Should We Address Psychosocial Factors Such as Catastrophizing Before Many Treatment Procedures?

Catastrophic thinking has emerged as one of the most powerful psychosocial predictors of problematic health outcomes. Catastrophic thinking has been broadly defined as an excessively negative orientation towards one’s symptoms and health status – ruminating, symptom magnification, helplessness, etc. Numerous clinical and experimental investigations have shown that people that can be identified as catastrophizers rate their pain as being 40-60% more intense than non-catastrophizers. This relationship between catastrophizing and problematic health outcomes have been observed in individuals with musculoskeletal conditions such as back pain, neck pain, and other common industrial injuries as well as osteoarthritis, rheumatoid arthritis, fibromyalgia, neuropathic pain, headaches, and more. Research has shown that individuals who score high on the pain catastrophizing scale will have higher incidents of delayed or problematic recovery. So the question to be asked is — should we be screening patients before treatment? Would it be beneficial to treat those patients differently who have high levels of catastrophizing?Recent research has shown that these high catastrophizing patients have similar levels of pain one year post total knee arthroplasty and are less satisfied with the surgical procedure. As many as 30% of joint replacement patients will follow a problematic course or recovery. This can often lead to a disappointing physician patient relationship as the patient feels the doctor “did not do a good job”. How would that effect your practice?

It would appear that basic screening of patients before a wide range of treatment procedures can help reduce these problematic outcomes as well as increase patient satisfaction with the treatment. Research strongly suggests that catastrophizing is a modifiable risk factor. This research also shows that a wide range of intervention programs can significantly reduce scores on measures of pain catastrophizing. By addressing this specific modifiable factor, research has shown significant benefits in return to work rates, post treatment pain, and a decrease in medications. One such intervention – PGAP – has shown to increase RTW rates up to 40% one year post treatment and a 50% reduction in medication use over tradition pain management treatments.