The Impact of Catastrophization and Emotions on Pain: A Narrative Review of Underlying Mechanisms

Pain is a common experience that can lead to poor physical, cognitive, and social function when it becomes chronic. Although the development of the biopsychosocial model of pain improved recognition that biologic factors alone are not enough to explain the experience of pain, psychosocial and lifestyle interventions remain underutilized. Two psychosocial constructs that have implications for pain perception are catastrophization and emotions. The objective of this narrative review was to examine the current understanding of the mechanisms by which catastrophization and emotions modulate pain. We found that key shared mechanisms of catastrophization and negative emotions were increases in HPA axis and sympathetic activity, which promote pain sensitivity. Additionally, both constructs interfered with endogenous opioids, leading to diminished pain resistance. Catastrophization differed from negative emotions in that it involved greater connectivity of the salience network with the default mode network, leading to increased attention to pain. In contrast, positive emotions were associated with much of an opposite effect with increases in parasympathetic activity and endogenous opioid release, which reduce pain intensity. Specific interventions that may be effective in blunting the mechanisms underlying the negative impacts of catastrophization and emotions include mindfulness and relaxation exercises, cognitive behavioral therapy, and yoga. Possible changes to the workflow suggested by our findings include better assessment of coping abilities and strategies at baseline, identifying individuals at risk of catastrophizing, and using contextual factors, such as a greater focus on positive outcomes.