Processes Underlying the Relation between Catastrophizing and Chronic Pain: Implications for Intervention

Michael J.L. Sullivan and Marc O. Martel


Over the past two decades, pain catastrophizing has emerged as one of the most robust psychological predictors of pain-related outcomes (Edwards et al. 2006a; Sullivan et al. 2001b; Turk et al. 1983; Weissman-Fogel et al. 2008). Hundreds of studies have documented associations between pain catastrophizing and adverse pain outcomes, including heightened pain intensity, emotional distress, and disability (Edwards et al. 2006a; Keefe et al. 2004; Sullivan et al. 2001b; Turk and Okifuji 2002).

Increasingly, researchers have turned their attention to questions concerning the mechanisms by which pain catastrophizing impacts on pain outcomes (Seminowicz and Davis 2006; Sullivan 2008; Turner and Aaron 2001). Research in this area has identified psychological, interpersonal (Cano 2004), physiological (Wolff et al. 2008), and neuroanatomical (Gracely et al. 2004) correlates of pain catastrophizing that might explain how pain catastrophizing impacts on pain experience. The identification of the mechanisms that link pain catastrophizing to pain outcomes has both clinical and theoretical implications. From a clinical perspective, understanding the processes by which pain catastrophizing influences the experience or expression of pain might point to new avenues for intervention that could reduce the suffering and burden of persistent pain conditions. From a theoretical perspective, understanding how pain catastrophizing influences pain might contribute to the elaboration or refinement of conceptual frameworks that address the linkages between psychology and physiology in the generation of pain experience.

This chapter summarizes research that has addressed the mechanisms implicated in the relation between pain catastrophizing and pain outcomes. Given the volume of research that has been conducted in this area, the review of the literature is intended to be illustrative as opposed to exhaustive. The chapter ends with a discussion of the clinical and theoretical implications of the research that has accumulated to date.

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