The reciprocal associations between catastrophizing and pain outcomes in patients being treated for neuropathic pain: a cross-lagged panel analysis study.
Catastrophizing is recognized as a key psychosocial factor associated with pain-related negative outcomes in individuals with chronic pain. Longitudinal studies are needed to better understand the temporal relationship between these constructs. The aim of this study was to determine if changes in catastrophizing early in treatment predicted subsequent changes in pain intensity and interference later in treatment, or alternately, if early changes in pain intensity and interference predicted subsequent changes in catastrophizing. A total of 538 patients with neuropathic pain were recruited from 6 multidisciplinary pain clinics across Canada. Study participants were asked to complete measures of catastrophizing, pain intensity, and interference when first seen in the clinic and then again at 3- and 6-month follow-ups. Cross-lagged panel analyses were used to determine the temporal associations among the study variables. The results showed that decreases in catastrophizing early in treatment prospectively predicted improvement in both pain intensity and interference later in treatment. Converse temporal relationships were also found, where a reduction in pain intensity and interference early in treatment predicted a subsequent diminishing of catastrophizing. All 4 unique cross-lagged correlations significantly accounted for an additional 4% to 7% of the total variance. The findings are consistent with theoretical models hypothesizing a causal impact of catastrophizing on pain, suggesting a mutual causation between these factors. The results support that treatments targeting catastrophizing may influence other pain-related outcomes, and conversely that treatments aiming to reduce pain could potentially influence catastrophizing. There may therefore be multiple paths to positive outcomes.
Department of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.|Lawson Health Research Institute, London, ON, Canada.
Mélanie
M
Racine
Department of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
Dwight E
DE
Moulin
Lawson Health Research Institute, London, ON, Canada.
Warren R
WR
Nielson
Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada.
Patricia K
PK
Morley-Forster
Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
Mary
M
Lynch
Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
Alexander J
AJ
Clark
LW Stitt Statistical Services, London, ON, Canada.
Larry
L
Stitt
Wasser Pain Management Centre, University of Toronto, Toronto, ON, Canada.
Allan
A
Gordon
Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Howard
H
Nathan
Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Catherine
C
Smyth
Department of Family Medicine, McGill University, Montreal, QC, Canada.
Mark A
MA
Ware
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Mark P
MP
Jensen
D000328:Adult; D000368:Aged; D002170:Canada; D058443:Catastrophization / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D011795:Surveys and Questionnaires