A Systematic Review of Pain Catastrophizing and Chronic Musculoskeletal Pain.
Sotaro Shimada, Ardith Z Doorenbos, Ellen Goldstein and 1 others
PMID 40858413WHAT IT FOUND
In adults with chronic musculoskeletal pain, higher pain catastrophizing consistently links to greater pain intensity and disability.
It acts as a mediator of treatment effects, meaning reducing it helps relieve pain, but it does not reliably predict who will respond best to physical interventions like exercise.
Key findings
01Pain catastrophizing is significantly associated with pain intensity and disability, but the strength of these associations may be weaker than previously reported in observational studies.
02Pain catastrophizing primarily acts as a mediator of treatment outcomes rather than a moderator, suggesting it is a mechanism of change rather than a predictor of treatment response.
03All included studies examining pain interference found a significant association with pain catastrophizing, indicating it may play a substantial role in how pain disrupts daily activities.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only English-language articles, potentially missing relevant studies from other regions. Many included studies were secondary analyses of RCTs, which raises the possibility that hypotheses were formed after seeing the results (post-hoc bias). Sixteen of the twenty studies had some concern about risk of bias, particularly regarding outcome measurement and selection of reported results. Most participants had chronic back pain, so findings may not apply to patients with other types of chronic musculoskeletal pain like fibromyalgia or neck pain. Heterogeneity in interventions and outcomes prevented a meta-analysis, so the strength of the associations could not be pooled into a single effect size.
Declared interests
The authors declared no competing interests. The study was supported by the National Institute of Nursing Research of the National Institutes of Health under award numbers R01NR017455 and R01NR020291.
The easy way to misread this
Do not use pain catastrophizing scores to rule out physical therapy or exercise. The review found it was rarely a moderator, meaning it did not predict who would respond to these treatments, so a high score is not a barrier to physical intervention success.