Pain Catastrophizing Affects Stair Climbing Ability in Osteo Arthritis (2019), Suzuki, Y et al.

This research in Clinical Rheumatology arrived in my Stork reseach feed this morning.
https://doi.org/10.1007/s10067-019-04881-y
Is there no end to the fad concept of catastrophizing? Could it be that people with knee osteoarthritis know from experience that stair climbing, above all other activities of daily living, can be excruciating and occur spontaneously? From my personal experience, yes.

Instead of asking why stair climbing is more painful than other activities, or even make the case that the question needs to be asked, the patient is labeled and given the responsibility of performing magic or magically thinking: that they can effect a change in a long process of cartilege degeneration.

Stair climbing uses every tissue around the knee and is a one-sided weight bearing movement which is highly stressing. It is not a stationary, direct up and down type of movement. It is highly stressing.

I think that the pain catastrophizing concept has run its course.

I find it disheartening.

 

I have not yet managed to see the questions in the questionnaire but do they ask:

1. Do you have an exaggerated response to pain, compared to normal people?
2. Do you ruminate on pain more than normal people do?
3. Do you get more emotional about pain than normal people?

Because if not, how do they know that the response is more than normal people?

If you had trouble doing stairs because of OA I think
a) you would think things pretty bad
b) you would do better with a knee replacement than a chat with a lady in a blue cardigan

 

The study headline is way out of line. It clearly implies a causal relationship. This is a cross-sectional study. It cannot show a causal relationship. It is obvious that people will be more worried about pain when they know they will do something that will cause them more pain. To define that "catastrophizing" as if it is a form of unwarranted exaggeration rather than something based on patients' experience is insulting and demeaning.

 

This is what psychologists think people need to cheer them up on Christmas Eve.
Beggars belief really.

 

It's nice being Jewish and not feel like you have to feel anything one way or the other on Christmas Eve.

 

An elderly family member has had a knee replacement as of late, and before that, he had to go down the stairs backwards. He was truly bone on bone. Getting up from sitting was also excruciating.

i despise the use of catastrophizing terminology and its use in research to imply that patients are over-emotional about their pain. Typically it is used in conjunction with poorly explained diseases and conditions such as chronic pain, fibromyalgia and occasionally ME.

In the case of OA, what are the benefits of using the concept of catastrophizing? Who benefits? health care systems who seek to delay costly surgeries? Psychology programs who want to educate patients on what catastrophizing is, so they can pre-blame patients and prevent them from complaining to their physician about the problem?

Catastrophizing as a measure of distress in research and clinical care must stop. It Is disrespectful and insulting to patients.

 

The study is supported (funded?) by Omron Healthcare, a medical devices company whose mission it is to “...do everything we can to minimize the effects of a patient's healthcare condition. To enable them to get more out of their lives because they aren’t controlled by their condition”.

If someone diagnosed with OA is catastrophising, then the difficulty with stairs can’t possibly be because the medical device prescribed to them to delay surgery or insurance payments is not working.

 

There is a bonus for psychologists who espouse this view. Using the concept of catastrophising and applying it willy-nilly will no doubt result in large numbers of people who feel their concerns are being dismissed so that those who's behaviour was quite reasonable in the situation may become increasingly agitated in the face of physical distress and gas-lighting (especially if they lack support). A lovely feed back loop of proof of concept. This applies more generally than just the OA of this study of course.

Until such time as we have a better understanding of the how why and what of pain there is no way to hold such people to account for their silly notions. Which makes it so easy for them to not concern themselves with forming a deeper understanding of the patient experience.

 

Pain Catastrophizing Scale (PCS) (each question is answered on a scale of 0 (not at all) to 4 (all the time):

1. I worry all the time about whether the pain will end. (H)
2. I feel I can't go on. (H)
3. It's terrible and I think it's never going to get any better. (H)
4. It's awful and I feel that it overwhelms me. (H)
5. I feel I can't stand it anymore. (H)
6. I become afraid that the pain may get worse. (M)
7. I think of other painful experiences. (M)
8. I anxiously want the pain to go away. (R)
9. I can't seem to keep it out of my mind. (R)
10. I keep thinking about how much it hurts. (R)
11. I keep thinking about how badly I want the pain to stop. (R)
12. There is nothing I can do to reduce the intensity of the pain. (H)
13. I wonder whether something serious may happen. (M)
    
    (Note: For the listed items above, (R) Rumination, (M) Magnification, and (H) Helplessness.)

____

The argument, as far as I can tell:

-Catastrophization is defined as having cognitions matching PCS questions, which causes the person to experience pain more intensely.
[edit for precision: ...which causes the person to have a more intense perception of pain than they would otherwise]
-People who score high on this scale are catastrophizing
-People who score high on this scale have worse pain
-Therefore: catastrophizing causes worse pain

I guess it's their choice as to whether they want a circular argument or an invalid argument. Might as well go with circular then.

 

Re: @Snowdrop
« There is a bonus for psychologists who espouse this view ». The bonus is positioning themselves as superior to people who experience intense, recurring pain and who have the memory and cognitive capacity to know it will happen again. Coming up with a label and supposedly diagnostic criteria make that superiority pitch official and justify their irrational claims to be sound rational scientists.

 

Yes, there's definitely arrogance involved with this thinking.

 

There is something a bit spooky about the logic here.

If I look at points 1-13 and think what I would have answered in the spring when my sciatica was rally bad I would have scored pretty near 4x13=52. I went to a neurosurgeon. After all these statements I would put in brackets (R) for realism.

Now I would score low, partly because I have less pain and partly because my MRI indicated that my symptoms were more likely to be due to old scarring then progressive narrowing.

But as far as I can see the hole point of demonstrating catastrophising is to demonstrate that the person does not actually have enough pain for the statements to be realistic or reasonable. So the people who catastrophise are less in need of treatment for pain.

Catastrophising does not contribute to pain by definition because it is what you do when there isn't enough pain for it to be reasonable to think that way.

 

I haven´t read the article, but this is nonsense in itself.


Pain isn´t something that is perceived but IS a perception. You do not perceive pain by something (whatever this is thought to be), instead you perceive your BODY by e.g. PAIN.

This does not exclude of course that any perception can be wrong. Chronical pain can in that sense that there is nothing wrong in the perceived body and it is generated at the side of such basal perception.


Understandable is if course to investigate how much possible it is NOT TO PAY attention to the pain (this inevitable sensation then). But this is a different question.

Catastrophizing in their sense might rather be a) paying too much attention to pain, a rather laughable approach or b) being too dishearted, what would they want to convey here?? Could somebody not simply say that we should care for each other, as far as there is opportunity?

The approach seems to me coming from the wrong end.
[edited twice for brain fog reasons]

 

I really wish it was their reasoning as well, but seemingly they postulate that the mental status causes the patient to create pain all by itself and by changing their psyche, they can alter the perception of pain. A character flaw if you will.

From my own experience of pain, some of the time i cannot predict what my level of pain will be up on weight bearing. Some of the time, there is little pain; other times, i get really sharp pain which leads me to limp. The rest of the time I have a level of pain which is fairly constant regardless of what i do, at a 3-5 out of 10.

Psychologizing pain is absolutely unhelpful in resolving issues especially when it becomes chronic. It stigmatizes patients and makes encounters in health care much more difficult.

 

Questions about the concept of catastrophization.

Does catastrophization imply that the patient is complaining more than they should? If so, given that pain is subjective, how can someone determine that another person is exaggerating their pain?

Or is catastrophization a behaviour that makes pain worse via some nebulous somatization process?

I'm not quite sure but it seems to be both. There are problems with both of these. It is impossible to determine how much pain a patient really has, therefore nobody is capable of determining what level of complaining would be within the norm and what would be excessive.

And somatization is a "god of the gaps" kind of explanation. Something that is evoked when nobody knows what is really happening. There's no way to measure somatization.

 

Basically it goes like this:

We can get people to shut up about their pain by making it clear that if they keep referring to it they will end up with a mental health label.

So whatever the cause is the Psych always wins.