Pain catastrophizing: an updated review

Lawrence Leung, Lawrence Leung

Abstract

Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions. It is a distinct phenomenon which is characterized by feelings of helplessness, active rumination and excessive magnification of cognitions and feelings toward the painful situation. Susceptible subjects may have certain demographic or psychological predisposition. Various models of pain catastrophizing have been proposed which include attention-bias, schema-activation, communal-coping and appraisal models. Nevertheless, consensus is still lacking as to the true nature and mechanisms for pain catastrophizing. Recent advances in population genomics and noninvasive neuroimaging have helped elucidate the known determinants and neurophysiological correlates behind this potentially disabling behavior.

Keywords: Disability; pain catastrophizing; rehabilitation; review.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Surrealistic painting titled “Without Hope” where Frida tried to externalize her chronic pain and hopelessness by portraying her bedbound self force-fed with a funnelled mixture of carcasses. Frida Kahlo, “Sin esperanza”, 1945. Oil on Canvas mounted on Masonite, 11”×14”. Collection Museo Dolores Olmedo Patino, Mexico City
Figure 2
Figure 2
Frida Kahlo's painting “broken column” where she depicted her spine as a broken marble column in the background of multiple nails driven into other parts of her naked body, giving her the continual undignifying pain. She told others “I am disintegration” Frida Kahlo, “La columna rota”, 1944. Oil on canvas mounted on rigid fiber, 16”×12”, Collection Museo Dolores Olmedo Patino, Mexico City
Figure 3
Figure 3
Conceptual diagram of the neuromatrix theory as a refinement of the gate-control theory. Itself visualized as an entity (like an incessant spinning sphere) comprising of the somatosensory (S), cognitive (C)and affective (A) domains, the neuromatrix receives inputs from areas of the brain governing sensation, emotions and cognitions; and in return, churns out a neurosignature (output) which activates various programs for pain recognition, motor response, emotional and stress reactions. (Adapted from Melzack, Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract 2005;5:85-94.)

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