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When Pain Catastrophizing Is Not Catastrophizing: Identifying Normative From Exaggerated Responses Relative to Referent Pain Intensity
Journal article   Open access   Peer reviewed

When Pain Catastrophizing Is Not Catastrophizing: Identifying Normative From Exaggerated Responses Relative to Referent Pain Intensity

Laura A. Frey-Law, Jennifer E. Lee and Adam Janowski
Pain research & management, Vol.2025(1), 8839902
01/2025
DOI: 10.1155/prm/8839902
PMCID: PMC12602029
PMID: 41221104
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1155/prm/8839902View
Published (Version of record) Open Access

Abstract

Background Although pain catastrophizing has been studied widely, there is no consensus on what constitutes an exaggerated response, that is, true catastrophizing, from what might be proportional unpleasant or negative responses to pain. Most available catastrophizing assessments ask respondents to consider when “in pain,” with no assessment of these referent pain anchors. Thus, the influence of referent pain on catastrophic thinking remains unclear. We aimed to assess consistency across referent pain scenarios and to characterize “high” catastrophizing—representing exaggerated responses relative to referent pain intensity. Methods A total of 228 adults (152F) completed this observational study. The Pain Catastrophizing Scale (PCS) was completed 4 times interspersed with other assessments. First, with standard instructions, then with specific referent scenarios in a blocked order to minimize order effects. Anticipated scenario pain intensities were rated using a 0–10-cm scale. PCS cross-situational consistency was assessed with intraclass correlations. Mixed linear models evaluated the PCS—referent pain relationship, with and without covariate adjustment. Results PCS cross-situational consistency was high, with ICCs = 0.79–0.84. However, total scores varied significantly across referent scenarios, where catastrophizing generally increased with referent pain intensity (R = 0.74, p < 0.0001), and pain explained 40% of PCS variability. The best fit model of “high” catastrophizing, using the 75th percentile, varied with referent pain intensity, underscoring the importance of contextual anchors, without notable sex differences. Conclusions Trait PCS scores should not be interpreted as context-free indices of catastrophizing. The wide range of published PCS cut points may in part reflect differences in referent pain, highlighting the need to contextualize catastrophizing scores for appropriate interpretation.
 mixed linear models negative affect negative emotionality Pain Catastrophizing Scale (PCS) pain intensity pain rating schema repeated measures state catastrophizing trait catastrophizing UIOWA OA Agreement

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