Yet how much pain people experience and how they view it is an individual thing. For some, thinking the worst becomes the default. The problem is that this can actually make your rheumatoid condition worse. In a study presented in early June at the annual congress of the European Alliance of Associations for Rheumatology (EULAR), a forum to present the latest in advancements in rheumatology care, this extreme negative thinking was shown to impact a person’s course of the disease.
What Is Pain Catastrophizing?
The study focused on the concept of pain catastrophizing, defined as the “tendency to report pain experience in exaggerated terms, to ruminate about it more, or to feel helpless about it,” study coauthor Mateusz Wilk, MD, a physician in the division of rheumatology and immunology at University Hospital in Krakow, Poland, told conference attendees. This is not about experiencing actual pain but rather the cognitive and emotional processes of thinking your pain is worse than it is, he says. In some ways, catastrophizing is the opposite of coping or having resilience in the face of a painful disease.
Catastrophizing About Pain Makes Many Conditions Worse
Prior research on catastrophizing about pain has shown how problematic this can be. For one, it increases the risk of experiencing additional pain, according to a report on people with various pain conditions published in November 2017 in The Journal of Pain. And in a study in Arthritis Care & Research published in December 2017, which evaluated 200 people with RA who were beginning biological therapy, catastrophizing over the course of the year correlated with the person’s own assessment of higher levels of disease activity, even though objective measurements of inflammation and disease activity did not concur. RELATED: How to Relieve Rheumatoid Arthritis Foot Pain
Assessing Pain and Rheumatoid Arthritis Symptoms
The EULAR study followed 1,200 people in Norway with either RA (nearly half of the sample), psoriatic arthritis, or axial spondyloarthritis. Those with RA who participated were primarily women who had their disease for more than a decade and were taking disease-modifying medication. The researchers evaluated the state of each person’s condition using an assessment tool known as disease activity score-28 with CRP (DAS28-CRP), which includes such measures as tender joint counts, swollen joint counts, C-reactive protein measurements (a blood marker for inflammation), and overall health. They then asked participants to rate their pain level on a scale of 1 to 10. Finally, each was asked two questions that assessed the level of pain catastrophizing. These questions, which participants rated on a scale from zero (never) to six (always) are:
“When I have pain, I feel I can’t stand it anymore.”“When I have pain, I think it’s never going to get any better.”
Scores of four or higher were labeled as pain catastrophizing.
Pain Catastrophizers Are Less Likely to Have RA Disease Remission
The researchers found that the percentage of RA patients in remission was significantly lower in high pain catastrophizers compared with low pain catastrophizers, some 34 versus 70 percent. Even when researchers adjusted their results to account for swelling and how long a person had their disease, these results held.
Why Catastrophizing Happens
It’s natural that people dealing with a painful condition might expect the worse, says Eve Kennedy-Spaien, an occupational therapist and certified pain specialist in the pain program at Spaulding Outpatient Center in Medford, Massachusetts. “Our brains have a negativity bias in trying to keep us safe. The brain focuses on danger as a way to help protect the body,” she explains. It’s also logical that these thoughts have a direct impact on the body. Kennedy-Spaien says that functional MRI imaging shows that when people think things like “I’ll never be able to work again,” parts of the brain associated with pain signaling are activated. “In response to the thought, your brain is going to shift that pain level way up and also increase inflammatory markers in the body,” she says. But this reaction is not inevitable, she says. “We have to teach the brain that chronic pain is like an alarm that just keeps going off. It doesn’t necessarily signal danger.”
Various Actions Can Limit Catastrophizing About Your RA
While some pain is indeed dangerous and requires our attention, most pain in people with a chronic condition like RA is not. For that pain, you can learn strategies to control it so you can get back to enjoying life, Kennedy-Spaien says. For example, say you’ve avoided an activity because it made you miserable the last time you tried it, and now even thinking about doing it increases your pain. Kennedy-Spaien suggests breaking down the activity into smaller pieces. Someone who stopped visiting friends or relatives, for instance, might consider having a shorter visit, bringing heat or ice to use while there, and/or positioning their body differently during the encounter, she says. If cooking has been painful, try prepping in small sessions throughout the day, sitting while you chop, or even just visualizing the joy that comes from creating and eating a delicious dish. “Visualizing is really powerful. Athletes use this all the time to improve their brains,” she says. Finally, when chronic pain flares, shift your attention to other parts of the body. “You can’t ignore pain because that never works,” Kennedy-Spaien says. Instead, she suggests telling yourself something like “I’m having pain right now and I’m going to get ice or do stretches, and this is just a moment in time, and in the next moment I will feel different.” “Pain catastrophizing is very changeable,” she says. “The most important thing is being curious, asking yourself if there’s another way to view what you’re feeling right now.”
