What Causes Pain Catastrophizing?

From the Lecture Series: Introduction to Psychology

By Catherine A. SandersonAmherst College

Psychological factors can lead to pain catastrophizing. For example, when we feel anxious or scared, signals from the brain’s stress-response system send messages down the spinal cord that make the pain get worse. This finding helps explain why people who catastrophize, ruminate and magnify pain, experience more intense pain and use higher levels of pain medication.

A woman with her head against a plastic sheet, screaming out of pain, stress, or anxiety
Fear and stress can magnify pain and make a person unable to manage it. (Image: Ullision/Shutterstock)

How to Test Your Tendency to Pain Catastrophizing

You can test your own tendency to pain catastrophizing, which means ruminating about and magnifying your pain yet feeling helpless to manage it, by answering the following questions:

  • I keep thinking about how much it hurts.
  • I can’t seem to keep it out of my mind.
  • I anxiously want the pain to go away.
  • I become afraid that the pain may get worse.
  • I wonder whether something serious may happen.
  • I think of other painful experiences.
  • I worry all the time about whether the pain will end.
  • I feel I can’t stand it anymore.
  • It’s awful and I feel that it overwhelms me.

These items measure three parts of catastrophizing: the tendency to ruminate about pain, magnify the experience of pain, and feel helpless to control pain.

Henry K. Beecher’s Observation

One of the first people to demonstrate how psychological factors influence the experience of pain and pain catastrophizing was Dr. Henry K. Beecher, who treated injured soldiers during World War II. Although all of the soldiers had undergone surgery for severe wounds, only 49% reported experiencing moderate or severe pain, and only 32% accepted medication when it was offered. 

When Dr. Beecher later evaluated civilian patients in his office who had undergone the same general type of surgery, 75% reported experiencing at least moderate pain and 83% requested medication. These contrasting observations led Beecher to believe psychological factors played some role in how people thought about the pain of surgery. 

Perhaps soldiers regarded their pain, however bad, as relatively minor when compared to their fellow soldiers who had not survived at all, whereas civilians saw their pain, however minor, as worse than that of the people all around them. Perhaps the soldiers even felt relieved to have had surgery and no longer being on the battlefield, so they found a positive upside to the pain that people in civilian life did not find.

This article comes directly from content in the video series Introduction to PsychologyWatch it now, on Wondrium.

Our Thoughts Influence Our Pain?

Later studies validated Beecher’s observations, demonstrating how our thoughts about pain have a major influence on our experience. People who believe their pain is caused by something very serious and debilitating perceive the pain as worse than those who believe the pain is caused by something minor and treatable.

A man suffering from headache
People in different psychological situations respond differently to a similar pain sensation. (Image: Carlos Caetano/Shutterstock)

People who willingly choose to undergo pain and/or recognize a clear benefit from that experience may well perceive it as less intense. Even subtle factors can affect our overall experience of pain.

Peak-end Theory

Nobel-prize-winning psychologist Daniel Kahneman proposes that our memories of both positive and negative experiences depend largely on how we feel at the peak, or more extreme part, of the experience and at the end of the experience. This is called a peak-end theory. 

In a simple illustration of this point, researchers found that people asked to put their hand in painfully cold water for 60 seconds would be more willing to repeat the experience if the same 60 seconds were prolonged with an additional 30 seconds of pain, when those last 30 seconds were somewhat less painful. 

That is, most people preferred to repeat the 90-second experience over the 60-second experience, even though they are in the same intense amount of pain in both conditions for 60 seconds, and actually have to endure pain for an extra 30 seconds.

Peak-end Theory in a Real-world Setting

Woman on a doctor's chair during a medical procedure, while the female doctor prepares the IV
Ending a medical procedure abruptly during the peak of the pain can make the patients feel uncomfortable trying the procedure again. (Image: Olena Yakobchuk/Shutterstock)

To show that these results replicate in real-world settings, where the pain is more intense and lasts longer, Kahneman conducted another test with patients who were undergoing a colonoscopy. This study was conducted in the 1990s, a time when only light sedation was more commonly used and patients could feel and remember the entire procedure. 

Patients in one group underwent the standard colonoscopy procedure for the standard amount of time. Patients in the second group underwent the same standard colonoscopy for the standard amount of time, but then for an additional three minutes, the scope was simply left inside their body, which caused some discomfort, but not pain.

Once again, people who underwent a longer procedure rated their experience as better when it ended with less pain than those who underwent the shorter and standard procedure. People who underwent the longer procedure that ended with mild discomfort were also more likely to return to the same physician for future procedures. 

Ironically, this finding suggests it’s better to “taper down” medical procedures, even if doing so increases their duration, than to end them more quickly and abruptly at a peak of the pain experience.

Common Questions about Pain Catastrophizing

Q: What psychological factors can lead to pain catastrophizing?

Some psychological factors can lead to pain catastrophizing. For example, in times of fear or anxiety, the brain’s stress response system sends messages to the spinal cord, leading to the worsening of the pain. These findings help researchers understand why people who catastrophize experience more severe pain and need stronger painkillers than people who don’t catastrophize.

Q: What is pain catastrophizing?

Pain catastrophizing is a condition in which a person constantly ruminates and magnifies pain in his mind while not being able to manage it.

Q: What was Dr. Henry Beecher’s observation?

Dr. Beecher was one of the first to show how psychological factors can affect pain experience and pain catastrophizing. During WWII, he examined two groups of patients: soldiers wounded in war, and civilians. While both groups had undergone similar surgeries, he found out that the soldiers reported much less pain than the civilians. The reason for this may have been that soldiers were comparing their situation with the unlucky soldiers who did not make it, while the civilians saw their situation as worse than the other ordinary people, and thus experienced more pain.

Keep Reading
The Critical Senses That We Aren’t Usually Aware Of
How Do Stressful Events Affect Our Well-being?
How Does the Fight-or-flight Response Work?