The 13-Item Pain Catastrophizing Scale

Resource The 13-Item Pain Catastrophizing Scale

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Cort submitted a new resource:

The 13-Item Pain Catastrophizing Scale - If you're catastrophizing your pain will almost certainly be worse

Catastrophizing is a natural response to being in pain. It has, however, been shown to increase pain levels and suffering. If you're doing it and you can stop it, you should see a reduction in your pain. One way to stop catastrophizing is to watch for times when you use words (either to yourself or others) like "always" or "never".

Studies show that people who are catastrophizing show more activation in the parts of their brains that control the anticipation of and attention to pain....
Read more about this resource...
 

ShyestofFlies

Well-Known Member
My pain actually got worse when I was in denial about pain. I don't know how much I buy this, if you have a temporary injury that's one thing, but when you've been in a flare for 7+ years with pain averaging 6-7/10 a day, why should you believe it will end? That seems much more hopeless, and without proof.

I'm a cynic as you can see. :)
 

GG

Well-Known Member
My pain actually got worse when I was in denial about pain. I don't know how much I buy this, if you have a temporary injury that's one thing, but when you've been in a flare for 7+ years with pain averaging 6-7/10 a day, why should you believe it will end? That seems much more hopeless, and without proof.

I'm a cynic as you can see. :)
Yeah, I call BS on this as well!

GG
 

San Diego

Well-Known Member
I'm a cynic as you can see. :)
Unrelenting pain will do that to a person. I don’t view it as cynical - I think it’s just being honest, realistic, and protective.

After several years of riding the hope / hope crushed waves, I gave up on thinking I was going to get better. It was too difficult to be continually disappointed.

Of course I still hope and try, but I no longer expect. I hope that makes sense.
 

Onslow

Active Member
I think it's natural to be skeptical about recovery after suffering for years. However there is real science behind catastrophizing making pain worse, and I don't think it's the same as denying the pain. (Pushing through severe pain is probably as bad an idea as pushing through severe fatigue).

From what I've seen from the research into pain, what makes pain worse is:

- Expectation. If you expect the pain, it will make it worse. You can see in studies such as http://www.ncbi.nlm.nih.gov/pubmed/7829288 that even in healthy controls, the brain can be conditioned to expect pain, which activates the pain circuits in the brain *before* the pain actually occurs.

- Focusing on the body part that is painful.

- Negative emotions. The part of the brain that deals with emotional memories also controls the pain response. If you think this is an issue, I would recommend reading John Sarno for some advice.

You can actually completely remove pain through hypnosis. Although obviously not advisable for pain after an injury, it might be useful in chronic pain. Clinical trials do show that hypnosis helps fibro more than CBT alone (http://www.sciencedirect.com/science/article/pii/S152659001100887X).
 

San Diego

Well-Known Member
Although obviously not advisable for pain after an injury, it might be useful in chronic pain.
I’m confused. What is the difference between pain from an injury and chronic pain? Both represent inflammation, and both are exacerbated by activity? I understand that walking on a broken ankle is damaging, but that’s because we can measure the “pain” on an x-ray. Is not chronic pain, when it flares, not also a signal from the body that we should stop and rest?

I’m really not trying to start an argument, ( I don’t have the energy) I’m just trying to understand why we, as a society, treat chronic pain so differently than acute pain. One is acceptable, and the other is not. One is allowed to rest, the other is expected to push through.

That said, I wholeheartedly agree that the mind can be a powerful tool in controlling pain.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
For some reason I didn't email alerts on this.

I put this resource in to go along with a book review I did where I learned about catastrophizing and other aspects of pain. It was really illuminating. The review is coming out this morning.

The research on the ability of catastrophizing to increase pain levels is robust across many diseases including diseases like sickle cell anemia, osteoarthritis, traumatic brain injury, low back pain, multiple sclerosis, rheumatoid arthritis, fibromyalgia, and I imagine many others.

It makes perfect sense to me; how can you not catastrophize when you're in chronic pain? The two go hand in hand. As autoimmune patient Donna Jackson Nakazawa pointed out in her book on her immersion into mind/body therapies over a year, when you're under stress your body pumps out chemical including cytokines that sensitize the nerves to become more sensitive to pain signals. How can you not be under enormous stress when you're in pain.

Yeah, I call BS on this as well!

GG
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I think it's natural to be skeptical about recovery after suffering for years. However there is real science behind catastrophizing making pain worse, and I don't think it's the same as denying the pain. (Pushing through severe pain is probably as bad an idea as pushing through severe fatigue).

From what I've seen from the research into pain, what makes pain worse is:

- Expectation. If you expect the pain, it will make it worse. You can see in studies such as http://www.ncbi.nlm.nih.gov/pubmed/7829288 that even in healthy controls, the brain can be conditioned to expect pain, which activates the pain circuits in the brain *before* the pain actually occurs.

- Focusing on the body part that is painful.

- Negative emotions. The part of the brain that deals with emotional memories also controls the pain response. If you think this is an issue, I would recommend reading John Sarno for some advice.

You can actually completely remove pain through hypnosis. Although obviously not advisable for pain after an injury, it might be useful in chronic pain. Clinical trials do show that hypnosis helps fibro more than CBT alone (http://www.sciencedirect.com/science/article/pii/S152659001100887X).
I found out about this after reading Judy Foreman's book A Nation in Pain which she wrote after having a horrible time with neck pain. She said she was a mad as hell when her doctor and boyfriend (who was a psychiatrist) suggested that a behavioral approach could help.

Then she found out that she was, as she put it "a world class catastrophizer" :). She had no idea, and tapping that down helped...She did end up getting cured and it wasn't the main thing but she acknowledged that it really did help.

Gotta get out of that fight/flight response that upregulates pain problems.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
The differences are many. Many more parts of the brain get activated in chronic pain - which is why its clearly a central nervous system disease. The filters at the spinal cord that stop pain signals from hitting the brain get whacked - instead of blocking signals they let them through.....Sometimes significant amounts of brain matter get lost - it's as if the nerve cells just burn out from too much activity. The glial cells in the brain get hyper-activated.

Some researchers and doctors believe that the signals the brain is giving in chronic pain are wrong and that resting is not the answer; that resting can actually help keep the brain reset in place. With acute injury rest is the answer, with chronic pain it may not be.

I don't know how this works in fibromyalgia, though. Exercise is helpful but there are limits. In other diseases with more localized problems the right kind of activity can be incredibly helpful.

I’m confused. What is the difference between pain from an injury and chronic pain? Both represent inflammation, and both are exacerbated by activity? I understand that walking on a broken ankle is damaging, but that’s because we can measure the “pain” on an x-ray. Is not chronic pain, when it flares, not also a signal from the body that we should stop and rest?

I’m really not trying to start an argument, ( I don’t have the energy) I’m just trying to understand why we, as a society, treat chronic pain so differently than acute pain. One is acceptable, and the other is not. One is allowed to rest, the other is expected to push through.

That said, I wholeheartedly agree that the mind can be a powerful tool in controlling pain.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
My pain actually got worse when I was in denial about pain. I don't know how much I buy this, if you have a temporary injury that's one thing, but when you've been in a flare for 7+ years with pain averaging 6-7/10 a day, why should you believe it will end? That seems much more hopeless, and without proof.

I'm a cynic as you can see. :)
I think you just demonstrated why catastrophizing is a natural response to being in chronic pain! I don't think its about believing it will end but in removing the thoughts that indicate that you don't expect it to end, or that you can't have a quality life without not having pain or that this shouldn't have happened to you and things like that and seeing if the pain load decreases a bit.
 

San Diego

Well-Known Member
The differences are many. Many more parts of the brain get activated in chronic pain - which is why its clearly a central nervous system disease. The filters at the spinal cord that stop pain signals from hitting the brain get whacked - instead of blocking signals they let them through.....Sometimes significant amounts of brain matter get lost - it's as if the nerve cells just burn out from too much activity. The glial cells in the brain get hyper-activated.

Some researchers and doctors believe that the signals the brain is giving in chronic pain are wrong and that resting is not the answer; that resting can actually help keep the brain reset in place. With acute injury rest is the answer, with chronic pain it may not be.

I don't know how this works in fibromyalgia, though. Exercise is helpful but there are limits. In other diseases with more localized problems the right kind of activity can be incredibly helpful.
Great explanation, Cort. That makes sense. You learn something new every day!
 

Onslow

Active Member
I’m confused. What is the difference between pain from an injury and chronic pain? Both represent inflammation, and both are exacerbated by activity? I understand that walking on a broken ankle is damaging, but that’s because we can measure the “pain” on an x-ray. Is not chronic pain, when it flares, not also a signal from the body that we should stop and rest?

I’m really not trying to start an argument, ( I don’t have the energy) I’m just trying to understand why we, as a society, treat chronic pain so differently than acute pain. One is acceptable, and the other is not. One is allowed to rest, the other is expected to push through.

That said, I wholeheartedly agree that the mind can be a powerful tool in controlling pain.
Cort provided a very good explanation. Nobody is saying that chronic pain is not acceptable, or that you should push through.

The problem with chronic pain seems to be that the brain incorrectly keeps the pain signal going long after the injury (or sometimes in the absence of an injury). Or at least, that is what is presumed to be happening (because at the moment we can't actually see where the pain signals originate). It's not about society treating it differently, it's about what science and clinical experience has learned about chronic pain.

I'm not sure it's true that chronic pain represents inflammation.
 

Blueskytoo

New Member
My pain level requires high daily doses of morphine to deal with, but I only seem to suffer from it on a physical level. I scored 0 on the scale, despite having both Fibromyalgia, and ME, as well as severe arthritis. I'm also female. I do suffer a bit from anxiety, but that's nothing to do with pain and more to do with the emotional lability that comes with ME. I have no emotional connection to my pain, no fear attached to it, which I think makes the difference. I'm in pain most of the time, even with the high levels of pain relief I take but I think because I'm not frightened of it - I know what causes it, I have sufficient pain relief to manage it to a level that I'm happy with, even though I know there's no end in sight - I can manage it better. Having decent pain relief does make a difference though, I actually take less than I need a lot of the time, because somehow knowing I have it there to take if i need it means that I can manage without it for longer.

Where I do suffer is that my body tends to react to pain quite badly - it's like it goes into shock with sweating and clamminess and my skin goes pale. Sometimes it even does this when I, emotionally, don't consider that the pain is that bad. I have to treat it though, because I know from experience that ME, for me at least, doesn't react well to physical stress and will cause a relapse if I just motor on through it without taking the meds I need to calm it down. So I don't necessarily buy into the whole psychologising of pain, I think we're in danger of, once again, making a physiological "illness", a pain reaction, into a psychological one. Obviously this is just a personal reaction, and i absolutely don't think that people who find that psychological support for pain helps are in any way weak or malingering, living with chronic pain with no hope of cure is devastating - in my view if it works for you then grab it with both hands. I'm just saying that from my experience, it's not as simple as this apparent connection between levels of pain and psychological distress would have you believe.
 

bobby

Well-Known Member
I’m just trying to understand why we, as a society, treat chronic pain so differently than acute pain. One is acceptable, and the other is not. One is allowed to rest, the other is expected to push through.
This is an excellent question! The answer as to why this is, is probably going to make us end up in the realms of philosophy, so let's not go there, too exhausting! ;)
Some researchers and doctors believe that the signals the brain is giving in chronic pain are wrong and that resting is not the answer; that resting can actually help keep the brain reset in place. With acute injury rest is the answer, with chronic pain it may not be.
There is no actual proof for this theory... There is proof though for the fact that pain alters your brain. So the problem IMO is the pain, not the brain. It's not because the source of pain isn't visible (i.e. physical injury) that it's automatically a 'faulty response'. We currently just lack the information to understand it.

IMO there's nothing wrong with the catastrophizing scale in itself, but it is being abused by some medical professionals to insinuate your chronic pain is your own fault, that it's all in your own hands. If you stop catastrophizing, your pain becomes bearable. That's obviously BS. But I'm sure catastrophizing won't make your pain any better either...
 

Onslow

Active Member
There is no actual proof for this theory... There is proof though for the fact that pain alters your brain. So the problem IMO is the pain, not the brain. It's not because the source of pain isn't visible (i.e. physical injury) that it's automatically a 'faulty response'. We currently just lack the information to understand it.

IMO there's nothing wrong with the catastrophizing scale in itself, but it is being abused by some medical professionals to insinuate your chronic pain is your own fault, that it's all in your own hands. If you stop catastrophizing, your pain becomes bearable. That's obviously BS. But I'm sure catastrophizing won't make your pain any better either...
I think the catastrophising is only part of the issue. In some cases the pain can be caused by emotions that are unrelated to the pain (e.g. muscle pain caused by stress).

The problem is that we have no way of knowing which pain is caused by an injury and which is caused by emotions or something else, so all we can do is see what works.

I would recommend reading John Sarno's books, as he has a lot of clinical experience successfully treating chronic pain. It may work and it may not, but I think it's certainly worth the time to read his books.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I think the catastrophising is only part of the issue. In some cases the pain can be caused by emotions that are unrelated to the pain (e.g. muscle pain caused by stress).

The problem is that we have no way of knowing which pain is caused by an injury and which is caused by emotions or something else, so all we can do is see what works.

I would recommend reading John Sarno's books, as he has a lot of clinical experience successfully treating chronic pain. It may work and it may not, but I think it's certainly worth the time to read his books.
It is truly only part of the issue - it's just one part of a deranged central nervous system network. As I noted earlier a key part of the brain that processes pain also processes emotions. So you have this emotional response to pain - which can be dealt with with work - and you still have this overly activie pain producing network.

Norman Doidge has an incredible story of a mind/body approach to pain in his latest book. That approach doesn't work with everyone but it can, at times, produce some astonishing results.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
My pain level requires high daily doses of morphine to deal with, but I only seem to suffer from it on a physical level. I scored 0 on the scale, despite having both Fibromyalgia, and ME, as well as severe arthritis. I'm also female. I do suffer a bit from anxiety, but that's nothing to do with pain and more to do with the emotional lability that comes with ME. I have no emotional connection to my pain, no fear attached to it, which I think makes the difference. I'm in pain most of the time, even with the high levels of pain relief I take but I think because I'm not frightened of it - I know what causes it, I have sufficient pain relief to manage it to a level that I'm happy with, even though I know there's no end in sight - I can manage it better. Having decent pain relief does make a difference though, I actually take less than I need a lot of the time, because somehow knowing I have it there to take if i need it means that I can manage without it for longer.

Where I do suffer is that my body tends to react to pain quite badly - it's like it goes into shock with sweating and clamminess and my skin goes pale. Sometimes it even does this when I, emotionally, don't consider that the pain is that bad. I have to treat it though, because I know from experience that ME, for me at least, doesn't react well to physical stress and will cause a relapse if I just motor on through it without taking the meds I need to calm it down. So I don't necessarily buy into the whole psychologising of pain, I think we're in danger of, once again, making a physiological "illness", a pain reaction, into a psychological one. Obviously this is just a personal reaction, and i absolutely don't think that people who find that psychological support for pain helps are in any way weak or malingering, living with chronic pain with no hope of cure is devastating - in my view if it works for you then grab it with both hands. I'm just saying that from my experience, it's not as simple as this apparent connection between levels of pain and psychological distress would have you believe.
We always in danger of turning a physiological problem into a psychological problem but that doesn't mean that we should ignore the fact that there are things you can do to calm your nervous system. That mind/body duality that suggests its either one thing or the other is just what we have to deal with.

This statement below captures why anticipating pain can makes things worse. So long as you know you have pain relief available you can go longer without taking drugs. This is probably because you're less worried about being in pain and therefore actually experience a bit less pain.

I can manage it better. Having decent pain relief does make a difference though, I actually take less than I need a lot of the time, because somehow knowing I have it there to take if i need it means that I can manage without it for longer.
This isn't an all or nothing thing - stopping catastrophizing doesn't mean the pain will go away or that it causes all the pain anyone has. It certainly doesn't. It does however increase the intensity of one's pain and the suffering that goes along with it.

Judy Foreman got really upset when it was suggested that she try a behavioral approach to her horrific neck pain. It was just one of many things she did and it helped her - it didn't cure her - it helped.

You can find more about that here - http://www.healthrising.org/forums/resources/a-nation-in-pain-healing-our-biggest-health-problem-a-review.387/
 

San Diego

Well-Known Member
IMO there's nothing wrong with the catastrophizing scale in itself, but it is being abused by some medical professionals to insinuate your chronic pain is your own fault, that it's all in your own hands. If you stop catastrophizing, your pain becomes bearable. That's obviously BS. But I'm sure catastrophizing won't make your pain any better either...
First off, just the word “catastrophising” is dangerous in the hands of most doctors. Who’s to decide where a person crosses from a healthy and normal response to their pain, to catastrophizing that pain?

Most days I get through my pain, but some days it’s just too much and it overwhelms my resources, both physical and emotional. On those days, I often lay in a dark quiet room and cry. Is that catastrophizing? I think not. I think it’s a normal response to a never-ending battle.

At the end of the day, I find it deplorable that people who’ve never experienced daily pain are the ones who get to define it. It’s sad that patien’t’s voices are so often ignored.
 

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