The term "catastrophizing" was first introduced in 1962 by A. Ellis to describe a key factor in emotional dysfunction.1 He defined it as “exaggerating adversities into something far worse than they actually are; seeing things at their worst when they are sometimes relatively minor; and greatly exaggerating the frequency and/or danger of something that you dislike”.1 Later, in 1987, A. Beck used the term to describe a harmful thinking style in people with anxiety and depression.2 The concept entered the pain field in 1987 through the Coping Skills Questionnaire, including two subscales about rumination and feelings of helplessness when coping with pain.3 In 1995, the Pain Catastrophizing Scale was developed to assess how often patients experience three aspects of catastrophizing related to pain: overthinking, exaggerating, and feeling helpless.4 While the term ‘pain catastrophizing’ has been widely used in both research and clinical settings to assess and manage chronic pain, a recent study by Webster et al. (2023)5 sheds light on how patients themselves perceive this term, raising important questions about its impact on patient care and the potential need for more patient-centered terminology. The study was recently presented at the IASP World Congress on Pain in Amsterdam, the Netherlands.
What is pain catastrophizing?
Pain catastrophizing refers to an exaggerated negative mental state in response to pain. This includes thoughts like “I can’t stop thinking about how much it hurts,” feelings of helplessness, and expectations that pain will only worsen over time. While it has been widely used in clinical settings to assess patients' pain responses, its application has been controversial, particularly among patients.
The study: exploring patient perspectives
Webster et al. conducted an international study involving 3,521 participants from 47 countries to explore how patients perceive the term "pain catastrophizing." The sample was predominantly female, with an average age of 41.6 years, and most participants had been living with chronic pain for over ten years. The study found that 45% of respondents had encountered the term, and of these, 12% had been labeled as “pain catastrophizers” by their healthcare providers.
Patient reactions to the term
The study revealed that many patients feel stigmatized by the term. A significant portion reported feeling blamed, judged, and dismissed when the term was used to describe their pain experience. This emotional impact was particularly strong among women, who felt that the term reinforced negative gender stereotypes about emotional fragility. Overall, 32% of respondents highlighted the problematic nature of the term, suggesting that it could undermine the therapeutic relationship between patients and healthcare providers.
The need for change
Given these findings, the authors of the study advocate for the adoption of more patient-centered language in pain management. They argue that terms like “pain catastrophizing” can carry unintended negative connotations that may hinder effective communication and care. Instead, the study suggests exploring alternative terms that are less stigmatizing and more reflective of the patients' lived experiences.
Conclusion
The insights from Webster et al.’s study emphasize the importance of language in healthcare, particularly in how it shapes patient experiences and outcomes. As the field of physiotherapy continues to evolve, it is crucial for practitioners to be mindful of the terminology they use and to prioritize patient-centered approaches in both diagnosis and treatment. By doing so, they can foster a more supportive and effective therapeutic environment, ultimately improving the quality of care for those living with chronic pain.
Emma Rheel
Postdoctoral Researcher at the Pain in Motion research group (PAIN), Vrije Universiteit Brussel
2024 Pain in Motion
References and further reading:
[1] Neblett, R. (2017). Pain catastrophizing: An historical perspective. Journal of Applied Biobehavioral Research, 22(1), 1–6. https://doi.org/10.1111/jabr.12086
[2] Leung L. (2012). Pain catastrophizing: an updated review. Indian journal of psychological medicine, 34(3), 204–217. https://doi.org/10.4103/0253-7176.106012
[3] Keefe, F. J., Caldwell, D. S., Queen, K. T., Gil, K. M., Martinez, S., Crisson, J. E., Ogden, W., & Nunley, J. (1987). Pain coping strategies in osteoarthritis patients. Journal of consulting and clinical psychology, 55(2), 208–212. https://doi.org/10.1037//0022-006x.55.2.208
[4] Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524
[5] Webster, F., Connoy, L., Longo, R., Ahuja, D., Amtmann, D., Anderson, A., Ashton-James, C. E., Boyd, H., Chambers, C. T., Cook, K. F., Cowan, P., Crombez, G., Feinstein, A. B., Fuqua, A., Gilam, G., Jordan, I., Mackey, S. C., Martins, E., Martire, L. M., O'Sullivan, P., … Darnall, B. D. (2023). Patient Responses to the Term Pain Catastrophizing: Thematic Analysis of Cross-sectional International Data. The journal of pain, 24(2), 356–367. https://doi.org/10.1016/j.jpain.2022.10.001
