Pain Catastrophizing: Connecting brain and body

How does catastrophizing influence your pain?
Pain is a common human experience. For some, pain is a passing occurrence. But for more than 100 million people in the US, this complex social, emotional, and physical phenomenon exists as chronic, lasting pain.  It is frustrating when pain refuses to fade, especially after countless visits with a healthcare provider. Lingering pain may lead to disability, increased healthcare costs, and decreased quality of life. Often pain relief begins with your mind.
One of the most important and often overlooked causes of chronic pain is the process of pain catastrophizing. It’s a big fancy word, one I’d like to find a substitute, but it works for the moment. Too often we focus on the physical mechanisms of pain and ignore the very real effect emotions have on our bodies. Pain catastrophizing is a mental process consisting of constant negative cognitive and emotional responses to pain. This may be the reason your pain continues to stick around, even when it seems to have no obvious physical explanation. Pain catastrophizing can occur after any injury. It may even be causing you pain when there is no injury present!
These counterproductive thoughts can have numerous negative effects on your wellbeing. Emotional distress surrounding pain amplifies your pain intensity, prevents healing from occurring, and has the potential to increase your dependence on addictive opioid medication. By allowing these the proliferation of these thoughts, you are your pain’s best friend. Pain catastrophizing acts in a vicious cycle that propagates feelings of pain and despair. It takes away your control over pain and reduces self-confidence.
Could You Be A Pain Catastrophizer?   Печать
You may be if you experience the following thoughts and emotions:

  • “If I move, I might get seriously injured.”
  • “The pain can always get worse”


  • “My pain is always on my mind. I worry about it often.”
  • “My pain distracts me from my work.”


  • “I am unable to make my pain better.”
  • “Nothing can fix my pain. I will always hurt.”

Taking a simple questionnaire, the Pain Catastrophizing Scale can determine if the process of pain catastrophizing is contributing to your symptoms. Once you become mindful that these damaging thoughts are amplifying your brain’s perception of pain, you can start to combat these feelings. Research has shown that pain catastrophizing can be treated in as little as one session. In fact, there are strategies you can start to implement right now to move from a pain friend to a pain fighter.
1. Recognize the Signs
Learn to identify when pain catastrophizing begins. Are you stressed? Do you feel hopeless or scared? Are you unable to push the pain to the back of your mind? Do you feel threatened by the thought of your pain getting worse? Identifying when you have an unhealthy mindset towards pain is your first step to fighting back against these unhelpful thoughts. Pause and check in with your thoughts and emotion about once every hour. A minimum of 5x/day is recommended.
 2. Self-treat
Find the thoughts and behaviors that empower you and take your mind off the pain. Direct your thoughts to something you love, perhaps by listening to a favored song or playing with a beloved pet. Take steps to a pain-free life by just taking steps- walk around the block and prove to yourself that your body is strong. Create a mindful moment through deep, diaphragmatic breathing and purposeful muscle relaxation. Replace the pain in your mind with the things that make you feel alive.
3. Modify Expectations
Re-frame the way you think about pain. Remember when you went to the doctor as a child to get shots? Often times the anticipation was worse than actually receiving the shot. Our expectations have power over our perception of reality. Write down the thoughts you experience when pain begins. Then consider how you could change those thoughts to be more helpful. Believe that you can control your emotional responses. Have confidence that you have power over your pain. Below is a list of common harmful pain responses and their healthier counterparts.

Pain Catastrophizers Pain-Free
“This is the worst pain I have ever felt. I doubt I will ever feel like myself again.”  “This is tough, but I know that pain is temporary and my body is capable of healing.”
“Moving causes pain, therefore movement should be avoided.”  “Movement may be difficult at first, but I know that being active releases pain-fighting endorphins.”
“I think about my pain constantly.” “I choose to think about positive things in my life instead of pain.” 
“I am afraid of my pain.”  “Pain is a normal experience for us all.”
 “What if the pain continues to get worse?”  “I will do my best to take care of my body and to heal.”

4. Change Your Habits
Surrounding yourself with people and practices that promote positive thinking is a great way to create a lifestyle that facilitates healing and pain relief. Support groups exist for many chronic pain conditions. These are a good opportunity to learn helpful coping strategies from others and find support in shared experiences. Enroll in an exercise class that you look forward to attending, whether that is yoga, rock climbing, or Zumba. Keeping a regular exercise schedule keeps you accountable and helps you build a stronger, happier, and pain-free life.
Pain catastrophizing is treatable and affects many people living chronic pain. Your pain is real and often this is an unwanted side-effect of pain and the fear it causes. Keeping these strategies in mind, you can transform the way your brain responds to pain. The pain you feel is very much real, but reacting negatively puts up a barrier to healing. Harness the power of positivity, and begin taking steps towards a pain-free life. Don’t allow pain to influence your life any longer than it already has. When we stop viewing pain as a permanent problem, the healing process can truly begin.
Knowledge is the fastest way to decrease pain.
Knowledge decreases fear.  When fear decreases so does pain.
Pain-free is possible,
Dr. Joe Tatta, DPT, CNS
References 1, 2, 3, 4

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