How to get out of catastrophizing chronic pain

One of the biggest challenges with chronic pain is what we call pain catastrophizing. As the word implies, you experience the pain as a disaster, something terrible that will never end. Catastrophizing chronic pain has many negative consequences that can severely affect quality of life.

The good news is that catastrophizing can be turned into improved coping skills.

The elements of pain catastrophizing

Pain catastrophizing consists of three subconscious activities: rumination, magnification, and helplessness.

Rumination is constantly brooding about the pain. You cannot stop thinking about how severe it is; you keep wishing it would go away. With magnification, the pain takes up more space in your mind than it needs to. Magnification is subconscious, so you don’t see it as exaggeration. Helplessness regarding the pain is just what it sounds like.

If you also have unresolved psychological trauma, catastrophizing pain often leads to overactive orientation responses. Your attention is constantly drawn to the traumatic events. You can read more about important precautions for meditation in the context of post-traumatic stress in this article.

A negative spiral

When catastrophizing takes over, you often become more passive. Fear of the pain leads you to avoid anything you think might increase or prolong it, whether justified or not. And that constricts your entire life. Your body becomes less resilient. You avoid social contact and other nurturing activities, even those that might actually help you cope with the pain.

That in turn keeps you from getting positive feedback, resulting in shame, remorse, sadness, irritation, anxiety, and even depression. And that can lead to a negative spiral that maintains or even worsens the catastrophizing and its consequences.

Here is a diagram of the negative spiral that maintains catastrophizing, as well as another process that shows the way out of it.

From Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000; 85 (3): 317–32.

The biggest part of ending the catastrophizing is to face both the physical and emotional discomfort of the pain. In the diagram, this is called confrontation, and it is the alternate to avoidance. Read more about how to confront physical pain below.

If you find confrontation difficult, you might seek support from a professional such as a psychotherapist, trauma specialist, or meditation teacher, ideally one with pain skills. Physiotherapy or mild touch therapy can also help.

Meditation skills to address catastrophizing chronic pain

Equanimity, particularly acceptance, is the central meditation or attention skill to help with catastrophizing [see study]. Acceptance helps you confront discomfort. All meditation strengthens equanimity and acceptance, but promoting restful states (for example, Focus on Rest) is especially effective.

To apply acceptance, try focusing particularly on the inner experience of your pain, the thoughts and emotions that accompany it. Focus In is one such method. This reduces those maladaptive inner experiences, which helps you confront them and get out of the negative spiral.

You can also actively strengthen positive thoughts and feelings with the meditation technique Nurture Positive. Here are examples of replacing maladaptive negative thoughts with more fruitful adaptive ones.

Adaptive: I can manage this
Maladaptive: The pain doesn’t change no matter what I do

Adaptive: If I take it more easy and relax a bit, the pain will improve
Maladaptive: I can’t stand this pain

Adaptive: I can do something about my pain
Maladaptive: This will never end

Adaptive: It will be better soon
Maladaptive: This pain is a disaster

Adaptive: I have tools to change my experience
Maladaptive: I am a hopeless case

Adaptive: I can turn my attention away from the pain
Maladaptive: I can’t take it anymore.

A psychotherapeutic approach related to Focus In and Nurture Positive is ACT (Acceptance and Commitment Therapy). ACT draws insights from cognitive behavioral therapy and is often used in conjunction with mindfulness meditation. There is strong research support for the effectiveness of ACT with chronic pain.

Using movement to reduce pain

All these approaches are basically about one thing: reducing bodily pain. For that to happen, you have to move, the more the better. Movement can improve your attention skills, and even make you more creative in addressing your own chronic pain and catastrophizing. The technical term for this is graded exposure.

In graded exposure, you confront the chronic pain by exposing yourself gradually to activities that may trigger the pain. This confrontation takes a certain amount of mindfulness and should be exercised within an attitude of self-care and kindness to oneself. Over time, you learn to do these activities without the pain flaring up. Learning to keep within one’s own limits is often called pacing, and there are many practical tips for learning this skill in this article.

What is the best way to train movement? By doing movement you enjoy doing. You can find some suggestions in the article on mindful movement.