Catastrophizing and Soft-Tissue Injuries

In recent years numerous studies have focused on the relation between catastrophizing and pain and disability in chronic pain patients. Catastrophizing, as conveyed in this current study, can be defined as, "exaggerated negative orientation toward pain stimuli and pain experience."

A goal of the study was to determine if a high score of catastrophic thoughts predicted occupational disability and employment status in soft-tissue injury patients. 86 patients were involved in the study, and the primary diagnoses were lumbar sprain and cervical sprain, resulting (for the most part) from motor vehicle accidents. The researchers' main tool of measurement in the study was the Pain Catastrophizing Scale (PCS). The PCS is broken down into three subscales: rumination ("I can't stop thinking about how much it hurts"), magnification ("I worry that something serious might happen"), and helplessness ("There is nothing I can do to cope with the pain"). The researchers also hoped to see which component of catastrophizing predicted pain intensity and occupational disability. And since previous studies have linked anxiety and depression with catastrophizing, they wanted to assess any distinctions between the two in predicting disability.

The researchers utilized a variety of assessment tests in addition to the PCS: the Beck Depression inventory, the McGill Pain Questionnaire, and the Pain Disability Index. The authors found a definite correlation between patients' ratings of occupational disability, depression/anxiety, pain disability and catastrophizing—which translated to high rates of unemployment, pain intensity, and occupational dysfunction. The authors write:

"The present findings suggest that, following injury, individuals who engage in catastrophic thinking about their pain may face greater challenges in their efforts to return to employment. Catastrophizing accounted for almost 30% of the variance in patients' ratings of their occupational dysfunction, and 9% of the variance in actual employment status. Catastrophizing predicted ratings of occupational dysfunction even after controlling for patients' level of pain. These findings suggest that rehabilitation interventions that specifically target catastrophizing, may have a positive impact on occupational outcome."

The "rumination" component of catastrophizing was most strongly linked to disability. "The present findings suggest that individuals who attend excessively to their pain sensations are not only likely to experience more pain, but are likely to show evidence of greater disability as well." This excessive focus on pain sensations can interfere with coping strategies and promote a helpless disposition. The authors discuss several possible methods of rehabilitation. Since current literature does not confirm that exercises which divert the patients' attention from their pain is actually effective, the authors propose self-instruction and expression. Self-instruction involves having the individual identify their negative and fearful thoughts and transform them into positive pain-coping techniques. Also, a previous study has found that if a catastrophizer internalizes or inhibits their negative emotions, it tends to foster excessive attention on pain and breed intrusive thoughts. The authors conclude that by simply expressing their concerns and worry—by just having someone to talk to—they can alleviate that excessive focus that normally is thrust inward.

And finally, the authors observed a correlation between depression/anxiety and catastrophizing. Although the authors admit the two factors "confound" one another, they do not undermine the power of catastrophizing. They write, "While catastrophizing may overlap to some degree with depression and anxiety, catastrophizing adds significantly to the predictive power of models of pain-related disability."