Worry and catastrophizing about pain in youth: a re-appraisal

Catastrophizing about pain is defined as “an exaggerated negative ‘mental set’ brought to bear during actual or anticipated pain experience” [25]. It is a salient form of worry, and one that has proven useful in explaining pain severity, disability, and adaptation to treatment in a range of different conditions and settings [7] and [12]. Catastrophizing involves repeated thought about threat as uncontrollable and likely to have awful consequences. These aspects have been captured neatly by Sullivan and colleagues with the labels of “rumination,” “helplessness,” and “magnification” [24].

Catastrophizing was identified as important for children’s adaptation to pain and included in early measurement tools focused on coping [20]. However, interest has been fuelled by the development of the child version of the adult Pain Catastrophizing Scale, the PCS-C [3], [27] and [29]. We suggest that a reappraisal of catastrophic thinking about pain in young people is needed before research blooms. In what follows, we focus on a developmental view of emotional coping, we look again at how catastrophizing about pain has been researched with children, and we suggest an alternative view. Finally, we introduce the research and clinical implications of this reappraisal.