaniani, S. (2023) · Bali Medical Journal · doi:10.15562/bmj.v12i3.4689 · Cited by 6
“30 In chronic LBP patients, depression is known for a strong relationship with intensity and duration of pain and disability, 8 and low efficacy to exercise therapy.”
BackgroundInfluence of Family-Learned Fear-of-Pain on Patients.
Fang, Y.-X., Shi, L., Qin, F., Li, T., Zhang, X., & Li, M. (2023) · Pain Management Nursing · doi:10.1016/j.pmn.2023.04.003 · Cited by 6
Postoperative pain management: are we ready to move beyond the ‘kitchen‐sink’ approach?
Abdallah, F. W., Neuman, M. D., & Mariano, E. R. (2023) · Anaesthesia · doi:10.1111/anae.16025 · Cited by 6
“These predictors may be combined with others that have been associated with greater than expected postoperative pain, such as pain catastrophising [16] or serum biomarkers [17], to aid modern-day anaesthetists and acute pain services in the assignment of patients to specific pain management protocols, prioritisation f…”
BackgroundJames, K., Patel, M., Goldsmith, K., Moss-Morris, R. E., Ashworth, M. J., Landau, S., & Chalder, T. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104224 · Cited by 7
Galambos, A., Stoll, D. P., Bolczár, S., Lazáry, Á., Urbán, R., & Kökönyei, G. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e08026 · Cited by 6
Spinoni, M., Gesto, C. D., Porpora, M. G., & Grano, C. (2025) · European Journal of Pain · doi:10.1002/ejp.70198 · Cited by 5
“…catastrophizing (Trudel and Cormier 2024), a cognitive tendency characterised by exaggerated worrying, a sense of helplessness, and amplification of distressing thoughts in response to pain (Sullivan et al. 2001), often reported among patients with chronic pain (Petrini and Arendt-Nielsen 2020).”
Yap, A. U., Zheng, Y., Liu, T., Li, Y., Liu, Y., Zhou, X., Wang, J., & Xiong, X. (2025) · Journal of Oral Rehabilitation · doi:10.1111/joor.14023 · Cited by 5
Proposition of Two Subtypes of Patients at Risk of Suicide: Pain Hypersensitive Vs. Dissociative
Bianco, F., Courtet, P., Olié, É., López‐Castromán, J., Madeddu, F., & Calati, R. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01600-0 · Cited by 7
“Additionally, a possible adverse consequence of inflammation-induced interoceptive hyper-vigilance is pain catastrophizing, one of the most important correlates of pain chronicity and disability [ 44 ].”
Liu, J., Li, J., Wang, T., Wu, Y., Liu, X., Gao, X., Zhou, Z., & Zhou, H. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06648-z · Cited by 6
“Research on pain vigilance also demonstrated that interoception links emotion regulation, behavioral inhibition/activation, pain vigilance, and rumination [33].”
A brief screening tool for risk of self-medication of pain with substance use
Bush, N. J., Ferguson, E., Zale, E., & Boissoneault, J. (2024) · Journal of addiction medicine · doi:10.1097/adm.0000000000001289 · Cited by 5
Wang, G. A., Dawson, S. J., Huberman, J. S., & Rosen, N. O. (2024) · Journal of Social and Personal Relationships · doi:10.1177/02654075231224327 · Cited by 6
“…catastrophizing and these constructs (e.g., increased cognitive attention to negative cues), catastrophizing is distinct in that it captures three facets of this attentional focus and encapsulates a broader pattern of maladaptive thinking when faced with challenges (Petrini & Arendt-Nielsen, 2020).”
BackgroundInfluentialVinstrup, J., Bláfoss, R., López‐Bueno, R., Calatayud, J., Villadsen, E., Clausen, T., Doménech‐García, V., & Andersen, L. L. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.05.009 · Cited by 5
Liu, S., You, B., Zhang, X., Shaw, A., Chen, H., & Jackson, T. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001103 · Cited by 7
Raiisi, F., Raisi, H., & Kolivand, M. (2022) · International Journal of Musculoskeletal Pain Prevention · doi:10.52547/ijmpp.7.3.772 · Cited by 5
“Because research has shown that physical pain can be catastrophic under the influence of mental and cognitive factors [7].”
BackgroundGevers‐Montoro, C., Deldar, Z., Conesa‐Buendía, F. M., Lazar, E. A., Mahíllo, I., Khatibi, A., & de Mues, A. O. (2021) · European Journal of Pain · doi:10.1002/ejp.1872 · Cited by 6
“Catastrophizing itself is not only dependent on previous painful experiences but can also be influenced by environmental factors (Petrini & Arendt- Nielsen, 2020).”
BackgroundInfluentialHarrison, R., Salomons, T. V., MacGill, S., & Little, M. (2025) · British Journal of Pain · doi:10.1177/20494637251358334 · Cited by 4
“59 Our sample, who received earlier treatment for mild-moderate OA, maybe more psychologically malleable and have more opportunity for impactful bene fi t, including adaptive improvements in the cognitive appraisal of pain.”
Pérez-Martín, Y., Pérez-Muñoz, M., Martín-Castro, B., Núñez-Nagy, S., Díaz-Pulido, B., & Rodríguez‐Costa, I. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134748 · Cited by 2
“Helplessness beliefs are associated with catastrophizing and heightened perception of pain intensity [60], while levels of self-esteem are significantly lower among individuals prone to pain compared to their healthy counterparts [61].”
Kori, A., Singh, A., Caroicar, Y. S., Thomas, P. E., & Chandra, A. (2025) · Cureus · doi:10.7759/cureus.86344 · Cited by 7
Zhang, W., Löffler, M., Usai, K., Mišić, M., Nees, F., & Flor, H. (2025) · Journal of Pain Research · doi:10.2147/jpr.s512911 · Cited by 4
Silva-Ribeiro, S., Godinho, C. I. A., Camilo, C., Marques, M. M., Chisari, C., Segura, Ú., & Bernardes, S. F. (2025) · Health Psychology Review · doi:10.1080/17437199.2025.2478877 · Cited by 5
“For example, although pain-related worrying is a main predictor of poor adjustment to chronic pain conditions (Jensen et al., 2011; Petrini & Arendt-Nielsen, 2020), this cognitive process was one of the least investigated in our study.”
Asanova, A., Khaustova, O., Skrynnyk, O., & Mukharovska, I. (2025) · INTERNATIONAL NEUROLOGICAL JOURNAL · doi:10.22141/2224-0713.20.8.2024.1124 · Cited by 4
Metadata
- Authors
- Petrini, L., & Arendt-Nielsen, L.
- Affiliations
- Aalborg University (DK)
- Corresponding author
- Petrini, Laura
- ORCID
- Petrini, Laura
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2020-12-16
- Volume
- 11
- Pages
- 603420-603420
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC7772183
- OpenAlex
- W3113360819
- Cited by
- 259
- References
- 177
- Citations by year
- 2026: 41 · 2025: 72 · 2024: 65 · 2023: 43 · 2022: 28 · 2021: 10
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Aalborg Universitet
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- pain catastrophizing, chronic pain, pain-related disability, conceptual definitions, emotion regulation, rumination, behavioral inhibition, behavioral activation, interoceptive sensitivity, biopsychosocial model, pain processing, psychological intervention
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