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Catastrophizing, pain, and functional outcomes for children with chronic pain: a meta-analytic review

Miller, Megan M.a; Meints, Samantha M.b; Hirsh, Adam T.a,*

doi: 10.1097/j.pain.0000000000001342
Systematic Review and Meta-Analysis: PDF Only

Pediatric chronic pain is associated with numerous negative outcomes including increased physical disability, increased rates of depression and anxiety, and decreased quality of life (QOL). Pain catastrophizing–broadly conceptualized as including rumination, magnification, and helplessness cognitions surrounding one's pain–has been linked with poor functional outcomes in children with chronic pain. Pain catastrophizing in pediatric chronic pain is often considered a key factor on which to focus treatment efforts. However, absent a systematic review that integrates the relevant literature, this call for routine assessment and targeted treatment may be premature. This study aimed to: (1) meta-analytically quantify the relationship between catastrophizing and pain and functional/psychosocial outcomes (functional disability/physical functioning, anxiety, depression, and QOL) in children with chronic pain, and (2) examine potential moderators of these relationships. Using a random-effects model, a total of 111 effect sizes from 38 studies were analyzed. Effect sizes ranged from medium to large, with anxiety, depression, and QOL demonstrating a strong association with catastrophizing. Pain intensity and physical disability had a moderate association with catastrophizing. These relationships were robust, minimizing potential publication bias. None of the examined moderators were significant. The strong relationships found between catastrophizing and anxiety, depression, and QOL suggest that successfully intervening on catastrophizing could have far reaching implications in improving pain outcomes in pediatric chronic pain.

aDepartment of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States

bDepartment of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, United States

Corresponding author. Address: Department of Psychology, Indiana University-Purdue University Indianapolis, LD124, 402 N Blackford St, Indianapolis, IN 46202, United States. Tel.: (317)-274-6942; fax: (317)-274-6756. E-mail address: athirsh@iupui.edu (A.T. Hirsh).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received March 04, 2018

Received in revised form June 04, 2018

Accepted June 20, 2018

© 2018 International Association for the Study of Pain
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