Targeting a Saboteur of Surgical Outcomes: Pain Catastrophizing
Pain catastrophizing is a negative cascade of cognitive and emotional responses to actual or anticipated pain. For instance, one may worry a great deal about the possibility that their pain will worsen. Or they may find themselves fearfully ruminating that there may be a serious yet unknown medical problem underlying their pain. Or they may be unable to disengage from how awful and horrible their pain is.
Pain catastrophizing is commonly measured with the Pain Catastrophizing Scale.1 The Pain Catastrophizing Scale is a 13-item self-report measure that contains 3 subscales:
- feelings of helplessness.
Respondents indicate how frequently they experience each of the catastrophizing items, with 0=”not at all” to 4=”all the time”. The 13 items are summed to yield a total catastrophizing score (0-52). A person’s sum score can predict many different types of outcomes, and for this reason pain catastrophizing provides a powerful example of how one’s psychology can influence one’s health.
Greater Catastrophizing Score, Greater Pain Intensity
A quarter century of research has shown that higher catastrophizing scores are associated with greater pain intensity and disability in outpatient chronic pain patients. Catastrophizing is also associated with poorer response to multidisiciplinary and medical treatment for pain,2-4 thus underscoring the value of early screening and intervention.
Studies in adult surgical patients have shown that pre-surgical pain catastrophizing predicts post-operative:
- pain intensity4,5
- opioid use4,6
- whether or not a person will have their pain persist after surgery.
In other words, catastrophizing can predict the development of post-surgical chronic pain.5,8
The recent Rabbitts et al study extends our understanding by showing that parental catastrophizing similarly has a negative impact on postsurgical pain in children.9 These findings underscore the need to screen parents / caregivers for catastrophizing and to provide education and catastrophizing treatment prior to their child’s surgery as a pathway to optimizing pediatric surgical outcomes. Given the volume of surgeries performed each year, brief, targeted, and easy-to-access catastrophizing treatments are needed.
Stanford's "My Surgical Success" Program
At Stanford, we developed My Surgical Success© as an online, fully automated perioperative psychobehavioral treatment package that delivers targeted treatment for pain catastrophizing. The idea is to treat catastrophizing before the surgery. We are currently conducting pilot studies in multiple adult surgical populations at Stanford to determine its effect on post-surgical outcomes. Our goal is to adapt the intervention for the parents of children undergoing surgery so they can learn more about how to help their children recover from surgical with less distress.
Until brief treatments are fully developed and widely available, health care providers may consider talking to parents about how their psychology and behavior impacts their child—and how it can relate to their child’s surgery. Such information may motivate parents / caregivers to learn more about monitoring their own distress, and learning how to best respond to their child’s distress. It is important for both parents and children to learn about catastrophizing, be able to identify it and stop it; in other words, to “de-catastrophize”.
A critical aspect of stopping and preventing catastrophizing is learning and using adaptive coping behaviors because these counter feelings of helplessness—one of the three components of catastrophizing. An important pre-emptive step for parents is to develop a list of things they can do to help their child when their child is in pain or distress. Foremost on that list is controlling their own stress responses so that they model calmness and are able to make decisions that will best help their child--not just in the moment--in the very long run.