Association of Pain Catastrophizing with Clinical Outcomes for Chronic Widespread Pain: A Retrospective Cohort Study




Vu, Stephanie
Thornton, Tyler
Baker, Joshua


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Purpose: Chronic widespread pain (CWP) is diffuse musculoskeletal pain lasting for 3 months or longer and is associated with numerous psychological symptoms, including fatigue, distress, difficulty concentrating, and depression. It affects over 20% of the population and may contribute to adverse health effects. Pain catastrophizing is defined an exaggerated negative mental set brought to bear during actual or anticipated painful experience. This study aimed to measure the association between pain catastrophizing and CWP, focusing on such clinically relevant outcomes as pain intensity, disability, and health-related quality-of-life (HRQOL) deficits. Methods: Study participants were selected from the PRECISION Pain Research Registry during the period from April 2016-December 2021. Eligible participants had chronic low back pain according to the National Institutes of Health case definition at registry enrollment and ranged from 21 to 79 years of age. Participants were classified as having CWP if they reported being "bothered a lot" by widespread pain or pain in most of their body in the 4 weeks prior to enrollment. Pain catastrophizing was measured at enrollment with the Pain Catastrophizing Scale and participants were classified as low, intermediate, or high pain catastrophizers based on tercile cutpoints. Multiple logistic regression was used to identify predictors of CWP at enrollment, and clinical outcomes were measured at quarterly encounters over 12 months. The primary outcomes included low back pain intensity measured with a numerical rating scale, back-related disability measured with the Roland-Morris Disability Questionnaire (RMDQ), and HRQOL measured with the SPADE cluster (sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue). Repeated measures analysis of variance was used to compare outcomes over 12 months according to pain catastrophizing level, including adjustment for potential confounders using propensity scores. Results: A total of 1,260 participants were studied. There were 337 (26.7%) participants with CWP, of whom 212 (62.9%) had complete follow-up data. Pain catastrophizing was the strongest predictor of CWP (OR, 1.93, 95% CI, 1.39-2.68; P< 0.001 and OR, 3.22, 95% CI, 2.10-4.94; P< 0.001 for intermediate and high pain catastrophizers vs. low pain catastrophizers, respectively). A strong association was initially observed between pain catastrophizing and all longitudinal outcomes (P=0.004 for low back pain intensity, and P< 0.001 for back-related disability and HRQOL). However, only the findings for back-related disability and HRQOL remained significant following adjustment for confounders. The overall mean RMDQ scores were 16.0 (95% CI, 14.7-17.3), 16.6 (95% CI, 15.7-17.5), and 18.4 (95% CI, 17.7-19.1) (P< 0.001) for low, intermediate, and high pain catastrophizers, respectively. Similarly, the overall mean SPADE scores were 57.9 (95% CI, 56.3-59.6), 60.5 (95% CI, 59.4-61.6), and 63.2 (95% CI, 62.3-64.1) (P< 0.001) for low, intermediate, and high pain catastrophizers, respectively. Conclusions: This study demonstrates that pain catastrophizing strongly predicts long-term disability and HRQOL deficits in patients with CWP. There is a need for further investigation into psychological treatments aimed at reducing pain catastrophizing to mitigate its impact in this population.