Pain and Catastrophizing Leads to more Pain!

I am often asked by my patients why their pain feels so much worse when they are stressed out or feeling in the dumps. Today, I found a review of the best reason I’ve ever heard, and the new explaination I’ll give to my patients. Believe me, in the field of healthcare there is something new to learn every day. As a take home point from this article, I’d say that it is to do whatever you can to increase your positive outlook on the world, especially if you have a new injury or suffer from chronic pain. Your good health depends on it. Here’s the entire review from the fantastic group at the Neuro Orthopaedic Institute Australasia (

“The article (Edwards RR et al 2008 Association of catastrophising with interleukin-6 responses to acute pain. Pain 140: 135-144 ) really struck home. In essence, these authors demonstrated a link between catastrophisation and elevated levels of the pro-inflammatory cytokine interleukin-6. Interleukin-6 (IL-6) is one of a number of pro-inflammatory molecules produced by immune organs and cells (eg bone marrow, macrophages, glial cells) and is known to be involved in hypersensitivity, such as the aching you get when you get the flu, but also related to the severity of pain in back pain, fibromyalgia, OA and RA and neuropathic pains. This study basically says that the more you catastrophise, the higher the levels of and influence of IL-6 (and surely other cytokines such as TNF alpha). Cognitions and emotional responses are translated into known chemistry. It harks back to Candice Pert’s “Molecules of Emotion.”

The research adds to the growing literature that proinflammatory cytokines play a role in the development and maintenance of persistent pain syndromes. (Watkins and Maier 2002; Marchand, Perretti et al. 2005; Thacker, Clark et al. 2007)

The author’s suggestion is that a range of ongoing pain states such as Type II diabetes and cardiovascular disease, known to be associated with IL-6 levels, may be influenced by catastrophisation and therapy could be directed to it. Said in another way – catastrophisation can lead to tissue inflammation and damage. It is not too much of an extrapolation to add low back pain, whiplash and neuropathic pains to the list – indeed any persistent pain state. By the way, as the authors remind us, catastrophisation is a complex response to varied stimuli and the influences on immune cells and inflammation and pain may be just one of a number of influential pathways. For example, IL-6 can also blunt the endogenous opioid system.” (NOI group newsletter –

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