Pain Catastrophising in Individuals with Fibromyalgia: A Critical Review, Outline
PART ONE, OUTLINE
Effective Interventions for Pain Catastrophising in Individuals with Fibromyalgia: A Critical Review
Affecting nearly 2-5% of the population worldwide, fibromyalgia is a chronic pain condition often regarded with great frustration by both patients and the academic community alike (Lami et al., 2018). Currently no distinct pathophysiology nor explicit biomarkers have been defined, leaving professionals unable to agree able as to the most effective level of intervention for treatment (Elligson et al., 2018).
A persistent pain disorder of an unknown pathophysiology, fibromyalgia affects an estimated 2-5% of people worldwide (Lami et al., 2018). Generally characterized by widespread musculoskeletal pain, fibromyalgia presently has no known biomarkers, thus making it difficult to understand and properly treat (Ellingson et al., 2018). A dysfunctional set of pain-related cognitions, pain catastrophising is the single most important factor in predicting the chronicity of fibromyalgia and long-term outcomes (Paschali et al., 2021). Presently, no comprehensive review has been performed examining the systemic effects of catastrophising specifically as well as comparing the relative advantages of different psychotherapeutic approaches to treatment. A comprehensive examination of the underpinnings of pain catastrophising as well as the most efficient treatment methodologies in reducing it may serve to clarify what has long been a disorder of great confusion and disagreement.
Most commonly measured via the Pain Catastrophizing Scale devised by Sullivan et al. (1995), these inflated and threatening appraisals of pain are neatly characterized by the three fundamental concepts of rumination, magnification, and helplessness in response to aversive stimuli. Catastrophising itself has a direct impact on numerous psychosocial concepts such as disability, pain severity, self-efficacy, quality of life, and affective states such as depression and anxiety (Lami et al., 2018). Effective reductions in high catastrophising individuals with fibromyalgia have shown improvements in all of these aforementioned domains (Lami et al., 2018). Also affecting physiological structures, high levels of catastrophising in fibromyalgia also have the ability to alter pain perception through the modulation of neural activity (Ellingson et al., 2018). Heightened activity in regions of the brain devoted to attention allocation, anticipation of pain, and emotional responses are evidenced in high catastrophising individuals with fibromyalgia unlike in healthy controls (Ellingson et al., 2018).
Purporting the most established base of research, cognitive behavioural therapy (CBT) has shown moderate although mixed effectiveness in treating catastrophising through cognitive restructuring and coping skills (Alda et al., 2011). More promising than traditional CBT are newer, less researched psychotherapies such as acceptance and commitment therapy (ACT) and mindfulness practices (Luciano et al., 2013). Rather than formulating coping strategies, ACT preaches freedom in accepting pain as a part of everyday life (Luciano et al., 2013). It aims to reduce a key construct known as psychological inflexibility, a mindset in which individuals allow pain to drive them to act incongruously with their values (Luciano et al., 2013). By adopting a flexible mindset, individuals are able to decrease the urge to catastrophise the effects of pain on daily life. These practices encompass a variety of activities including meditation, yoga, body awareness exercises, and contemplative appraisal of feelings, behaviours, and thought processes (Pérez-Aranda et al., 2019). Both ACT and mindfulness practices have returned preliminary, albeit unanimously medium to large significant effect sizes in improving catastrophising as well as associated psychosocial and physiological constructs (Luciano et al., 2013; Pérez-Aranda et al., 2019). These results have also proven superior when tested against current treatment as usual models (Luciano et al., 2013; Pérez-Aranda et al., 2019).
This critical review will serve to further the understanding of how pain catastrophising perversely impacts the psychosocial and physiological condition in those suffering from fibromyalgia. Further, it will compare and contrast CBT, ACT, and mindfulness practices and discuss their utility in effectively reducing catastrophising both immediately post-treatment as well as at long-term follow ups. Literature reviews for this project will include individuals aged 18 years or older and any mention of diagnosed psychotic disorders or substance abuse within the study population will exclude it from consideration.
References
Alda, M., Luciano, J. V., Andrés, E., Serrano-Blanco, A., Rodero, B., Del Hoyo, Y., Roca, M., Moreno, S., Magallón, R., & García-Campayo, J. (2011). Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial. Arthritis Research & Therapy, 13(5), R173. https://doi.org/10.1186/ar3496
Ellingson, L. D., Stegner, A. J., Schwabacher, I. J., Lindheimer, J. B., & Cook, D. B. (2018). Catastrophizing interferes with cognitive modulation of pain in women with Fibromyalgia. Pain Medicine, 19(12), 2408-2422. https://doi.org/10.1093/pm/pny008
Lami, M. J., Martínez, M. P., Miró, E., Sánchez, A. I., & Guzmán, M. A. (2018). Catastrophizing, acceptance, and coping as mediators between pain and emotional distress and disability in Fibromyalgia. Journal of Clinical Psychology in Medical Settings, 25(1), 80-92. https://doi.org/10.1007/s10880-018-9543-1
Luciano, J. V., Guallar, J. A., Aguado, J., López-del-Hoyo, Y., Olivan, B., Magallón, R., Alda, M., Serrano-Blanco, A., Gili, M., & Garcia-Campayo, J. (2014). Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study). Pain, 155(4), 693-702. https://doi.org/10.1016/j.pain.2013.12.029
Paschali, M., Lazaridou, A., Paschalis, T., Napadow, V., & Edwards, R. R. (2021). Modifiable psychological factors affecting functioning in Fibromyalgia. Journal of Clinical Medicine, 10(4), 803. https://doi.org/10.3390/jcm10040803
Pérez-Aranda, A., Feliu-Soler, A., Montero-Marín, J., García-Campayo, J., Andrés-Rodríguez, L., Borràs, X., Rozadilla-Sacanell, A., Peñarrubia-Maria, M. T., Angarita-Osorio, N., McCracken, L. M., & Luciano, J. V. (2019). A randomized controlled efficacy trial of mindfulness-based stress reduction compared with an active control group and usual care for fibromyalgia: The EUDAIMON study. Pain, 160(11), 2508-2523. https://doi.org/10.1097/j.pain.0000000000001655
Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain Catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524-532. https://doi.org/10.1037/1040-3590.7.4.524