The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

Chronic pain is a serious and complex health issue. Patients dealing with chronic pain demonstrate multifarious behavioral and cognitive responses to their widely varying individual experiences. How can we, as health professionals, best serve these patients? In this paper, we discuss the place of pain within the historical conceptualization of health and normalcy, and the more current biopsychosocial model. We also review contemporary theories on how cognition plays a vital role in the psychological processing of stimuli, including pain. We focus on the significant interactions between catastrophizing appraisals of pain and the chronic pain experience, including increases in pain perception, pain sensitivity, depression and disability. In light of these significant interactions, we assert that catastrophizing must be specifically addressed in the treatment of chronic pain. We therefore explore the mechanisms through which catastrophizing comes to influence the pain experience, and its etiology. Then, with an understanding of cognitive processing of stimuli, along with the causes and consequences of catastrophizing, we suggest several targets of treatment for catastrophizing in chronic pain. We explore how the cognitive models meet or fail to meet those targets. We conclude with suggestions for further research on the topic of catastrophizing and chronic pain.