Catastrophising Pain: Feels Like An Insult But Actually Reflects How You Feel About Chronic Pain

Today's post from brainlessblogger.net (see link below) talks about yet another label that is attached to chronic pain management - catastrophising! One of the buzz words surrounding conditions like neuropathic pain is catastrophising and if someone suggests that that is what you're doing, it cuts like a knife. It's as if somehow you're exaggerating the pain in order to get attention, yet that couldn't be further from the truth. You feel what you feel when it comes to pain and yes it seems that some people can bear pain for longer than others, or experience it to a lesser or greater degree but that doesn't make your experience any less or more genuine. The idea that you're making a 'mountain out of a molehill', decreases your self-worth to the point where you doubt yourself and imagine that others (including doctors) are doubting you too. This article discusses the issue and tries to put it in context but believe me, if you have permanent neuropathic pain, you lean towards understating your pain rather than catastrophising it because you know very well how the effect of someone continually expressing their pain can turn friends, family and colleagues into glassy-eyed bystanders in a matter of weeks. Well worth a read for all those living with chronic pain.

Chronic pain: Catastrophizing
February 17, 2019 Nikki 


Individuals differ in how they perceive pain, and in how they react to any painful experience. Some can work through the pain and make it through the day, while others think about their pain constantly, worry about when it will end and how much worse it will get. This negative emotional response to pain is called pain catastrophizing, 



Pain 101: The Latest Thinking About Pain Catastrophizing and Why It Matters for Chronic Pain

I don’t think any of us would disagree that when we focus on the pain, it is worse. When we can distract from it and negative thoughts, it helps. But many of do not like to think we are ‘catastrophizing’. Because it sounds like we are making mountains out of molehills. But really it means we can’t stop thinking about how much it sucks climbing that mountain. Instead of climbing the mountain, because we must. The mountain is there and it isn’t going anywhere. So we have no choice but to climb it. And never reach the downhill part. Because, damn, it is the highest mountain ever. And we don’t like the term catastrophizing inherently. Like… exaggeration. Whereas it is more about pain perception, our reaction to pain, and our emotional existence with pain. And we can refer to it as ‘pain appraisal’ instead, as is now in conversation as it doesn’t have that negative connotation to it. Just how we are thinking and reacting to our pain in various ways.




“I say this over and over again: Your pain is real, there’s a medical basis for it,” said Dr. Darnall of communicating with her patients. “And we can still find opportunities to help each person be best equipped to help themselves.” Pain Catastrophizing: What Practitioners Need to Know
But we know emotions get tangled into pain and that can lead to negative thought patterns of:


“Pain catastrophizing or negative pain appraisal is a persistent pattern of having difficulty shifting the focus away from the worst aspects of pain,” explained Dr. Darnall. In these cases, people will often ruminate on their pain (eg, “I can’t stop thinking about how much it hurts”); magnify their pain (eg, “I’m afraid that something serious might happen”); and feel helpless to manage their pain (eg, “There is nothing I can do to reduce the intensity of my pain”).

Pain Catastrophizing: What Practitioners Need to Know
 
So we feel when we catastrophize:

Helpless about our pain. In that, we have no control over it and nothing will make it better
We ruminate of pain and the associated feelings that come with pain
We magnify pain and pain outcomes. We will not do things because of pain consequences. We see no future for us. The future seems vastly consumed by pain.

This is a pattern that is well known to me when my depression was in full gear. Depression leads to a lot of rumination on negative realities… and that means pain for me. And I did feel out of control with it, like it couldn’t be managed and I couldn’t sustain a normal life with it. It consumed everything and would in the future.
What helped me through this negative thought pattern was:

Treating the comorbid depression with medication
Seeing a pain psychologist… one who is familiar with pain and the pain process. This often involves CBT.
Meditation
Acceptance: that there will be pain, of some sort, regardless of treatment. To stay within my limits and accept those limits.

But these thoughts will occur, as long as there are not frequent, it is part of the pain experience. But catastrophizing can limit the effectiveness of treatment itself. So it is something we have to acknowledge if we do and try different ways to manage It, so it doesn’t manage Us.


The ultimate goal in optimizing self-regulation of pain is to help patients feel that they have more control. Not only does more control make pain more tolerable for patients, it also helps them have a better response to the medical treatment.

Research is underway to better understand how cognitive and emotional regulation of pain can help patients suffer less. Dr. Darnall and others have worked to develop and validate scales to assess mental/emotional patterns in chronic pain,7,8 and to learn how treatments can be applied to shape adaptive neural networks that help steer neurophysiology toward a sense of safety – even in the face of pain.

 Pain Catastrophizing: What Practitioners Need to Know

And ultimately it IS about control in the sense we want to have Some control over suffering, if not the very real physical sensation of pain itself. We intuitively know some ways while coping to regulate the pain experience. We know distraction, when the pain isn’t too severe, is one way to cope with pain. We discover multiple individual ways to reduce suffering and other ways, such as medication, to reduce the pain itself. And all those ways have to be individually discovered. A psychologist helped me because he made me think about my thinking. And it helped alter my perception of the pain experience. As in, I wasn’t doing myself any favours by ruminating on it in negative ways. And I knew that. I just couldn’t fathom a way around that when in high pain. It was a slippery slope of negative thoughts I couldn’t escape from… except by, say, sleeping. And it took thinking about how I was thinking to find ways around it. Like countering negative thoughts with more realistic thoughts. And that was a good foundation to start with for sure, along with treatment of the comorbid depression.

So just remember one thing: Pain is really, real. Catastrophizing doesn’t mean you are exaggerating the literal pain you are in. It is just about the way we focus on pain, feel emotions like hopelessness with pain, magnify the pain by ruminating on it. All the things we know make the very real pain experience worse.
But the act of catastrophizing negatively affects
treatment outcomes and how we cope with future pain.

It varies with the intensity of pain and how long we have been in pain.

I can’t say I stopped this, just that it got better. I think very much linked to the depression being medically treated so I could think outside of that dark abyss. And that does help me cope with the pain that exists. A difficult thing at the best of times. But I don’t want to make it more difficult on myself than it has to be. I do want to find new ways to cope and new ways to reduce suffering. This one is a hard one, though. A real hard one since it is easy to ruminate on the pain in our past, present, and future and to feel a hopelessness to control and manage the pain in our lives. It is really easy to slip into, for sure. 

More reading:

Pain catastrophizing: a critical review

Suffering from pain is optional: Pain catastrophizing and your brain
Other posts:

CBT for fibromyalgia? Worth it?

Let’s look at ‘thinking positive’

Chronic pain and cognitive therapy

https://brainlessblogger.net/2019/02/17/chronic-pain-catastrophizing/