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Pain Catastrophizing Predicts Pain Intensity, Disability, and Psychological Distress Independent of the Level of Physical Impairment

Severeijns, Rudy M.Sc.*; Vlaeyen, Johan W.S. Ph.D.; van den Hout, Marcel A. Ph.D.; Weber, Wim E.J. Ph.D.

The Clinical Journal of Pain: June 2001 - Volume 17 - Issue 2 - p 165-172

Objective The aim of the current study was to examine the relation between catastrophizing and pain intensity, pain-related disability, and psychological distress in a group of patients with chronic pain, controlling for the level of physical impairment. Furthermore, it was examined whether these relations are the same for three subgroups of chronic pain patients: those with chronic low back pain, those with chronic musculoskeletal pain other than low back pain, and those with miscellaneous chronic pain complaints, low back pain and musculoskeletal pain excluded.

Design Correlational, cross-sectional.

Patients and Setting Participants in this study were 211 consecutive referrals presenting to a university hospital pain management and research center, all of whom had a chronic pain problem.

Results Overall, chronic pain patients who catastrophize reported more pain intensity, felt more disabled by their pain problem, and experienced more psychological distress. Regression analyses revealed that catastrophizing was a potent predictor of pain intensity, disability, and psychological distress, even when controlled for physical impairment. No fundamental differences between the three subgroups were found in this respect. Finally, it was demonstrated that there was no relation between physical impairment and catastrophizing.

Conclusions It was concluded that for different subgroups of chronic pain patients, catastrophizing plays a crucial role in the chronic pain experience, significantly contributing to the variance of pain intensity, pain-related disability, and psychological distress. These relations are not confounded by the level of physical impairment. Some clinical implications of the results are discussed. Finally, the authors concluded that these results support the validity of a cognitive–behavioral conceptualization of chronic pain–related disability.

*Department of Medical Psychology and ‡Pain Management and Research Center, University Hospital of Maastricht; and the †Department of Medical, Clinical and Experimental Psychology, University of Maastricht, Maastricht, The Netherlands

Received November 3, 2000;

revised February 9, 2001; accepted February 21, 2001.

Address correspondence to Dr. R. Severeijns, Department of Medical Psychology, University Hospital of Maastricht, PO Box 5800, 6229 HX Maastricht, The Netherlands; email:

© 2001 Lippincott Williams & Wilkins, Inc.