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Pain Catastrophizing and Function In Individuals With Chronic Musculoskeletal Pain

A Systematic Review and Meta-Analysis

Martinez-Calderon, Javier, MSc*; Jensen, Mark P., PhD; Morales-Asencio, Jose M., PhD‡,§; Luque-Suarez, Alejandro, PhD*,§

doi: 10.1097/AJP.0000000000000676
Review Articles

Objectives: Pain catastrophizing (PC) is the most consistent psychosocial factor predicting of adjustment to chronic pain and may contribute to the development and long-term maintenance of chronic pain. The aim of this review was systematically review and critically appraise the concurrent and longitudinal associations between PC and both pain intensity and disability in individuals with chronic musculoskeletal pain (CMP).

Materials and Methods: An electronic search of PubMed, Scopus, AMED, CINAHL, PsycINFO, and PubPsych databases, as well as gray literature, was undertaken from inception until September 2018. Cross-sectional and longitudinal studies reporting on the associations between measures of PC, pain intensity, and disability were selected for review.

Results: A total of 85 observational studies (92% cross-sectional) were included, with a total sample of 13,628 participants with CMP. Very low-quality evidence (based on the GRADE criteria) indicated that higher levels of PC were often, but not always, significantly associated with and prospectively predicted both chronic pain intensity and disability. Heterogeneity was large after conducting multiple meta-analyses.

Discussion: Despite the very low quality of the available evidence, the general consistency of the findings highlights the potential role that PC may play in delaying recovery from CMP. Research that uses higher quality study designs and procedures would allow for more definitive conclusions regarding the impact of PC on pain and function.

*Department of Physiotherapy

Department of Nursing, Faculty of Health Sciences, University of Malaga

§Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain

Department of Rehabilitation Medicine, University of Washington, Seattle, WA

J.M.-C. is supported by the University of Malaga through a predoctoral grant, Malaga, Spain. The authors declare no conflict of interest.

Reprints: Javier Martinez-Calderon, MSc, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa, 3, Malaga 29071, Spain (e-mail:

Received September 13, 2018

Received in revised form November 15, 2018

Accepted November 25, 2018

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