The Communal Coping Model of Pain Catastrophising: Clinical and Research Implications

Abstract Pain catastrophising has been broadly defined as an exaggerated negative orientation to actual or anticipated pain comprising elements of rumination, magnification, and helplessness. Hundreds of studies have documented associations between pain catastrophising and adverse pain outcomes, including heightened pain intensity, mental health problems, and disability. This article contrasts different conceptual models that have been advanced to explain how pain catastrophising might impact on pain outcomes. It is argued mat traditional "intrapersonal" models of pain catastrophising are overly simplistic and lacking in explanatory power. Research is reviewed showing mat interpersonal variables and social context are central determinants of the relation between pain catastrophising and pain outcomes. Discussion addresses the clinical implications of research showing that interpersonal factors underlie the relation between pain catastrophising and adverse pain outcomes. Discussion also addresses the implications of research on the interpersonal dimensions of pain catastrophising for theories of the psychology of pain. Keywords: catastrophizing, pain, disability, depression Over the past two decades, pain catastrophising has emerged as one of the most robust psychological predictors of pain-related outcomes (Edwards, Bingham, Bathon, & Haythornthwaite, 2006; Sullivan et al., 2001; Turk, Meichenbaum, & Genest, 1983; Weissman-Fogel, Sprecher, & Pud, 2008). Hundreds of studies have documented associations between pain catastrophising and adverse pain outcomes, including heightened pain intensity, mental health problems, and disability (Edwards et al., 2006; Keefe, Rumble, Scipio, Giardano, & Perii, 2004; Sullivan et al., 2001; Turk & Okifuji, 2002). Increasingly, researchers have turned their attention to questions concerning the processes by which pain catastrophising impacts on pain outcomes (Seminowicz. & Davis, 2006; Sullivan, 2008; Turner & Aaron, 2001). Research in this area has identified psychological, interpersonal (Cano, 2004), physiological (Wolff et al., 2008), and neuroanatomical (Gracely et al, 2004) correlates of pain catastrophising that might explain how pain catastrophising impacts on pain experience. The identification of the mechanisms that link pain catastrophising to pain outcomes has both clinical and theoretical implications. From a clinical perspective, understanding the processes by which pain catastrophising influences the experience or expression of pain might point to new avenues for intervention that could reduce the suffering and burden of persistent pain conditions. From a theoretical perspective, understanding how pain catastrophising influences pain outcomes might contribute to the elaboration or refinement of conceptual frameworks that address the linkages between psychology and physiology in the generation of pain experience. This article focuses on research that has addressed the interpersonal processes involved in the relation between pain catastrophising and pain outcomes. Given the volume of research that has been conducted in this area, the research reviewed in this article is intended to be illustrative as opposed to exhaustive. The article ends with a discussion of the clinical and theoretical implications of the research that has accumulated to date. Catastrophising: The Construct Pain catastrophising has been broadly defined as an exaggerated negative orientation to actual or anticipated pain comprising elements of rumination, magnification, and helplessness (Sullivan et al., 2001). Early research on pain catastrophising proceeded in the relative absence of a guiding theoretical framework (Spanos, Perlini, & Robertson, 1989). Interest in pain catastrophising continued to grow primarily as a. result of the consistency with which research showed that pain catastrophising was associated with a wide range of adverse health and mental health outcomes. …