Pain catastrophizing

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Pain catastrophizing has been classified as a tendency to misinterpret and exaggerate situations that may be threatening.[1] Individuals who are found to catastrophize about pain find it difficult to shift their focus of attention away from painful or threatening stimuli, and attach more threat or harm to non-painful stimuli. Catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.[2]

Measuring pain catastrophizing[edit]

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.[3] 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.[4] It is hypothesized [5] that pain catastrophizing is related to various levels of pain, physical disability and psychological disability in clinical and nonclinical populations.

Pain catastrophizing scale[edit]

  1. I worry all the time about whether the pain will end. (H)
  2. I feel I can’t go on. (H)
  3. It’s terrible and I think it’s never going to get any better. (H)
  4. It’s awful and I feel that it overwhelms me. (H)
  5. I feel I can’t stand it anymore. (H)
  6. I become afraid that the pain may get worse. (M)
  7. I think of other painful experiences. (M)
  8. I anxiously want the pain to go away. (R)
  9. I can’t seem to keep it out of my mind. (R)
  10. I keep thinking about how much it hurts. (R)
  11. I keep thinking about how badly I want the pain to stop. (R)
  12. There is nothing I can do to reduce the intensity of the pain. (H)
  13. I wonder whether something serious may happen. (M)

(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.[6]

Through various studies the PCS was shown to be invariant, with most accuracy in the three oblique factor structure, across genders and both clinical and non-clinical groups. The gender focused study expressed that female subjects report more frequent experiences of pain, varied intensity with increased persistence, and lower pain tolerances and thresholds.[7] With minimal modification, to address the subject of the catastrophizing, the PCS can also be applied to pain catastrophizing in a social context. The social aspects studied were parents of disabled children and spouses of individuals with chronic pain. Specifically it has been shown to determine illness related stress and depression issues that arise from parent’s catastrophizing about their child’s pain in regards to a disability or illness.[8] Similarly with respect to pain catastrophizing between romantic partners, spouse catastrophizing about a partner’s chronic pain was related to depressive and pain severity levels in both spouses.[9]


Research of pain catastrophizing has found that catastrophic thinking can result in a more intense experience of pain. By this association, catastrophizing has led to over predictions of pain, increased use of health care and longer hospital stays.[1] The use of the PCS in clinical and nonclinical settings can provide a more specific tool for healthcare providers to better care for their patients. A greater understanding of a person’s experience of pain can allow for a better care regimen to be implemented helping reduce problems that have previously come from catastrophizing.[2]

Treatment for Pain Catastrophizing[edit]

The primary treatment for pain catastrophizing is cognitive behavior therapy for chronic pain.[10] This is typically delivered in individual psychotherapy sessions, or in group pain coping skills classes. These sessions and classes typically span 6 to 12 weeks, and cover a variety of psychobehavioral topics in addition to pain catastrophizing.[10] In 2014, researchers at Stanford University found that a single-session class they developed to specifically to treat pain catastrophizing was effective.[11]


  1. ^ a b Van Damme, S., Crombez, G., Bijttebier, P., Goubert, L., & Houdenhove, B. V. (2001). A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. International Association for the Study of Pain, 96(3), 319-324. Retrieved October 10, 2013, from
  2. ^ a b Gracely, R. H. "Pain Catastrophizing and Neural Responses to Pain among Persons with Fibromyalgia." Brain 127.4 (2004): 835-43. Oxford Journals. Web.
  3. ^ The Pain Catastrophizing Scale: Development and Validation, Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, Psychological Assessment, 1995, Vol. 7, No. 4, 524-532
  4. ^ Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development And Validation.. Psychological Assessment, 7(4), 524-532.
  5. ^ Osman et al., Factor structure, reliability, and validity of the pain catastrophizing scale, Journal of Behavioural medicine, vol.20, no. 6, 1997
  6. ^ The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. Osman, Augustine; Barrios, Francisco X.; Gutierrez, Peter M.; Kopper, Beverly A.; Merrifield, Traci; Grittmann, Lee Journal of Behavioral Medicine, Vol 23(4), Aug 2000, 351-365. doi: 10.1023/A:1005548801037
  7. ^ D'Eon, J. L., Harris, C. A., & Ellis, J. A. (2004). Testing Factorial Validity And Gender Invariance Of The Pain Catastrophizing Scale. Journal of Behavioral Medicine, 27(4), 361-372.
  8. ^ Goubert, L., C. Eccleston, T. Vervoort, A. Jordan, and G. Crombez. "886 Parental Catastrophizing About Their Child'S Pain. The Parent Version Of The Pain Catastrophizing Scale (Pcs-P): A Preliminary Validation." European Journal of Pain 10 (2006): S229. Web.
  9. ^ Cano, Annmarie, Michelle T. Leonard, and Aleda Franz. "The Significant Other Version of the Pain Catastrophizing Scale (PCS-S): Preliminary Validation." Pain 119.1-3 (2005): 26-37. Web.
  10. ^ a b Williams, A.C., C. Eccleston, and S. Morley, Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev, 2012. 11: p. CD007407
  11. ^ Darnall BD, Sturgeon JA, Kao MC, Hah JM, Mackey SC. From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing. J Pain Res. 2014 Apr 25;7:219-26. doi: 10.2147/JPR.S62329