Pain Catastrophizing: Is it making your chronic pain worse?

By March 10, 2018May 9th, 2019No Comments

Pain catastrophising

Pain Catastrophizing: Is it making your chronic pain worse?


Are you scared your pain won’t get better?

Are you afraid your pain will get worse?

Does your pain make you feel anxious – a lot?

If you are dominated by thoughts of your pain – it might be making your pain worse.

When you live with constant pain, unpredictable symptoms & low levels of energy – it is only natural that you don’t have a sunny outlook on life.

However, if your mind is occupied with negative thoughts & feelings – it can increase your levels of pain.


Pain catastrophizing is the tendency to have unhelpful, dominating thoughts.


Pain catastrophizing is a very normal response to pain but it can hamper your recovery & intensify your pain levels.

Studies have found that for people with chronic pain – pain catastrophizing can lead to a range of nasty experiences including:

  • Greater pain intensity
  • Muscle & joint tenderness
  • Increased tension
  • Disability
  • Lower chance of successful treatment (such as surgery)

Studies have also linked pain catastrophizing to developing chronic pain after injury.

People with a tendency for pain catastrophizing were 47% more likely to develop chronic lower back pain after a period of acute pain.

Pain catastrophising

Why does Pain Catastrophizing Make Your Pain Worse?


When you are in pain – a natural response is to feel anxious, worried or stressed.

Pain catastrophizing increases these feelings of anxiety, stress & worry.

In response to the pain & distress, your body produces the stress hormone – cortisol.

Cortisol prepares you for fight or flight.

It does this by raising your heart rate, increasing blood flow & keeping you alert.

All great if you stumble across a grizzly bear but very unhelpful for chronic pain.

Pain & stress have a nasty two-way effect

Cortisol increases the intensity of the pain signals from your body to your brain.

Pain catastrophizing increases your feelings of distress.

The more distressed you feel when you are in pain – the more pain you feel.

If you are concerned about your levels of distress you might like to read our article on 7 Surprising Signs of Depression.

Rachel Kovacevic, clinical psychologist & director of Innovative Rehab, says it is possible to reduce the impact of pain catastrophizing & the associated pain & distress.

“It’s not easy, but with a bit of coaching, most people can learn to recognise and settle the stress response that is triggered by pain.  Over time, this can have a real impact on the pain experience.”


Pain catastrophising

How to Recognize Pain Catastrophizing


One proven way to combat pain catastrophizing is to recognize it.

Research has found 3 common thought patterns related to pain catastrophizing:

Rumination – are your thoughts dominated by ‘what if?’ and ‘worst case scenarios’? If you focus on the negative aspects of your pain this increases your feelings of distress. Increased distress leads to increased cortisol & increased pain intensity.

Magnification – it can be very easy to blow things out of proportion when you are in intense pain. For example ‘this pain is so intense there must be something seriously wrong’ or ‘my spine must be snapping’. These exaggerated thoughts are often driven by a fear of what might happen – rather than by what is actually happening or likely to happen.

Helplessness – believing there is no positive way to manage or overcome pain is a horrible feeling. If you ever feel like “I can’t go on” or “things will never get better” you probably feel helpless. Feeling helpless not only feels awful but also can lead you to quit treatment that could help in the long term.

Pain catastrophizing is a very normal response to your pain.

The key thing is to recognise these thought & feelings & work to reduce their impact.

How to Reduce the Impact of Pain Catastrophizing


You can reduce the impact of pain catastrophizing by staying aware of your thoughts.

Try to step back from them & see things in proportion.

Although easier said than done – try to focus on the positive to reduce the impact of pain catastrophizing.

  • Focus on what you can do rather than what you can’t.
  • Recognize every win – no matter how small & celebrate it!
  • Learn the science of pain so you understand what your body is doing every time you are in pain. Sign up for a free mini-course here.
  • Learn psychological strategies such as cognitive behavioural therapy (CBT) or acceptance & commitment therapy (ACT).
  • Adopt a holistic approach to wellness & learn self-care strategies for your body, mind & social wellbeing.
  • Plan ahead for a pain flare up. Make a list of strategies that work for you so you can avoid catastrophic thinking during the hardest of times.
  • Talk things through with a professional such as your doctor, a psychologist or a counsellor.



Pain catastrophizing is a very normal response to pain but it can hamper your recovery & increase your pain.

If your mind is dominated by negative thoughts of your pain, you will feel more distressed. Increased distress will increase your body’s production of the stress hormone, cortisol.

Higher levels of cortisol increase the intensity of pain signals to your brain.

Reduce the impact of pain catastrophizing by recognising unhelpful thoughts & feelings when they occur.

By recognising these unhelpful thoughts you can then step back & view them in proportion.

There are a number of proven strategies that can help to reduce the impact of pain catastrophizing.

Try to focus on the positives & what you can do rather than what you can’t.

Do you recognise any of the thought patterns associated with pain catastrophizing in yourself?