Effects of Pain Catastrophizing on Women With Chronic Low Back Pain

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Understanding how pain catastrophizing works can assist clinicians with providing effective treatments to patients with chronic pain.
Understanding how pain catastrophizing works can assist clinicians with providing effective treatments to patients with chronic pain.

PALM SPRINGS, Calif. — Understanding how pain catastrophizing works can assist clinicians with providing effective treatments to patients with chronic pain, according to research presented at the 32nd Annual Meeting of the American Academy of Pain Medicine (AAPM).

“Heightened pain catastrophizing appears to be associated with amplified pain in tasks than involve central processing of pain,” Chloe Taub, MA, from the Stanford University School of Medicine told Clinical Pain Advisor. “This suggests that all negative stimuli — whether physical, cognitive, or emotional — share processing pathways. Pain catastrophizing may contribute to chronic pain by way of increased facilitation of pain processing or impaired modulation of pain processing.”

According to Taub and colleagues, the purpose of the study was to "provide a clearer picture of the pain processing mechanisms behind catastrophizing by removing the coping aspect by actually directing people with chronic pain to catastrophize during a pain catastrophizing induction.”

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The researchers examined 40 women with chronic low back pain. Subjects underwent a round of several quantitative sensory testing (QST) tasks including weighted pin pain, heat ramp pain threshold and tolerance, cold water pressor pain, pressure pain threshold, and conditioned pain modulation using heat and cold pain, which were then succeeded by a 10-minute pain catastrophizing induction for the induction group (n=20) or a 10-minute break for the control group (n=20). A second round of the same QST tasks followed.

The researchers found that the calculated pain density for the weighted pin task was significantly higher at QST 2 (post-induction) compared to QST 1 (pre-induction). This suggests that QST and pain catastrophizing measure a person's ability to suppress any type of negative stimuli. 

"Understanding how inductions of positive and negative emotions affect pain processing in people, independent of general coping, will help us better pinpoint and therapeutically target the mechanisms at play," the authors wrote.

According to Taub, “Clinicians should be aware of the impact that catastrophizing has on pain processing so that they can screen pain patients for high catastrophzing and offer or refer them to psychological resources to lower their catastrophizing as part of an interdisciplinary approach to pain management.”

The researchers noted that this pilot study should be replicated with a larger sample. “A more effective method of temporarily knocking out trait coping should be developed so that we can better isolate the impact of catastrophizing on pain processing. The methods could be replicated using male participants for a gender comparison,” Taub said.

“In the long term, improved treatments for pain catastrophizing are needed and emotional induction is one potential alternative approach. A model that reveals how a negative induction knocks out coping would provide a foundation for investigating how positive inductions might buffer coping and holds promise for a novel, non-invasive pain treatment.”

The study was funded by the National Center for Complementary and Integrative Health (NCCIH); the National Institute on Drug Abuse (NIDA); the NIH Pain Consortium; and the Chris Redlich Pain Research Endowment (SCM) provided funding.

Reference

Taub C, Darnall B, Johnson K, Mackey S. Abstract #168. Effects of a Pain Catastrophizing Induction on Quantitatively Measured Pain Perception in Women with Chronic Low-Back Pain. Presented at: AAPM 2016. February 18-21, 2016; Palm Springs, California.

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