So, in the overview
segment, I was describing how thoughts and
emotions have the capacity to influence pain, either
for better or for worse, our thoughts and our
feelings influence or experience of pain. And I want to talk
very specifically about a psychological
construct that is shown to have an
incredibly powerful influence on sensory perception. And that is pain
catastrophizing. There is about a quarter
century of research that shows that pain
catastrophizing is one of the most important
determinants of pain outcomes, for pain outcomes. So pain catastrophizing
is going to influence how a person responds
to pain treatment. And this psychological construct
is comprised of three factors. So pain catastrophizing is
when we ruminate about pain. It’s when we magnify
pain, like we’re not able to think about
anything other than the pain and how awful it is. And that leaves us feeling
very helpless about our pain. So it’s magnification of
pain, rumination about pain, and feelings of
helplessness about pain. And together these
three factors are what comprise this
construct that we call pain catastrophizing. And it turns out to be quite
toxic in terms of pain itself, because it has such a
negative influence on pain and also related
outcomes for pain. The way that we
measure catastrophizing is we give a
questionnaire that’s been scientifically
validated for this purpose, and we’re able to
tabulate the score and then determine
where a person falls on the continuum of
pain catastrophizing. And what we know
is that people who are on the higher end
of catastrophizing, we just simply call
them catastrophizers. People who are catastrophizers
experience greater pain intensity. And, you know, that’s
somewhat surprising, because when we
catastrophize, we’re actually feeding our own pain experience,
unwittingly and unknowingly, but that’s actually
what’s happening. So people have greater
pain intensity, they have a greater need
for pain medications, so opioid medication
for instance. They’re going to need and
use more opioid medication. People who catastrophize
have poor response to multidisciplinary
pain treatment. So they just simply
get worse outcomes for various pain treatments. A couple of pieces
of information that are particularly
interesting is that catastrophizing is
associated with a longer length of hospital stay. So if you go into the
hospital for any reason, and you are a
catastrophizer, you are more likely to need a
longer stay in the hospital than someone who does
not catastrophize. And lastly,
catastrophizing has been shown to actually predict the
development of chronic pain. And so there is a
particular, actually, a couple of different studies
that have looked at this, and they look at people
prior to surgery, and they measure whether
they have a tendency to catastrophize or not. And then everyone goes
through and has a surgery, let’s say it’s a knee
surgery, and then researchers will determine who
recovered from the surgery, and who went on to
acquire chronic pain, post-surgical chronic pain. And what the research shows is
that catastrophizing predicts whether or not a person acquires
chronic pain following surgery. So catastrophizing
is very potent. It is an exquisite example
of the mind-body connection, that the power of the brain,
our mind, our thoughts, and our feelings, and
the power of our thoughts and our feelings to determine
our pain experience, and to determine the
trajectory of our pain. It doesn’t just determine
what we feel in the moment. Catastrophizing has the
capacity to determine how long our pain lasts,
whether our pain becomes chronic or not. And so, for this reason,
it is incredibly important that we determine whether or not
a person is a catastrophizer, and if they are, we
want to treat it. This is a treatable
phenomenon, and so a person can work with a
pain psychologist or another provider
to acquire a skill set in which a person
learns to calm their mind and calm their body. And they can also learn
ways to think differently, to think in a more helpful way. We use specific
techniques, we call them cognitive behavioral
therapy techniques, and these are learnable,
and it’s literally a question of learning
the right skills and then implementing
them on a daily basis. And if a person is
able to do that, you can literally change
your brain and the way that your brain is
processing information. And this is of vital importance,
because all pain is actually located in the brain. It’s where we process
the sensory information, and it’s where we process
our cognitive and emotional information. And all of that’s happening
in the same place, and it’s all related. And so by learning these
specific techniques, we can learn a way
to put a container around catastrophizing. We can learn to stop
catastrophizing, and actually reverse some of
these patterns so that we are having less
pain, better response to pain treatments. Ideally, we will need
less pain medication. And we will simply be
more comfortable and more in control. The preceding program
is copyrighted by the Board of Trustees of
the Leland Stanford Junior University. Please visit us at
med.stanford.edu.

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