Pain Catastrophizing and Back Muscle Endurance
Tuesday, October 19, 2010 at 1:00PMPain catastrophizing sounds like something you do when a mother-in-law comes to visit.* The term, though, has become popular in the medical pain literature of late and is worth considering.
Pain catastrophizing “refers to a negative view of the pain experience.” Often it is exaggerated or out of proportion to what generally would be expected. “Sometimes it refers to a person 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.”[1]
I see people in the office every day that have divergent habits for managing pain. On one hand, I have the prototypical old-time rancher with a horrible looking spine on x-rays who does not want pain medication or surgery but is interested in a shot or exercises to them get back out to bale more hay (or whatever else they do on a ranch). On the other hand, I have pain catastrophizers – people that are incapacitated by the pain experience, paralyzed by “rumination, magnification and helplessness.”[2]
A recent study published in Spine shed some important light on this cycle of pain catastrophizing and offers potential solutions worth considering. [3]
The authors took a group of healthy and chronic low back patients and attempted to measure whether pain-related psychological characteristics such as pain catastrophizing and kinesiophobia are related to physical deconditioning. The investigation demonstrated several interesting findings:
- Subjects with high pain catastrophizing scores showed lower back muscle endurance
- Subjects with chronic back pain and low pain catastrophizing scores showed signs of better back muscle endurance than healthy controls
At first blush those findings may not look that surprising. However, the fact that people with pain but low pain catastrophizing scores demonstrated higher levels of endurance than even controls would suggest that “a subgroup of chronic low back pain patients try to ignore pain sensations by attention diversion and tend to finish all activities despite severe pain (pain-related behavioral endurance).” [4] So some people are good at “toughing it out.” Others fear activity and get trapped in a cycle of diminished activity, associated diminished endurance in back muscles and inevitable increase in pain.
“Avoiders were more fatigable than “confronters”. [5] Maybe that should be a mantra for life.
In the end, this study reinforces the notion that exercise programs, even if “they do not deliberately target cognitive factors can reduce pain catastrophizing in addition to address physical conditioning.” [6]
*Just for the record, I am (or was) on good terms with my mother-in-law.
[1] eOrthopod
[2] Spine 2010. 35(22): E1178-1186
[3] Spine 2010. 35(22): E1178-1186
[4] Spine 2010. 35(22): E1178-1186
[5] Spine 2010. 35(22): E1178-1186
[6] Spine 2010. 35(22): E1178-1186
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