By Ed Coghlan
Over this weekend in her column for the National Pain Report, For Grace founder Cynthia Toussaint openly cringed at the use of “catastrophizing” at a recent Stanford Twitter Chat on chronic pain. We reached out to Beth Darnall PhD, a pain psychologist at Stanford who organized the Twitter chat (and interestingly is writing a book on catastrophizing pain due out in 2017). Here’s our interview:
National Pain Report: “What is a simple definition of catastrophizing?”
Dr. Darnall: “A negative mental set brought to bear in the context of actual or anticipated pain. (MJ Sullivan). You may wonder how one would not feel negatively about pain. Pain automatically grabs your attention and can trigger negative emotional responses. If you remain in that space of pain focus and negative emotions, it will serve to amplify pain in your spinal cord and brain. The trick is to identify it early, then use strategies to redirect the brain in order to dampen pain processing.”
National Pain Report: “Cynthia Toussaint made the point that using the term is particularly offensive to women in pain–do you agree?”
Dr. Darnall: “The science shows that men and women catastrophize equally. It is a gender-neutral experience, so I disagree at the surface. When women have experiences of having been marginalized or judged by medical professionals—their pain was disbelieved—then the term may be experienced as offensive, absolutely. The experience of being offended is predicated on one’s experience with the professional, and with how the term is used. It should not be used pejoratively. Women are more likely to have such pejorative experiences, as Cynthia correctly notes. On the flip side, ignoring it altogether would be a tremendous and unethical disservice.
We need to be careful here. Pain is a psychobiological experience with potentially greater implications for women. I believe we should focus on better treatment that attends to all aspects of the pain experience.
I understand the label “catastrophizing” can be off-putting. I would love for someone to create an alternative that is both accurate and engenders receptivity.”
National Pain Report: “Pain sufferers do get very defensive when it’s stated or implied that the pain “is in their head”, right?”
Dr. Darnall: “Rightly so. I say this frequently: Your pain is real and your pain is medically based. And yet, psychological factors will either amplify or dampen pain processing in your nervous system. Across multiple scientific studies and decades of research, catastrophizing turns out to be one of the most powerful predictors of pain outcomes. Personal empowerment lies in understanding how to best modulate pain processing—these are learned skills. To say someone has high levels of catastrophizing does not imply their pain isn’t real. It tells me that I can help them reduce their suffering around pain—and decrease pain intensity—by treating it.”
National Pain Report: “The Twitter chat was promoting the importance of pain psychology in the continuum of care–talk about the progress being made in having both physicians prescribe and insurance companies pay for pain psychology.”
Dr. Darnall: “In the 2016 study put forward by the AAPM Pain Psychology Task Force (“Pain Psychology: A Global Needs Assessment and National Call to Action; Darnall BD et al. Free and open access here: http://www.ncbi.nlm.nih.gov/pubmed/26803844) survey respondents identified insurance coverage as being a barrier to good pain psychology care. This report published 2 months ago, so I am not aware of policy progress in that short time lapse, but the information alone is progress toward our understanding of what needs to change. Critically, we need better pain training and education for mental health professionals and psychologists in the U.S. to best equip them to treat the psychological and behavioral aspects of pain with their clients. Our study showed that currently, many therapists feel ill-prepared to treat pain and thereby avoid it; it’s a huge missed opportunity to reduce suffering for men and women alike.”