Pain Catastrophizing Higher in Patients with Obesity

Pain is widely considered the “fifth vital sign” — and for good reason. By some estimates, pain accounts for as much as 4 out of every 5 doctor visits in the US. Thus, learning more about the correlates and determinants of pain is particularly important.

Recent pain management practice has reflected a greater understanding of the complex factors that lead to pain, including the potentially complex combination of sensory, emotional, cognitive, and personalized factors that lead to it. An even further step in pain treatment is an examination of psychosocial factors, including pain catastrophizing, which is characterized by the tendency to magnify the threat value of a pain stimulus and to feel helpless when facing pain — as well as a relative inability to prevent or inhibit pain-related thoughts before, during, or after experiencing the discomfort.

Many pain management specialists have come around to the idea that pain catastrophizing is a significant predictor of a variety of pain-related outcomes. A study in Headache recently looked at the relationship between pain catastrophizing and obesity and found a strong connection between pain severity and low rates of treatment effectiveness.

The study participants consisted of 105 women who both suffered from migraine and were seeking weight-loss treatment. The participants recorded daily migraine activity for a month on a smartphone and completed the Pain Catastrophizing Scale (PCS). The PCS was developed as part of seminal research by Michael Sullivan, PhD, and it has subsequently been widely used in clinical practice and research.

One-quarter of the patients met the criteria for clinical catastrophizing, including a higher body mass index, longer duration of migraine attack, and greater experience of depression and anxiety. The odds of chronic migraine were nearly fourfold greater in those with PCS scores greater than 30, which was the baseline measure used to determine clinical catastrophizing. In all participants, higher PCS scores were linked to more days suffering from migraine, longer duration, and lower scores on the Headache Management Self-Efficacy Scale.

Alongside other research showing that pain catastrophizing is related to exaggerated negative mood and depression, and given that chronic pain is associated with high rates of suicide and suicide ideation, the need for greater awareness of — and treatment for – pain catastrophizing is clear.

This study adds to the growing evidence that high levels of catastrophizing should be considered a risk marker for adverse pain-related outcomes and should become a more prominent target of chronic pain management programs.