Causes of and Treatment for Pain Catastrophizing


In this study, 120 patients diagnosed with pain catastrophizing were randomized to perioperative SSRI or placebo before and after total knee surgery. Overall pain upon ambulation and at rest was lower in the SSRI group than the placebo group in postoperative days two through six. There was no difference in pain 24 hours after the operation. The authors suggest that further studies are needed.2

“Other studies have shown SSRIs not to be very effective or to be less effective. For now, the mainstay of treatment is cognitive-behavioral therapy (CBT). This may include learning better coping skills, and practicing acceptance and mindfulness,” said Campbell. 

George agrees that CBT is the best option currently available. 

“But we still have to treat the pain. It is a bit of the chicken and the egg. Which comes first? If we reduce that pain, catastrophizing gets better. If we reduce the catastrophizing, pain gets better,” said George.

Bottom Line on Pain Catastrophizing

“The key takeaway is that pain catastrophizing is not just a psychological experience. Doctors need to resist the temptation to label these patients as negative or difficult. This is a real condition that needs to be recognized and managed. As we include it in more studies, we will learn more about how to treat it,” Campbell said.

“It is an important condition, but it is hard to fit into a traditional medical model. The pain experience is different for different people. We need to accept that, George said.

Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.

This article was medically reviewed by Pat F. Bass III, MD, MS, MPH.


1. Quartana PJ, et al. Pain catastrophizing: a critical review. Exp Rev Neurother. 2009; 9(5):745-758.

2.  Lunn TH, et al. Analgesic Effect of Perioperative Escitalopram in High Pain Catastrophizing Patients after Total Knee Arthroplasty. Anesthesiology 2015; 122:884–94.

This article originally appeared on Clinical Pain Advisor