Pain catastrophizing

[OtisDaMan]

I've always been "okay" with chronic pain, in the sense that I am still willing to exercise - hard or moderate - while knowing a bucket of pain descends upon me as a consequence, fading only slowly within a few hours of ceasing the exercise. So, does admitting to a doctor that "I know I will be in more pain" after doing exercise X somehow constitute "pain castrophizing", or is it as I've always thought just a reasonable assessment of years of experience and experimenting to see if the pain could be avoided/reduced without avoiding the associated exercising?

Perhaps a better question I would like some answer to, whether from a pain specialist and/or GP and/or patient is this:

"In terms of verbal responses to questions about pain, what would you consider to be the bare minimum response that would be a reasonable indicator of pain catastrophizing?" Or several questions that explore the patient's responses and the minimum response you would consider as a set to those questions?

I'm rather curious about this now, given so much variation in the scientific literature on this concept and its manifestations.

[Tuckamore]

Great conversation. In my experience all physicians chose terms to use to their advantage!...... For or against their patients.

In my many years in the medical field this term is not one I have heard, "Pain Catastrophizing" which doesn't mean it's not utilized. It however means to me that it is not widely used in my area of the USA. ....which I find comforting.

Dgg I think you are correct in your assumption. I continue to do the things that I know will increase my pain...and I do so with a healthy attitude. I think that is the difference between acceptance ....living with chronic pain...and "Pain Catastrophizing."

Just my two cents worth....
~Tuck

[deadgamegrrl]

Hi!

I agree with inga511 about the exercise.  And I think that the difference in 'catastrophzing ' and real statements of fact should not be misinterpreted by the medical community.  I'm somewhat horrified to find out that this is going on.  I guess I'm lucky in that I have been with my PCP for 25 years, well before my fibro diagnosis this year, and we have a great relationship.
Even before I had CP, if I exercised, I experienced muscle soreness to one degree or another.  If I didn't, I probably wasn't working hard enough!  To me, that statement is legitimate fact!
If I was catastrophizing, it would be more along the lines of:  if I lift these weights, I'm going to be unable to function for weeks, and I'll probably injure myself and never recover etc.  Just like the difference between other healthy thoughts ie 'my marriage is breaking up, I'm grieving and money is going to be really tight' and catastrophe thoughts 'my marriage is breaking up, no one will ever love me again, and I'm going to end up a bag lady on the street'.
Thank you for bringing this topic up.

~~ dgg

[OtisDaMan]

Thank you Tuck, and Inga511, for communicating with me on this. Tricky, pain is. [h/t Yoda]

The term has been in the clinical literature for quite some time, which is good up to a point as it implies that the clinical definition is now relatively stable (ie doctors define their "cut-offs" for assessment of a patient as "pain catastrophizing" or not). However, our clinical and academic knowledge of the chronic pain conditions is much more advanced when compared to the date of the original definition of the term "pain catastrophizing".

My interest in this, I suppose, is that doctors may carry around the old connotations of the term "pain catastrophizing" as part of their stereotypical template for assessing the condition in a patient; meanwhile, advances in both the science and technological aspects of chronic pain knowledge have led to a newer group of doctors and specialists who interpret the term "pain catastrophizing" in a subtle but distinctly different way to their peers on the surgery floor. Obviously some to-ing and fro-ing happens between older and younger cohorts of doctors, and this is one of the quite legitimate mechanisms by which meanings evolve.

Which leads to the behind the back use of this epithet as connoting someone who is simply unable to handle the mildest setback in life, like a splinter or bothersome spiderbite or a few headaches, etc. The words chosen for a new expression must be chosen I think, with some view as to future usage. It is as much an ethical issue as it is a scientific or clinical one. In mathematics, many words are co-opted from modern English, and this can lead to some---ah, unsettling overhead conversations. In mathematics though, the risk of causing harm by use of a slightly ambiguous epithet for a new symbol, or something, is fairly slight indeed. But a specialist in pain care?

Finally, I am impressed with your answer, inga511, concerning exercise as helping in other ways that are important to you - a clearer feeling cognitively speaking is important to me too, and like you I have found exercise beneficial. While I do detest swimming - it hurts my neck even with good training - I found walking at a relatively set pace for 30--45 min to be good. Oddly enough, anything less than about 20 mins often left me feeling much worse; maybe it stirs up the pain-causing circuits, but isn't a long enough time exercising to kick in the pain-modulators, Nature's Own Endorphins (morphine, anyone). Keep it up, just be careful not to confuse injury with normal chronic pain; I've done that on the odd occasion and it prolongs healing.

[inga511]

Otis-I don't know if I am catastrophizing but I have exercised for years knowing that I would be in extreme pain for days afterwards bc I believed that was just part of life. That life was pain. I didn't know differently until I recieved my diagnosis of Fybromyalgia that I actually had a pain condition. That not everyone was in pain all the time. That was a wake up call. Now I exercise because it clears my head and I am willing to pay the price even if it means being in pain.

Inga

[Tuckamore]

Hello Otis,

Haven't seen you for awhile. It's good to hear from you but sorry you are still struggling with chronic pain. You know we can relate.

Pain catastrophizing is a fairly new term and concept....or at least relatively new to being to tagged. I found this good explanation: "It refers to a negative view of the pain experience. It is exaggerated or blown out of proportion. Sometimes it refers to a patient who actually has pain already. In other cases the person isn't even in pain yet -- he or she is still just anticipating it might happen." It's also being suggested that catastrophizing is strongly associated with depression.

I too have a lot of questions about this term and how it is diagnosed. Personally I find that the literature is not very clear and varies from article to article.

In my humble opinion you are not experiencing and or exhibiting "pain catastrophizing."  My PCP who is also my PMP claims that I am a survivor and a fighter who accepts my CP very well.....one of the reasons she gives is because even though I know or recognize that a certain activity will induce or greatly increase my pain I do it any way....because I choose to live as normal of a life as possible in spite of my chronic pain.

In my opinion one could not successfully argue that, that is pain catastrophizing for a variety of reason. I assume that would hold true for you. You chose to exercise in spite of your CP and knowing full well what will follow. It's called living your life...trying to function within "normal" parameters....and accepting the consequences without depression...or without fear of the exacerbation of your pain.  That's how I understand it.

I hope others will comment. I think you asked a very good question. This is a fairly new concept or assumption, so it may be that not very many ppl are familiar with it yet.

I'll be very interested to hear what your physician(s) have to say about your question(s).

Peace,
~Tuck