• Mélanie Racine, Dwight E Moulin, Warren R Nielson, Patricia K Morley-Forster, Mary Lynch, Alexander J Clark, Larry Stitt, Allan Gordon, Howard Nathan, Catherine Smyth, Mark A Ware, and Mark P Jensen.
• aDepartment of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, CanadabLawson Health Research Institute, London, ON, CanadacDepartment of Anesthesia and Perioperative Medicine, Western University, London, ON, CanadadDepartment of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, CanadaeLW Stitt Statistical Services, London, ON, CanadafWasser Pain Management Centre, University of Toronto, Toronto, ON, CanadagDepartment of Anesthesiology, University of Ottawa, Ottawa, ON, CanadahDepartment of Family Medicine, McGill University, Montreal, QC, CanadaiDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
• Pain. 2016 Sep 1; 157 (9): 1946-1953.

AbstractCatastrophizing 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.

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