Pain catastrophizing

Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to ruminate on it more (e.g., "I kept thinking 'this is terrible'"), and/or to feel more helpless about the experience ("I thought it was never going to get better"). People who report a large number of such thoughts during a pain experience are more likely to rate the pain as more intense than those who report fewer such thoughts.

It is generally assumed that the tendency to catastrophize plays a causal role in the pain experience – that is, it causes the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain. However, we cannot yet rule out the possibility that at least some aspects of catastrophization may actually be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.

The components of catastrophizing that are considered primary were long under debate until the development of the pain catastrophizing scale (PCS). The pain catastrophizing scale is a 13-item self-report scale to measure pain catastrophizing created by Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik. In the PCS, each item is rated on a 5-point scale: 0 (Not at all) to 4 (all the time). It is broken into three subscales being magnification, rumination, and helplessness. The scale was developed as a self-report measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations. It is hypothesized that pain catastrophizing is related to various levels of pain, physical disability and psychological disability in clinical and nonclinical populations.

(Note: For the listed items above, (R) Rumination, (M) Magnification, and (H) Helplessness.)

Before the development of the PCS there had been no other self-report measurement tool that focused primarily on catastrophizing. Other self-report measurement tools such as: the Coping Strategies Questionnaire (CSQ), the Pain-Related Self-Statements Scale (PRSS) and the Cognitive Coping Strategy Inventory (CCS) had subscales for assessing catastrophizing but failed to explore specific dimensions of catastrophizing.

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