This month we wanted to talk about the implications of catastrophic thinking in chronic pain rehab, look at the psychology of pain catastrophizing and explore some of the ways in which you can help your patients to manage it.
Catastrophizing has been classified as “a tendency to misinterpret and exaggerate situations that may be threatening” (1) and has been identified as a considerable risk factor for long-term disability following a soft tissue injury.
Chances are, you will have come across patients who have an excessively negative orientation towards pain and who experience trouble shifting their focus away from their pain symptoms, which in most cases, makes things worse and hampers the rehabilitation process.
What we’ve found is that a tendency to catastrophize pain can greatly influence an individual’s experience or perception of pain and often magnify their emotional response to the pain too.
In order to help manage pain catastrophizing, it first helps to break the idea down and understand what it actually ‘looks like’. So here goes!
Research has show that there are three major elements common to pain catastrophizing. These are:
- Rumination – which is a compulsive focus on symptoms, causes and consequences, rather than on solutions, with a tendency to stay fixed in negative thought patterns associated with pain and its implications on life. Patients who ruminate often tumble negative thoughts and ‘worst case scenarios’ over and over in their head, leading to heightened feelings of distress.
- Magnification – for people in pain, this translates as mentally exaggerating symptoms or blowing certain aspects of their situation out of proportion. These exaggerated thoughts are often driven by fear of what may happen rather than by what’s actually happening or likely to happen.
- Helplessness – is the horrible feeling that there may be no solution to positively managing or overcoming the current pain experience. When helplessness sets in, people feel like they “can’t go on” and that “things will never get better”. Sadly, this state of mind can often lead to giving up on soothing strategies that have actually been found to be effective at less stressful times.
One way to help patients manage their tendency to catastrophize pain is to talk them through these elements and help them to understand that it’s a pretty natural response to dealing with pain.
Having an awareness of the thoughts and feelings that come up when they’re in pain, and recognising when thought patterns might be getting bogged down in rumination, magnification or helplessness means that the patient has a chance to step back and see things in proportion.
We’ve also found that it helps to keep patients’ thoughts focused positively on their management and recovery, rather than on symptoms, causes and consequences. This might take a little coaching, but most patients respond positively when the focus is shifted to what they can do, rather than what they can’t.
It may be helpful to plan ahead and make a list of strategies to use at times of pain flare-up when catastrophic thinking is likely to be at its worst – and rational planning is difficult.
A really useful (and we’d say, underutilized) tool that is commonly used in clinical psychology practice and by Work Safe is the Pain Catastrophizing Scale.
This short questionnaire is broken down into 13 statements along with a rating scale that patients apply to each statement.
For example: When I’m in pain… “I worry all the time about whether the pain will end“, “There’s nothing I can do to reduce the intensity of the pain” or “I feel I can’t stand it any more“.
Responses measure rumination, magnification and helplessness and give an insight into where the individual might be ‘stuck’.
By talking through it together, there’s a great opportunity to diffuse the intensity of much of the catastrophizing and help to maintain a more balanced and realistic view of what’s going on and how to move forward.
Do you use the Pain Catastrophizing Scale in your work? If so, have you found that it helps? If not, let us know if you want to know more.
1) Van Damme, S., Crombez, G., Bijttebier, P., Goubert, L., & Houdenhove, B. V. (2001). A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. International Association for the Study of Pain, 96(3), 319-324. Retrieved October 10, 2013, from www.sciencedirect.com/science/article/pii/S0304395901004638