Pain Catastrophizing vs. Actual Pain: The Psychology of Pain
Pain can be useful, even if we tend not to like it very much. Whether you cut your finger chopping onions or sprain your ankle on a run, pain is your body’s way of notifying your brain that damage has occurred (and more could be imminent).
But not every pain interaction is so straightforward. The experience of pain, after all, is negotiated by a wide variety of mental, emotional, and social factors.
Long-term or chronic pain can evoke a different emotional reaction, for example, than a minor injury. If you can’t identify the cause of a particular pain, you may feel helpless. Pain associated with a traumatic event can trigger a more emphatic response than one free of such associations. These more complex responses can fall into patterns and sometimes lead to a maladaptive response called pain catastrophizing.
What Is Pain Catastrophizing?
Pain catastrophizing is a specific pain response that can present in a number of ways:
- An overwhelming sense of helplessness regarding (or in response to) pain.
- Incessant thoughts about pain, a hyperfixation that’s hard to shake.
- An exaggerated, magnified, or disruptive reaction that interferes with everyday activities.
Pain catastrophizing occurs when non-biological factors exaggerate or distort your perception of pain. In the long run, pain catastrophizing can increase your risk of developing chronic pain or cause other pain-related setbacks and difficulties.
Most evidence suggests that pain catastrophizing is situational rather than dispositional — in other words, pain catastrophizing can happen to anyone and it develops largely on a case-by-case basis.
When you put your hand on the stove and feel the pain of a burn, it’s a pretty instant, biological response. But for some, the fear of that pain might cause the sensations to feel more intense.
After an injury like a stovetop burn, thinking about it obsessively — and all the mixed emotions and responses to it — may make you experience the pain as worse than it truly is. This can be especially true when it comes to chronic pain, which is often unrelated to tidy cause-and-effect events.
None of these responses are necessarily intentional or even conscious. You may not be aware of your own pain catastrophizing, which may be rooted in a fear response. But even if you aren’t aware of it, pain catastrophizing may have a detrimental impact on your ability to heal, recover, or cope with pain.
Clinically, pain catastrophizing is often associated with depression; as these negative and intrusive thoughts are magnified, they may start to interfere with your everyday activities. A distorted and overly pessimistic response can really interfere with your ability to cope, and compromise your quality of life.
In addition, research has linked high pain catastrophizing with a higher likelihood of continued disability or lack of improvement. To break that negative cycle, you need to replace it with something else. Treatments center around finding coping mechanisms that are healthy and sustainable.
Treatments for Pain Catastrophizing
Because pain is subjective, discussions regarding pain are inherently challenging.
That’s why treatment of pain catastrophizing is not about determining the “actual” level of pain you feel — it’s about helping you mend and improve your quality of life however possible.
Physical pain is always filtered through perception. In situations where the cause of pain is unclear, longer-term, or difficult to control, managing your response becomes critical. As a result, psychologists tend to focus treatment on managing the behaviors, emotions, and even thoughts surrounding your pain.
The goal is to provide you with useful behavioral strategies that help you recontextualize your pain in a more proportional way. Those strategies might include:
- Changing your frame of reference: If you suffer from chronic pain, for example, a psychologist might ask you to think about redefining “good days” and “bad days,” giving yourself a new baseline to work with. This can help you focus on improvements and hope, which often lead to gradual improvements in the quality of your life.
- Distracting yourself: Most chronic pain has ebbs and flows, so when it gets bad, a planned distraction can help. Getting your mind to focus on a movie or a book or a television show can help you break that pain catastrophizing cycle. This is why many specialists will recommend doing something that takes your mind off your pain. The pain may not go away, but it won’t be your focus.
- Being social: Creating social connections and maintaining friendships can be good for your overall mental health as well as your pain management. Most research indicates that social connections can help improve pain resiliency.
Many techniques use Cognitive Behavioral Therapy (CBT). At its core, CBT is designed to help individuals become more aware of their thought processes and give them tools to interpret and direct those thoughts more productively.
The power of knowing your pain
The success of therapies and strategies will, of course, vary from individual to individual and depend on the type of pain involved. But studies show that treatment does reduce pain catastrophizing. Participants in these studies also report a reduction in pain severity and less incidence of depression. One study, for example, shows that reducing pain catastrophizing by 38 to 44% leads to patients returning sooner to work and normal life, as well as lower reported pain overall.
Treatment helps you acknowledge the “actual” source of any pain, and examine the psychological and neurological processes at work. This is essential to changing your perception and processing of pain and to lasting recovery. In other words, knowing more about your pain can provide you with some degree of power over it.
If you suffer from chronic, intrusive pain, there’s help out there. Reach out to us at Skyler Health to connect with a counselor today.
