Researchers found that dwelling on pain, magnifying its threat, and feeling helpless about it impairs fibromyalgia (FM) patients’ ability to control it and leads to its exacerbation.
Scientists refer to this pre-occupation with pain as pain catastrophizing. Reducing pain catastrophizing may help improve FM symptoms, the researchers said.
Their study, “Catastrophizing Interferes with Cognitive Modulation of Pain in Women with Fibromyalgia,” was published in the journal Pain Medicine.
Fibromyalgia is a chronic pain condition that is also accompanied by sleep disturbance, fatigue, and cognitive problems.
The experience of pain in FM is influenced by many factors, including psychological, biological, behavioral, cognitive, and social. One factor, pain catastrophizing, is a cognitive and emotional response to pain that involves a tendency towards dwelling on it, magnifying the threat associated with it, and feeling helpless.
Doctors know that pain catastrophizing is related to symptom severity, disability, distress, and poor prognosis. Experimentally, pain catastrophizing has been shown to be associated with increased anticipation, greater sensitivity, and exaggerated brain responses to pain stimuli.
Pain modulation refers to a change in pain sensitivity that is mediated by both internal and external factors, the latter of which can include mood, distraction, and exercise. An example of pain modulation is a person feeling less pain when they are distracted. Dysfunctional pain modulation is associated with increased risk of chronic pain and is characteristic of FM.
There is limited data on the relationship between catastrophizing and pain modulation in FM. So researchers decided to study the relationship between pain catastrophizing and brain responses to pain in FM patients and healthy controls.
Twenty women with FM and 18 healthy controls underwent functional magnetic resonance imaging while receiving pain stimuli, some administered alone and some during distracting cognitive tasks.
In the study, the ability to modulate pain was demonstrated if the pain ratings were lower when an individual was distracted than when they received the pain stimuli without being distracted.
Pain ratings were assessed after each stimulus, and catastrophizing was assessed using the Pain Catastrophizing Scale (PCS).
Results showed that there was a significant relationship between PCS scores and pain ratings, with or without distraction.
“Our results show that the tendency to catastrophize about pain interferes with the neural processes involved in pain modulation in FM,” the researcher wrote.
Essentially, FM patients who exhibited higher levels of pain catastrophizing, as reflected by their PCS scores, were less able to distract themselves from pain. This indicated there were catastrophizing-related impairments in pain modulation.
“The study provides evidence that an FM patient’s tendency toward catastrophizing influences the ability to actively engage the central nervous system to inhibit pain during distraction,” the researchers wrote. “Therapies to reduce catastrophizing including cognitive-behavioral therapy and exercise may be effective for improving symptoms in FM patients via improvements in pain modulation.”