Embed Size (px)
Citation preview
Michael Sullivan, PhDProfessor
Departments of Psychology, Medicine and NeurologyMcGill University, Montreal, Canada
Catastrophizing and Return to Work Outcomes
Honorary ProfessorRecover Injury Research Centre
University of Queensland
F
Pain Catastrophizing
as an exaggerated negative “mental set” brought to bear during actual or anticipated pain experience,,,,comprising elements of
rumination, magnification and helplessness.
Pain Catastrophizing
Concurrent pain (Sullivan et al, 1995, 1997, 1998, 2004)
Post surgical pain (Forsythe et al., 2004; Pavlin et al., 2004)
Analgesic intake (Jacobson & Butler, 1997)
Length of hospitalization (Gil et al., 1992)
Health care utilization (Turner et al., 2005)
Mental health problems (Sullivan et al., 2006)
Lower quality of life (Borsbo et al., 2008)
Disability (Burton et al., 1995; Sullivan et al., 1998)
Activity intolerance (Sullivan et al., 2002)
Work absence (Sullivan & Stanish, 2003)
Catastrophizing Predicts…
Over 3000 studies published
Experimental pain Musculoskeletal pain
Arthritis Fibromyalgia
Neuropathic pain Cancer Pain Headache
Gastrointestinal pain Post-surgical pain
The Relation Between Catastrophizing and Pain
Catastrophizing associated with increased activation of brain centres responsible for modulation of affective, and motor aspects of pain.
Catastrophizing associated with decreased activation of brain centres involved in descending inhibition of pain.
The Biology of Pain Catastrophizing
“The amplification of inflammatory responses to acute stress may partly underlie catastrophizing’s
enduring effects on pain outcomes.”
”...alterations in central pain processingmay play a role in the effects of catastrophizing”.
Catastrophizing and Widepread Pain
Delayed onset muscle sorenessDOMS
Day 1
Low PCS High PCS
Day 2
Catastrophizing and Physical Performance Decrements
Delayed onset muscle sorenessDOMS
Day 1
Lift
Rep
etiti
ons
Day 1 Day 2
2
4
6
8
10
non-catastrophizercatastrophizer
Pai
n R
atin
gs
Col 1 Col 6
2
4
6
8
10
“Catastrophizing was associated with a 60% increase in pain across
repeated lifts.”
Catastrophizing and Response to Topical Analgesics for Neuropathic Pain
Pai
n R
atin
gs
(Sullivan et al., 2008)
Week 1 Week 2 Week 3
2
4
6
8
10
CatastrophizerNon-Catastrophizer
2
4
6
8
10 Castastrophizer
Non-Castastrophizer
Pre 6m 1y6w 2y
High catastrophizing as a risk factor for poor response to surgery
“The heritability estimate for pain catastrophizing was 37% with the remaining 63% of variance attributable to environmental influence”
Progressive Goal Attainment Program
Techniques to Target Catastrophizing
Education.
Activity participation as a means of assisting the client in disengaging from catastrophic
rumination.
Thought monitoring and emotional problem-solving.
Disclosure techniques.
Negative Consequences of
Inactivity
There is no curative process that occurs
at home.
Individuals need to be challenged in order to recover.
Individuals can return to work even if
symptoms persist.
Return to Work as the Stated Objective of
Treatment
Techniques to Target Catastrophizing
Education.
Activity participation as a means of assisting the client in disengaging from catastrophic
rumination.
Thought monitoring and emotional problem-solving.
Disclosure techniques.
Techniques to Target Catastrophizing
Education.
Activity participation as a means of assisting the client in disengaging from catastrophic
rumination.
Thought monitoring and emotional problem-solving.
Disclosure techniques.
100
Thought Reaction Record
Date/Time
Difficult Situation
(describe situations where your symptoms were bad, or
a situation where you felt stressed or had an
unpleasant interaction with someone)
Negative Thoughts
(describe the thoughts that were going through your
mind)
What you did
(describe how you reacted to the
situation)
What could you have
done differently?
(describe how you could have handled the situation
better)
Techniques to Target Catastrophizing
Education.
Activity participation as a means of assisting the client in disengaging from catastrophic
rumination.
Thought monitoring and emotional problem-solving.
Disclosure techniques.
A Tool Kit for Targeting Psychosocial Risk Factors for
Prolonged Disability
PGAP: Risk-Targeted Activity- Reintegration Intervention
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10
Weeklymee(ngswiththePGAPprovider.
Techniques• Disclosure of activity-related information at the
beginning of every session.
• Validation techniques to reduce the pressure to ‘prove’ one’s disability.
• Repeated exposure to discontinued activities.
• Developing a schedule of activity participation that will challenge the client’s disability beliefs.
Psychosocial Targets
Activity as a tool to reduce the negative impact of psychosocial risk factors on
disability.
End-of-treatment target: PCS < 20
Conclusions
Catastrophizing has emerged as the most robust psychological predictor of adverse pain outcomes.
Rehabilitation outcomes can be enhanced by the inclusion of techniques designed to target catastrophic
thinking.
Measures of catastrophizing should be included as standard approach to assessment of pain-related conditions.
![Unconscionability’s Greatly Exaggerated Death · 2020-04-25 · 2019] Unconscionability’s Greatly Exaggerated Death 967 INTRODUCTION Nearly every first-year Contracts class studies](https://img.pdfslide.net/doc/110x75/5f2db821c0bc323a853f1f2a/unconscionabilityas-greatly-exaggerated-death-2020-04-25-2019-unconscionabilityas.jpg)
