Pain Catastrophizing Scale Scores Research Articles

Catastrophizers with Chronic Pain Display more Pain Behaviour when in a Relationship with a Low Catastrophizing Spouse

The present study examined the relationship between couple concordance of catastrophizing and adverse pain outcomes. Possible mechanisms underlying the relationship between couple concordance of catastrophizing and pain outcomes were also explored. Fifty-eight couples were recruited for the study. The chronic pain patients were filmed while lifting a series of weighted canisters. The spouse was later invited to view the video and answer questions about the pain experience of their partner. Median splits on Pain Catastrophizing Scale scores were used to create four 'catastrophizing concordance' groups: low catastrophizing patient-low catastrophizing spouse; low catastrophizing patient-high catastrophizing spouse; high catastrophizing patient-low catastrophizing spouse; and high catastrophizing patient-high catastrophizing spouse. Analyses revealed that high catastrophizing pain patients who were in a relationship with a low catastrophizing spouse displayed more pain behaviours than patients in all other groups. These findings suggest that high catastrophizing chronic pain patients may need to increase the 'volume' of pain communication to compensate for low catastrophizing spouses' tendency to underestimate the severity of their pain experience. Patients' perceived solicitousness and punitive response from the spouse could not explain the group differences in pain behaviour. Theoretical and clinical implications of the findings are discussed.

Relationship Between Pain Catastrophizing Level and Sensory Processing Patterns in Typical Adults

AbstractOBJECTIVE. We examined the relationship between pain perception, as expressed by pain catastrophizing level, and sensory processing patterns among typical adults.METHOD. Two hundred ninety healthy adults participated in this study: 138 men and 152 women. Their ages ranged from 18 to 50 (mean age = 30.2 ± 6.8). All participants completed the Adolescent/Adult Sensory Profile and the Pain Catastrophizing Scale (PCS).RESULTS. PCS scores significantly correlated with Low Registration, Sensory Sensitivity, and Sensation Avoiding. Women had higher sensory sensitivity and a higher pain catastrophizing level than did men.CONCLUSION. Sensory processing patterns may be related to individual pain perception, as expressed in pain catastrophizing level. Intervention programs should take these factors into account to be more focused on the specific needs of each client, facilitate his or her optimal engagement in daily living activities, and elevate well-being.

Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain

Cross-sectional. To evaluate the accuracy with which physical therapists identify fear-avoidance beliefs in patients with low back pain by comparing therapist ratings of perceived patient fear-avoidance to the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia 11-item (TSK-11), and Pain Catastrophizing Scale (PCS). To compare the concurrent validity of therapist ratings of perceived patient fear-avoidance and a 2-item questionnaire on fear of physical activity and harm, with clinical measures of fear-avoidance (FABQ, TSK-11, PCS), pain intensity as assessed with a numeric pain rating scale (NPRS), and disability as assessed with the Oswestry Disability Questionnaire (ODQ). The need to consider psychosocial factors for identifying patients at risk for disability and chronic low back pain has been well documented. Yet the ability of physical therapists to identify fear-avoidance beliefs using direct observation has not been studied. Eight physical therapists and 80 patients with low back pain from 3 physical therapy clinics participated in the study. Patients completed the FABQ, TSK-11, PCS, ODQ, NPRS, and a dichotomous 2-item fear-avoidance screening questionnaire. Following the initial evaluation, physical therapists rated perceived patient fear-avoidance on a 0-to-10 scale and recorded 2 influences on their ratings. Spearman correlation and independent t tests determined the level of association of therapist 0-to-10 ratings and 2-item screening with fear-avoidance and clinical measures. Therapist ratings of perceived patient fear-avoidance had fair to moderate interrater reliability (ICC2,1 = 0.663). Therapist ratings did not strongly correlate with FABQ or TSK-11 scores. Instead, they unexpectedly had stronger associations with ODQ and PCS scores. Both 2-item screening questions were associated with FABQ-physical activity scores, while the fear of physical activity question was also associated with FABQ-work, TSK-11, PCS, and ODQ scores. Therapists' ratings of perceived patient fear-avoidance were not associated with self-reported fear-avoidance scores, showing a potential disconnect between therapist judgments and commonly used fear-avoidance measures. Instead, therapist ratings had small but statistically significant correlations with pain catastrophizing and disability, findings that may support therapists' inability to discriminate fear-avoidance from these other factors. The 2-item screening questions based on fear of physical activity and harm showed potential to identify elevated FABQ physical activity scores. Differential diagnosis, level 2b.

Situational Versus Dispositional Measurement of Catastrophizing: Associations With Pain Responses in Multiple Samples

Catastrophizing is widely recognized as an important risk factor for adverse pain-related outcomes. However, questions remain surrounding the details of its assessment. In particular, recent laboratory studies suggest that evaluation of "situational" catastrophizing (ie, catastrophizing measured during or directly after the administration of noxious stimulation) may provide information distinct from that obtained by standard, or "dispositional" measures, which assess individuals' recall of catastrophizing in daily life. However, comparatively little research has systematically investigated the interrelationships and properties of these 2 different forms of pain-related catastrophizing. The current study evaluated both situational and dispositional catastrophizing measures within multiple samples: healthy individuals (N = 84), patients with painful temporomandibular joint disorders (TMD; N = 48), and patients with painful arthritis (N = 43). All participants first completed the Pain Catastrophizing Scale (PCS), and then underwent psychophysical pain testing, which included heat, cold, and pressure pain. Participants then completed a situational catastrophizing measure with reference to the laboratory pain he/she had just undergone. Situational catastrophizing scores were not significantly correlated with dispositional PCS scores in the healthy participants and arthritis patients, though they were associated in TMD patients. Situational catastrophizing was more strongly associated with experimental pain responses than dispositional PCS scores for the healthy subjects and arthritis patients. In general, higher levels of situational catastrophizing were associated with lower pain thresholds and higher pain ratings across all 3 samples. The findings highlight the importance of multidimensional assessment of pain-related catastrophizing, and suggests a role for measuring catastrophizing related to specific, definable events. This study adds to a growing literature examining catastrophizing. Our findings highlight the potential importance of the multidimensional assessment of pain-related catastrophizing, and suggest a role for measuring catastrophizing related to specific, definable events.

Patients with painful bladder syndrome have altered response to thermal stimuli and catastrophic reaction to painful experiences

To compare cutaneous sensory thresholds, habituation to somatic stimuli, and tendency towards catastrophic reaction to painful stimuli in patients with Painful Bladder Syndrome (PBS) to controls without PBS. Thermal and vibratory sensory thresholds were established in 11 PBS patients and 10 controls at C5, T1, T12, and S3 dermatomes. Supra-threshold thermal stimuli were then applied at T12 and S3 for 60 sec while patients periodically rated the intensity of stimuli using a visual analog scale. A Pain Catastrophizing Scale (PCS) questionnaire was also completed by all participants before testing. PBS patients were less sensitive to warm stimuli in the T12 dermatome than asymptomatic controls (thresholds 36.6 +/- 1.10 degrees C vs. 35.3 +/- 1.0 degrees C, P < 0.02) but otherwise had similar thermal and vibratory thresholds. Habituation to supra-threshold stimuli at T12 and S3 dermatomes was more common in controls than PBS subjects (7 (70%) vs. 2 (18%), P < 0.03 and 9 (90%) vs. 3 (27%), P < 0.008, respectively). The PCS score correlated with the duration of PBS symptoms and with thresholds to warm stimuli at T12 dermatome (rho = 0.65, P < 0.03 and rho = 0.5, P < 0.021, respectively). Our data suggests that habituation to stimuli may be impaired and that a catastrophic reaction to perceived stimuli may be involved in the sensory experience of PBS patients and facilitate chronic pain. Neurourol. Urodyn. 28:400-404, 2009. (c) 2009 Wiley-Liss, Inc.

Poster 266: The Effect of Needle Position and Contrast Spread Pattern on Outcome of Lumbar Transforaminal Epidural Steroid Injections

Objective: To determine if medication delivery into epidural space confirmed by contrast enhancement fluoroscopic images is superior to a neurogram placement; to determine if lumbar transforaminal epidural steroid injections needle position can effect contrast spread pattern and outcome. Design: Prospective, evaluator-blind clinical trial. Setting: Outpatient multidisciplinary spine care center. Participants: 50 patients with L4 and/or L5 radiculopathy who failed conservative management. Interventions: L4-L5 and/or L5-S1 lumbar transforaminal epidural steroid injections. Main Outcome Measures: A survey that included Verbal Rating Scale (VRS), visual analog scale (VAS), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS). Fluoroscopic radiographs reviewed by a radiologist blinded to the patient and outcome to identify needle position (AP/lateral views) and contrast flow. With the AP view, the radiologist determined the needle point to be at medial or lateral by using the 6 o'clock position as midline. In the lateral view, the location of the needle tip was classified as 12 o'clock, 3 o'clock, 6 o'clock, or 9 o'clock position. Results: 68% of patients were women and 32% were men, with average age ± SD of 56.7±14.9 years (range, 19–86y). At the L4-L5 level, 58% were neurograms, 0% epidural only, and 26% with both patterns. At the L5-S1 level, 48% were neurograms, 6% epidural, and 44% had both patterns. There were no statistically significant differences between needle position and functional outcome using the VRS, VAS, and ODI. There appeared to be a trend for better outcome as measured by change in VRS, VAS, HADS, and ODI for epidural contrast pattern. Interestingly, there was a trend for worse PCS scores in the epidural group when compared with the neurogram-only group. Conclusions: These findings suggest that there is no benefit in functional outcome as related to needle position within the foramina. It is likely that regardless of needle position, epidural spread of the medication is the more important factor in functional improvement with lumbar transforaminal epidural steroid injections. Limitations include small sample size and possible overlapping effect with multi-level injections. Further studies with larger sample size are needed to address outcome improvement in correlation with fluoroscopic images.

(320) In-vivo vs. standard catastrophizing in multiple pain measures among healthy, TMD and arthritis patients

Catastrophizing is widely recognized as an important risk factor for adverse pain-related outcomes. There are, however, questions surrounding its assessment. In particular, recent laboratory studies suggest that evaluation of “in-vivo” catastrophizing (i.e., catastrophizing measured during the administration of noxious stimulation) may provide information distinct from that obtained by standard measures which assess catastrophizing in daily life. However, comparatively little research has systematically investigated these relationships using different stimulus modalities and subject samples. The current study sought to elucidate the associations of in-vivo and standard catastrophizing measures with a variety of experimental pain responses among healthy individuals (N=84), patients with painful temporomandibular joint disorders (TMD; N=48), and patients with arthritis pain (N=43). All participants first completed the Pain Catastrophizing Scale (PCS), and then underwent psychophysical pain testing, including evaluation of responses to noxious heat, cold, and pressure. Immediately following the pain induction procedures, participants completed an in-vivo catastrophizing measure with reference to the laboratory pain experience they had just undergone. In-vivo catastrophizing scores were uncorrelated with PCS scores in the controls (r= -.002) and arthritis patients (r=.24, p’s > .1), though there was a significant positive association in the TMD patients (r = .46, p = .001). Moreover, in-vivo catastrophizing was generally more strongly associated with experimental pain responses (e.g. pain threshold, suprathreshold pain ratings) than PCS scores, though these results varied by pain testing modality. Finally, the associations between catastrophizing and psychophysical pain responses were strongest in TMD patients relative to the other two groups. Overall, these findings highlight the importance of assessing in-vivo catastrophizing, and suggest a role for measurement of catastrophizing related to recent, specified painful events.

Psychological Differences between Patients that Elect Operative or Nonoperative Treatment for Trapeziometacarpal Joint Arthrosis

Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p = 0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p < 0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.

Prospective Relation between Catastrophizing and Residual Pain following Knee Arthroplasty: Two‐Year Follow‐Up

Pain is the primary indication for both primary and revision total knee arthroplasty (TKA); however, most arthroplasty outcome measures do not take pain into account. To document the prospective pain experience following TKA, with subjective pain-specific questionnaires to determine if comorbidities, preoperative pain or preoperative pain catastrophizing scores are predictive of long-term pain outcomes. Fifty-five patients with a primary diagnosis of osteoarthritis of the knee, who were scheduled to undergo TKA, were asked to fill out the McGill Pain Questionnaire (MPQ) and the Pain Catastrophizing Scale (PCS) preoperatively and at three, 12 and 24 months follow-up. Comorbidities were extracted from the Queen Elizabeth II Health Sciences Centre health information system. The overall response rate (return of completed questionnaires) was 84%. There was a significant decrease in the MPQ scores (P<0.05) postoperatively. PCS scores did not change over time. Receiver operating characteristic curves revealed the number of comorbidities per patient predicted the presence of pain postoperatively, as documented by the numerical rating subscale of the MPQ at 24 months (P<0.05). Receiver operating characteristic curves for preoperative PCS and rumination subscale scores predicted the presence of pain, as measured by the Pain Rating Index subscale of the MPQ at 24 months (P<0.05). Preoperative PCS scores and comorbidities were significantly higher in the persistent pain group (P<0.05). The number of comorbidities predicted the presence of pain at 24 months follow-up and, for the first time, preoperative PCS scores were shown to predict chronic postoperative pain. This may enable the identification of knee arthroplasty patients at risk for persistent postoperative pain, thus allowing for efficient administration of preoperative interventions to improve arthroplasty outcomes.

Maximal muscle strength and EMG activity of the shoulder/neck muscles in females with work-related neck muscle pain

Neck extensor endurance (NEE) and cervical proprioception are vital for maintaining cervical spine function and defects in these processes have been associated with chronic neck pain (CNP). The objectives of the study are 1) To investigate the association between NEE and cervical joint position error (JPE) in subjects with CNP; 2) to compare the cervical extensor endurance and cervical JPE of CNP subjects with those of asymptomatic controls; and 3) to determine the relationship between Pain Catastrophizing Scale (PCS) scores, NEE, and cervical JPE in subjects with CNP.Sixty-four participants (32 asymptomatic, 32 with CNP) participated in this comparative cross-sectional study. Cervical proprioception was assessed by measuring the absolute JPE in the sagittal and transverse directions. NEE was assessed using a clinical extensor endurance test. NEE capacity and JPE were compared and correlated between asymptomatic and CNP subjects. Pain catastrophic behavior was assessed using the Pain Catastrophizing Scale (PCS) in CNP subjects.CNP subjects showed lower NEE capacity (p < 0.001) and significantly larger JPEs (p < 0.001) than asymptomatic participants. NEE negatively correlated with JPEs in all directions (p < 0.001) in asymptomatic subjects and only neck extension errors showed a correlation in CNP subjects (r = −0.45, p = 0.009). PCS scores were negatively correlated with endurance capacity (r = −0.42, p = 0.017) and positively correlated with JPE (flexion: r = 0.57, p = 0.001).CNP subjects showed impaired proprioception and lower endurance capacity compared to asymptomatic participants. Neck extension errors alone correlated with JPE in CNP subjects. PCS scores negatively correlated with NEE in subjects with CNP.

Catastrophizing: A Risk Factor For Postsurgical Pain

This research was designed to test the hypothesis that presurgery "catastrophizing" would predict postsurgical pain and postsurgical analgesic consumption. A sample of 48 individuals who underwent anterior cruciate ligament repair participated in the study. All participants completed the Pain Catastrophizing Scale (described by Sullivan et al in 1995) prior to surgery. Measures of pain (pain scores on a scale of 0-10) were obtained in the postanesthetic care unit, as well as 1, 2, and 7 days after surgery. Opioid and nonopioid analgesic consumption was tabulated while patients were in the hospital and after discharge. Results showed that the Pain Catastrophizing Scale was a significant predictor of acute postsurgical pain in the postanesthetic care unit (r = 0.48, P = 0.004 for maximum pain in the postanesthetic care unit). Maximum pain ratings in patients with high Pain Catastrophizing Scale scores (> median of 13) were 33% to 74% higher numerically than in patients with low Pain Catastrophizing Scale scores (< or = median), and the duration of moderate-severe pain (>3/10) was more prolonged (45 minutes versus 28 minutes in patients with high and low Pain Catastrophizing Scale scores, respectively; P < 0.05). The Pain Catastrophizing Scale was also predictive of pain with activity at 24 hours (r = 0.65 for pain on walking, P < or = 0.0001). The Pain Catastrophizing Scale did not predict postoperative analgesic use. The pattern of findings suggests that high catastrophizing scores may be a risk factor for heightened pain following surgery. Clinical and theoretical implications of the findings are addressed.

An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description

A cold pressor task (CPT) was used with 203 college students (112 women and 91 men) in a study of sex differences in pain response. Physiological measures were taken before and after pain induction, and sex-differentiating personality traits were assessed with the Personal Attributes Questionnaire (PAQ). The Pain Catastrophizing Scale (PCS) was given with standard instructions prior to the CPT, and it was re-administered after the CPT with modified instructions to assess catastrophic thinking during the CPT. Hypotheses were formulated into an explanatory model that was evaluated by path analysis. Pain induction elevated blood pressures and cortisol levels for both sexes, but systolic blood pressure reactivity and cortisol response were greater in men, even with sex differences in CPT tolerance times controlled statistically. Post-CPT PCS scores were positively related to pain ratings and negatively related to tolerance, but baseline PCS scores did not predict tolerance or pain ratings. Pre-PCS scores were not well correlated with post-PCS scores ( r=0.46) and underestimated post-PCS scores, particularly for women. The Sex difference on the post-CPT PCS was largely attributable to the PAQ personality trait of Emotional Vulnerability. The differential results obtained from assessing catastrophizing before and after the CPT emphasized the importance of specifying the context in which catastrophizing is assessed (both timing and instructions). Theoretical considerations in the construct of catastrophizing are also highlighted, including, but not limited to, the confounding of variables such as pain intensity and unpleasantness.

Pain and depression: Relationships of pain catastrophizing, depression, and dysfunctional attitudes

The relation between pain and depression is well established but not well understood. Cognitions, beliefs, and attitudes are thought to influence depression and perceived pain. Pain catastrophizing leads to heightened pain experience, and dysfunctional attitudes may predispose to depression. This study used a structural-equation, cross-lagged panel analysis to examine dysfunctional cognitions in relation to depression and experimental pain. 82 college students were administered the Pain Catastrophizing Scale (PCS), Beck Depression Inventory-II (BDI-II), and Dysfunctional Attitudes Scale (DAS) two weeks prior to a cold pressor task (CPT), and again immediately after the CPT. Pain response was measured by tolerance time (TOL), Visual Analogue Scale (VAS) ratings, and the abbreviated McGill Pain Questionnaire (MPQ). Total MPQ score predicted post-CPT PCS scores (p < .01) but not post-CPT BDI-II or DAS scores, and VAS ratings predicted TOL (p < .005). Post-CPT PCS scores were higher than pre-CPT scores (p < .05), but BDI-II and DAS scores did not change significantly. Pre-CPT measures were not significantly related to pain response, but pre-CPT PCS predicted post-CPT BDI-II (p < .01) and DAS (p < .025) even with pre-CPT levels on these two variables controlled. Pre-CPT BDI-II was not significantly related to post-CPT PCS (p > .10) or DAS (p > .5), whereas Pre-CPT DAS approached significance in predicting post-CPT PCS (p < .06) and BDI-II (p < .07) with pre-CPT scores controlled. These results, although preliminary and based on only part of our ultimate sample, suggest that individuals who are predisposed toward pain catastrophizing are more likely to report dysfunctional attitudes and depressive symptoms following exposure to pain (i.e., catastrophizing before induced pain mediated the relationship between induced pain and depression, and between induced pain and dysfunctional attitudes). Importantly, the relationship between pain catastrophizing and future depression was not mediated by induced pain.

Dissertation Titles and Synopses

Dissertation Titles and Synopses

The Pain Catastrophizing Scale: Development and validation.

In Study 1, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n = 15) or noncatastrophizers (n = 15) on the basis of their PCS scores and participated in an cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance t o the prediction of pain intensity.