The reciprocal associations between catastrophizing and pain outcomes in patients being treated for neuropathic pain: a cross-lagged panel analysis study

Improvements in catastrophic thinking early in chronic neuropathic pain treatments predict later decreases in pain severity and inversely, early improvements in pain severity predict later decreases in catastrophic thinking


Catastrophic thinking is a widely known maladaptive cognitive construct that has often been found to exacerbate pain intensity and pain-related interference. According to experts in the field, catastrophizing is viewed as one of the strongest predictive psychological factors of persistent neuropathic pain. Given that pharmacological management of patients with neuropathic pain remains rather challenging with respect to adequate pain relief, studies interested in better understanding the role that psychological factors such as catastrophizing plays in pain-related outcomes are clearly warranted. This is even more true when taking into considerations that such psychological factors can be modified through non-pharmacological approaches, for example cognitive-behavioral therapy, another potential interesting treatment avenue for patients with intractable neuropathic pain.


Bearing this in mind, we were interested in examining the reciprocal temporal relationships between catastrophizing and pain intensity and interference in patients with neuropathic pain. To answer this research question, we conducted a large Canadian prospective observational cohort study in which 538 patients with neuropathic pain were consecutively enrolled from several multidisciplinary pain clinics. Using cross-lagged panel analyses, we obtained results showing that diminutions in catastrophic thinking early during neuropathic pain treatments subsequently lead to improvements of both pain intensity and interference later during treatment. Likewise, ameliorations of both pain intensity and interference early in treatment predicted subsequent decreases of catastrophic thoughts later in treatment.


The results from our study are promising, and have important underlying clinical and theoretical implications. Our findings raise the possibility that there is a mutual causation between catastrophizing and pain-related outcomes. In fact, these factors might share multiple pathways and/or treatment components such that non-pharmacological interventions reducing catastrophic thoughts might have a beneficial impact on pain intensity and interference in patients with neuropathic pain. Likewise, treatments focusing on reducing pain-related outcomes may also have a positive effect on catastrophic thinking. In summary, even though more research is needed to confirm our study results, it seems that there are different clinical ways of diminishing both catastrophizing and pain-related outcomes effectively in patients with neuropathic pain.


Dr. Mélanie Racine is a clinical psychologist and research associate at Western University’s (London, Ontario) Schulich School of Medicine & Dentistry Department of Clinical and Neurological Sciences. Her research interests mainly focus on pain-related activity management (pacing), suicidal ideation and sex/gender differences in patients with various chronic pain conditions. Over her career, Dr. Racine has published over 40 peer reviewed papers while encouraging knowledge translation and dissemination through teaching, guest speaking, and her website (

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