“I’m never going to feel better!” “My life is ruined.” “How can I possibly go back to work?”

These are the thoughts that run though the head of someone with chronic pain. But do our thoughts matter? Actually, yes they matter a lot!

Catastrophic thinking is a strong predictor of pain intensity. It is a way of thinking that is considered a cognitive distortion. It involves seeing an unfavorable outcome, deciding if that outcome will happen, and then deciding if it does, the results will be a disaster. Basically, it is a negative forecast of future events that is not positive. When we think negatively about our pain, expect the worse and magnify our problems, we turn up the volume on pain.

Catastrophic thinking is a type of mindset that involves ruminating on thoughts like, “This is terrible. The pain will never go away. I can’t cope. I can’t take it anymore. All I can think about is how much it hurts. Something terrible must be the cause. ” Notice the negative predictions about future outcomes that are most likely not realistic. Having this type of mindset predicts your pain intensity, your need for opioid medications, the length of hospital stay after surgery, how well your treatments will work, and if you will become disabled from the pain. During a pain episode or experience, the more you use catastrophic thinking, the more pain you have. That is how powerful our thoughts can be.

There are several ways to engage in catastrophic thinking. It can come into your mind from anxiety over the pain and worry about the future. It can be generated in the mind when a situation is vague or ambiguous. In those instances, we tend to fill in the blanks with catastrophic thoughts because we don’t know outcomes or reasons for our pain. Negative thinking is often involved when something we value, like our functioning, is threatened or can be lost or diminished. Fear can prompt this thinking, especially when it is related to our health. However you generate catastrophic thoughts, they are increasing your pain.

When catastrophic thinking takes hold it can also impact our relationships. Catastrophic thoughts may be a way to socially communicate our distress. The more we complain, the more we hope those around us will react with help. It may be a way of coping and getting others involved in our need for help. But when this happens, research reveals that we may receive critical responses from partners. Thus, the support that is desired may actually put a strain on relationships. The longer the pain persists, the more likely the interpersonal strain. The chronic pain partner is often viewed as dependent and constantly needing support, another reason to stop this type of thinking.

Another problem is that when catastrophic thinking finds a highway in our brain, it fills our mind with unnecessary emotions like depression, anxiety and hopelessness. It can be difficult to focus away from the pain when you perceive the pain as unusually intense and feel helpless to do anything about it. And it can interfere with descending inhibitory pathways, altering pain modulation. This means it can actually facilitate the pathway to pain.

Thus, one way to help your chronic pain is to lose those catastrophic thoughts. Be aware of how you are thinking, grab the negative thought and replace it with a more hopeful one. Doing this on a regular basis is one way you can help your pain.

Excerpt from Living beyond Pain (2019) Mintle & Kribs (Baker books)