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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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Latent Profile Analysis of Pain Catastrophizing in Post-Operative Lung Cancer Patients
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Hudson, M., & Johnson, M. I. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1244390 · Cited by 5
“This stagnant state of mind and body may create worry, rumination and catastrophising, a signi fi cant psychological factor related to the persistence of pain and disability (30 – 33).”
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Kınıklı, G., Bal, G. A., Aydemir-Guloksuz, E. G., & Kınıklı, G. (2022) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20220298 · Cited by 3
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“Pain catastrophizing has previously been defined as a heightened threat value of the pain stimulus, feeling helpless in the setting of pain, and the incapability of controlling pain-related thoughts before, during, or after a painful event [5].”
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“For example, thoughts, such as ‘my pain is terrible’ or ‘pain will ruin my life’, can amplify symptoms [57], negatively affect problem solving and prevent positive behaviors [58,59], and assist with development of communicative pain behaviors [60].”
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“Chronic pain patients have a slightly low degree of physical and emotional wellness, as chronic pain reduces physical function and emotional well-being (Suso-Ribera et al., 2017; Zhaoyang et al., 2020; Petrini & Arendt-Nielsen, 2020).”
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The Effect of Induced Optimism on Situational Pain Catastrophizing
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Child Abuse and the Psychological Dispositions of Pain Catastrophising, Resilience and Hope
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A Meta-Analysis of Sex Differences in Pain Threshold, Tolerance, and Intensity
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An evaluation of the pain characteristics of patients with thoracic outlet syndrome
Tek, Ş. T., Fırat, T., & Cangır, A. K. (2026) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.1177/10538127251411107 · Cited by 1
Mendoza-Contreras, L. A., Guillén-Núñez, M. D. R., Medina, D. A. R., Romo, J. F. M., Vazquez, O., & Trejo, B. D. (2026) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-025-10120-1 · Cited by 1
“This seeks to reduce catastrophising and promote more effective coping, decreasing pain intensity and interference (Beck, 2020; Petrini & Arendt-Nielsen, 2020).”
Identifying and characterizing clinical subgroups in individuals with endometriosis
Åkerblom, S., Jönsson, I. P., Ringqvist, Å., Nordengren, J., & Zhao, X. (2025) · Frontiers in Pain Research · doi:10.3389/fpain.2025.1610109 · Cited by 2
Rumination catastrophism and pain in injured athletes
Gómez-Espejo, V., Zafra, A. O., García‐Mas, A., Ortega, E., Sánchez‐Iglesias, I., & Rubio, V. J. (2025) · Scientific Reports · doi:10.1038/s41598-025-29247-0 · Cited by 1
Sperling, P. K., Giordano, R., Vollert, J., Arendt‐Nielsen, L., Danielsen, A. V., Rasmussen, B. S., Bisgaard, J., & Petersen, K. K. (2025) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001347
Self-citationSelective vulnerability of GABAergic neurons in chronic migraine
Hossain, K. H., Chuong, T., Abad, E., Lin, J., Xia, C.-C., Li, M., Chen, Y.-B., Arakaki, X., & Vasudevan, A. (2025) · The Journal of Headache and Pain · doi:10.1186/s10194-025-02223-9 · Cited by 1
“Chronic migraine is frequently accompanied by affective and cognitive disturbances, with pain catastrophizing, characterized by rumination, magnification of pain, and helplessness, emerging as a prominent psychological feature [8].”
Luo, D., Wong, W., Li, Z.-L., Qin, G., Lan, Z., Mo, F., & Wei, Y. (2025) · European spine journal · doi:10.1007/s00586-025-09449-w · Cited by 1
Genoese, F. M., Harkey, M., Liu, T.-S., Covassin, T., & Baez, S. (2025) · Journal of sport rehabilitation · doi:10.1123/jsr.2025-0099 · Cited by 1
Influence of low back pain on absenteeism and presenteeism among academics in public universities
Saufi, N. I. M., Zamri, E. N., Yusof, H. A., & Shari, N. I. (2025) · Work · doi:10.1177/10519815251366996 · Cited by 1
Validation of the menstrual sensitivity index in adolescents
Seidman, L. C., Handy, A. B., & Payne, L. A. (2025) · PAIN Reports · doi:10.1097/pr9.0000000000001315 · Cited by 1
“47 This finding also holds true in the context of dysmenorrhea.”
Wang, G. A., Péloquin, K., Rossi, M. A., MacDonald, Q., Brassard, A., Bergeron, S., Bouzayen, R., & Rosen, N. O. (2025) · Journal of Health Psychology · doi:10.1177/13591053251351686 · Cited by 2
“…reflect individuals’ attempts to elicit partner support, it can also heighten attentional focus on relational stressors such as sexual difficulties (Petrini and Arendt-Nielsen, 2020), and can thus be linked to lower sexual desire and greater sexual distress for both partners (Wang et al., 2024).”
InfluentialZheng, J.-Y., Chen, F.-Q., Yang, Y., Wang, K., Wang, J., & Gong, H.-R. (2025) · Current Medical Research and Opinion · doi:10.1080/03007995.2025.2545512 · Cited by 1
Variability in Pain Traits Among Young Individuals with High and Low Pain Sensitivity
Zhi, Y., Mao, Z., Zhang, M., & Kong, Y. (2025) · Journal of Pain Research · doi:10.2147/jpr.s529198 · Cited by 1
Carvalho, S. A., Eulálio, I., & Guiomar, R. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112205 · Cited by 17
Frietchen, R. E., Kinkel‐Ram, S. S., Stanley, T. B., Miller, M. G. B., Bodell, L. P., & Smith, A. R. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2520573 · Cited by 1
Sarno, D. L., Gureck, A. E., Cardenas‐Rojas, A., Eckley, M., Vu, K., Kurz, J., Fu, M., Isaac, Z., Phillips, E. M., Chin, B., et al. (2025) · Pain Practice · doi:10.1111/papr.70011 · Cited by 1
“22 Studies have demonstrated that pain catastrophizing is associated with decreased quality of life and increased pain intensity in patients with chronic pain conditions, suggesting that a person's quality of life is more associated with their beliefs about pain than with the pain intensity itself.”
Frey-Law, L., Lee, J. E., & Janowski, A. J. (2025) · Pain Research and Management · doi:10.1155/prm/8839902 · Cited by 1
The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth
Clark, C., Marahatta, S., & Hundley, V. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308129 · Cited by 1
“Worry is a central component of pain catastrophising and it is suggested that the link with chronic pain stems from the continued vigilance to the threat of the pain [30].”
Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review
Wirtz, M. R., Revenson, T. A., Ford, J. S., & Karas, A. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-024-10309-y · Cited by 1
“Presently, there is no consensus for treatment of ICPP [19, 20] which can exacerbate psychological distress [21, 22].”
John Henryism-racial stressors among older black men with low back pain
Fullwood, D., Fallon, E., Means, S., Stickley, Z. L., Booker, S. Q., Elie-Turenne, M.-C., & Wilkie, D. J. (2024) · Geriatric Nursing · doi:10.1016/j.gerinurse.2024.06.038 · Cited by 1
Rossini, B., Anstruther, M., & Fortin, M. (2024) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-230213 · Cited by 1
“Furthermore, pain catastrophizing is now recognised as an important psychological factor associated with pain chronicity and disability [15].”
Aoyama, T., & Matsuoka, M. (2024) · Cureus · doi:10.7759/cureus.52120 · Cited by 1
“Patients with chronic pain overestimate the disability caused by present and future pain, leading to catastrophic thinking and complicating pain resolution [9].”
BackgroundBoyette-Davis, J. A. (2023) · The American Journal of Psychology · doi:10.5406/19398298.136.1.08 · Cited by 1
向, 珍. (2024) · Advances in Social Sciences · doi:10.12677/ass.2024.133197 · Cited by 1
Abdelrahman, H., Qadire, M. I. A., Soliman, O., Boakye, M. D. S., & Zehry, H. I. (2026) · Pain Practice · doi:10.1111/papr.70204
“Prior studies have similarly shown that catastrophizing is closely intertwined with pain severity and other maladaptive pain responses, such that its apparent effects on mood and functioning may diminish when these factors are considered simultaneously [6–8, 37, 38].”
An Explainable AI-Guided Framework for Cancer Pain Phenotyping and Clinical Decision-Making.
Khalil, H., Shajrawi, A., Issa, W. B., Ahmed, F., Al-Sharman, A., Ozsahin, D., Emegano, D., & Al-Yateem, N. (2026) · Pain Management Nursing · doi:10.1016/j.pmn.2026.09.016
González-Lara, C., Camacho-Ruiz, J. A., Cortés‐Pérez, I., Obrero‐Gaitán, E., & Galvez-Sánchez, C. M. (2026) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2026.10308
“…pain catastrophising warrants specific attention in FMS as a clinically relevant cognitive-affective process that may shape adaptation to symptoms, rather than as a substitute for other important outcomes such as pain intensity, fatigue, or sleep disturbance (Petrini and Arendt-Nielsen, 2020).”
Tirla, S., Nistor-Cseppento, C., Osser, B., Farcaș, D., Pașcalău, N., Marge, C., Osser, G., & Radoi, L.-I. (2026) · Diagnostics · doi:10.3390/diagnostics16182913
“Increased attention to pain, maladaptive avoidance, emotional distress, and ineffective coping represent potential mechanisms underlying the association between catastrophic thinking and greater symptom and functional burden [15,25,39].”
Brain dysconnectivity patterns associated with chronic back pain development
Wunderlich, S., Schulz, E., Ringel, F., Stoecklein, V. M., & Stoecklein, S. (2026) · Brain Informatics · doi:10.1186/s40708-026-00328-8
Pallante, P., Hooyman, A., Sánchez, N., Sigward, S. M., Beisheim-Ryan, E. H., Smith, J., & Farrokhi, S. (2026) · European Journal of Pain · doi:10.1002/ejp.70340
Szeremeta, Y. C., & Brandemarte, A. (2026) · Consciousness and Cognition · doi:10.1016/j.concog.2026.104113
Assessing Pain Catastrophizing Through Free-Text Responses: A Validation of Large Language Models
Lee, A., You, D., & Dildine, T. C. (2026) · medRxiv · doi:10.64898/2026.07.22.26358710
“Pain catastrophizing is a cognitive-affective response to pain characterized by persistent rumination , magnification of pain threats, and helplessness towards pain control [14].”
From Mineral Waters to Mental Wellbeing: A Biopsychosocial Framework for Health Resort Medicine
Regazzo, G., Maraver, F., Fioravanti, A., & Masiero, S. (2026) · Water · doi:10.3390/w18141755
Raney, E., Dildine, T. C., Kim, S., Mackey, S., & You, D. (2026) · medRxiv · doi:10.64898/2026.06.15.26355697
“Several modifiable psychological factors have been identified as potential targets to mitigate these negative consequences, most notably pain catastrophizing and pain self-efficacy 5-6.”
Alharbi, B. S., Aljabri, M. M., & Ali, E. A. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1870366
“Pain catastrophizing shapes how patients interpret their illness, increasing negative emotional representations, such as fear and worry (34).”
Tejera, D. M., Di‐Bonaventura, S., Nijs, J., Ferrer-Peña, R., Fernández‐Carnero, J., Malfliet, A., Ickmans, K., Willaert, W., & Coppieters, I. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2671226
Multidimensional analysis of the clinical spectrum and symptom burden of unexplained myofascial pain
Sikdar, S., DeStefano, S., Pavón, M., Hsu, Y.-L., Lee, S. M., Srbely, J., Shah, J., Rosenberger, W., Acuña, S., Assefa, Y., et al. (2026) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2026.05.014
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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