Fibromyalgia Pain Science Education - Catastrophizing pain and symptoms

Episode 16 - Fibromyalgia Pain Science Education -   Catastrophizing pain and symptoms
Please Rate , Review, & Follow this podcast.

This episode continues pain science education of fibromyalgia and other chronic pain. 

Today we are talking about catastrophizing thoughts,  what they are, why you have them, how they affect pain and fibro, and how you can unlearn this way of thinking.  

Catastrophizing is a cognitive distortion that prompts people to jump to the worst possible conclusion, usually with very limited information or objective reason to lose hope. 

When a situation is upsetting but not necessarily catastrophic, they still feel like they are in the midst of a crisis.

Everyone has negative thoughts. But for some people, negative thinking can spin out of control and out of proportion to the reality of a situation. A relatively small error, disappointment, or source of embarrassment (or even the possibility of one), a lab result, a symptom, or a diagnosis - can sometimes become a cause for significant fear or distress— a catastrophe in one's mind.

Catastrophizing is a very common behavior in someone who has chronic pain. 

Pain catastrophizing has been proven to worsen pain, increase disability, decrease functioning, and worsen mental health. 

Please email me at rheumcoach@gmail.com if you try it or if you have questions. I would love to hear from you.

If you are not part of my newsletter, please sign up; the link to sign up is on my website https://www.rheumcoach.com/

 
You can see the full transcript: https://www.buzzsprout.com/1890983/10222422

www.rheumcoach.com - my website

www.rheumcoach.com/FibroCard - Download your FREE copy of the "Fibromyalgia is real" postcard to share with your family & friends

www.FaceBook/com/rheumcoach - lots more information about fibro
Follow me on Instagram:  https://www.instagram.com/rheumcoach/

Disclaimer: This podcast provides information only and does not provide any medical or psychological services or advice. None of the content on this podcast prevents, cures, or treats any mental or medical condition.

Transcript

Episode 16

Welcome back to mind Your fibro podcast, episode #16. Thank you so much for listening. 

A few weeks ago, I was talking to one of my patients, and she told me that she was astonished that she is not in a wheelchair. 

This was a young woman, only a few years older than me, with relatively mild rheumatoid arthritis, fully functioning without a hint of disability. Her RA is well controlled with medication, she has no pain, she is fully employed, and seems happy. 

I was puzzled by her to comment, so I asked her to explain. So here is her story. 

When she was diagnosed with RA, she was in graduate school, about to graduate, engaged to be married, full of hopes and dreams. 

The RA diagnosis was a shock. She gradually developed pain, then joint swelling that finally led to the diagnosis of RA by another rheumatologist she used to see. She started treatment. 

What was a relatively common diagnosis, unfortunately, triggered extreme anxiety, and she quit her graduate program not graduating and now not working in the field she dreamed about working; she broke up with her fiancé - "he did not sign up to marry a disabled person, but he was too nice to tell me that" and she decided never to have children - although she always dreamed about being a mother. She thought she would be in a wheelchair within a few years of the diagnosis and changed her world to prepare herself for that. 

Years later, she is not disabled, nor is she in a wheelchair. She is not in pain. She is a fully functional adult who now regrets altering her life to accommodate a possibility that never happened. She was grieving over her choices, and I was grieving with her. 

 Unfortunately, her story is not unique, maybe somewhat more dramatic than other stories I hear. 

Her story is an example of catastrophizing. 

Catastrophizing is a cognitive distortion that prompts people to jump to the worst possible conclusion, usually with very limited information or objective reason to lose hope. 

When a situation is upsetting but not necessarily catastrophic, they still feel like they are in the midst of a crisis.

Everyone has negative thoughts. But for some people, negative thinking can spin out of control and out of proportion to the reality of a situation. A relatively small error, disappointment, or source of embarrassment (or even the possibility of one), a lab result, a symptom, or a diagnosis - can sometimes become a cause for significant fear or distress— a catastrophe in one's mind.

Catastrophizing is a very common behavior in someone who has chronic pain. I see this in my clinic very often. 

Some concern about your pain is natural and doesn't present a problem. But if you find yourself constantly worrying about the pain and thinking the worst, you're 'catastrophizing.' Every time you excessively worry, you activate your nervous system, you signal more danger to the brain (which creates all pain), and as a result, you'll feel more pain more often. You probably are doing this not only about your health, but also many other aspects of your life – your job, relationship, world crisis or something even as simple as being late for an appointment or getting stuck in traffic. You may tend to go for the worst case scenario. 

So today, we will talk about catastrophizing and how you can unlearn this behavior. This thinking pattern can itself be destructive because unnecessary and persistent worry can worsen anxiety and depression as well as pain and other fibro symptoms. This behavior and the way of thinking does not serve you nor your health.

What is a symptom or pain catastrophizing? 

Catastrophizing pain or symptom is defined as "a persistent pattern of distressing mental and emotional responses to present or anticipated pain. " 

Basically, catastrophizing is your thoughts, beliefs, not reality, that you have about pain or other symptoms, disease, or events - like a procedure, test or surgery. An example would be every time you have recurrent migraine pain; you may think you have undiagnosed cancer, a brain tumor, even though you have had migraines since age 15 and now you are 45, and the pain is similar to every migraine you have had before. 

There are two critical things to understand: 

# 1st is that this isn't your fault; worrying about pain is a rational response. 

#2 is that you can learn to change it. 

I have had patients who improved this behavior just by learning they engaged in it.  

There are 3 ways you can be catastrophizing about your pain and symptoms: rumination, magnification and helplessness. 

Not everyone will experience them all, and they will vary in severity. Again, catastrophizing is just thoughts formed in your brain.

You may have different thoughts on different days, based on your pain level, other symptoms, or what else is happening in your life. 

#1 Rumination - this simply means that you cannot get the pain or other symptom off your mind. You may constantly be thinking about how much it hurts, feel unable to distract yourself or focus on anything else. Rumination involves negative thought patterns that are immersive or repetitive. The word Rumination literally means the action of a cow chewing the cud. Cows chew grass, regurgitate, chew some more, and regurgitate again. So, when we ruminate about a symptom or anything else in our life, we keep thinking about it, chewing on it, not letting go. Many people slip into Rumination when they are trying to process their feelings, but they become "stuck" in negative patterns of replaying past hurts without moving toward solutions or feelings of resolution. 

#2 Magnification: this means you may be focused on events that haven't even happened yet, thinking about how much worse they could potentially make you hurt, or be worrying about how your chronic pain condition is going to worsen over time. Magnification is the process of enlarging the apparent size, not the physical size, of something. A magnifying glass is an example. It is a form of an altered reality, enlarged pain based on your thinking, not facts.

The example of my patient, she magnified her RA symptoms to the point of a wheelchair disability. You may expect pain after standing or sitting too long, driving distance - preemptively. 

#3 Helplessness: this involves feeling as though you are not in control of your pain or symptoms, that your condition or symptoms are running your life. You may feel that there is nothing you can do to improve your life or your symptoms, essentially that there is no hope. 

Helplessness is the belief that there is nothing that you can do to improve a bad situation, such as being diagnosed with an illness. In many ways, helplessness is a belief that control over the situation, or its outcomes is impossible. Like all beliefs, helplessness is learned and practiced. You stop looking for a solution; you want someone to rescue you, find someone to take charge, control the situation or fix it. 

I see examples of helplessness in my clinic often. Some patients take no responsibility for their health or much of their life, wanting someone else take on decision making or be in charge of them. A husband for example may give all control over his health decisions to his wife – although he may act as he simply does not care or she knows better, often it is disguised helplessness, feeling afraid and hopeless. He may not follow through with any treatment at all, as he has already lost the battle – the wife is still fighting, looking for solutions, spinning her wheels, but he is just barely going with a flow, she has to nag him about everything.   

What Causes Catastrophic Thinking?

At the root of catastrophic thinking are fear and low self-esteem.
We believe we are incapable of handling problems and imagine ourselves
helpless. Those who struggle with catastrophic thinking most likely dealt with
a traumatic childhood. They may have seen parents who overreacted or panicked
about perceived situations. Their parents may have also been perfectionists who
criticized them for every mistake. 

How does catastrophizing affect fibromyalgia and chronic pain?

Pain catastrophizing has been proven to worsen pain, increase disability, decrease functioning, and worsen mental health. One study found that "pain catastrophizing accounted for up to 31% of the variance in pain severity" - so the negative thoughts and behaviors can worsen the pain level by 1/3!! 

Let's look at how and why catastrophizing affects chronic pain and other fibro symptoms in such a severe way.

# 1 - Increased stress 

Being in a constant state of worry can result in increased stress levels. My earlier episodes of this podcast discussed the pain stress connection in great detail. More stress leads to more pain. 

#2 The brain learns pain. I discussed in the past episodes the concept of neuroplasticity and central sensitization. Our brains are neuroplastic, which means they learn from what is happening in our environment and what our bodies experience. Chronic pain changes our brain, changes the nervous system pathways, meaning that our brain learns that it 'should' produce pain in certain situations. By expecting and worrying that certain actions are going to worsen your pain, you are reinforcing to your brain that these situations 'should' cause pain. Our nervous system becomes overactive and stuck in the fight or flight response. 

#3 Fear-avoidance 

Anticipating pain getting worse with activity can lead to fear of movement, also called kinesiophobia; I will discuss kinesiophobia or fear of movement in one of the future episodes. 

So you may begin to avoid situations that you feel could worsen your pain due to this fear. As you avoid activity, your body becomes deconditioned, meaning your muscles weaken. Deconditioning makes further activity harder as your body is not prepared for it, which reinforces to your brain that your worries were 'right' because the activity did cause pain. I see it often with patients. For example, the patient starts physical therapy; he starts hurting after 1st session, so he skips a few weeks, thinking PT hurt him, although in reality, it was his deconditioning that created a normal discomfort as it should if the muscles are not used in a while. So after a few weeks, he goes back to PT and hurts again - his distorted thinking is that PT causes pain, not that deconditioning and lack of movement causes pain; it contributes to fear of movement. 

#4 Exaggerated muscle responses - Catastrophizing about a specific area of the body being in pain can affect the reactions of the muscles in that area. For example, if you have chronic pain in your lower back and you are intensely focused on this area of your body, it can cause the muscles in your lower back to be overactive, tense, and more painful. 

As you can tell, feeling constantly worried about your pain and other symptoms can take a real toll on your mental health. Anxiety can develop or worsen; often, the feelings of helplessness, a lack of control or normalcy about your life, and living with the pain being the all-consuming and primary focus of your everyday attention can lead to depression. So addressing the anxiety and depression does improve the pain as well as catastrophizing. 

So what can you do about it? 

Here are a few possibilities:

1.     Think through the actual symptoms or pain. Chances are you have had this pain or a symptom before. What is the best-case scenario, more probable outcome, typical outcome? Do you catch yourself thinking of the worst-case scenario by default? 

2.     Find the catastrophic thought and replace it with a more realistic thought. As soon as you realize you are catastrophizing (and it can take some time), label the thought as catastrophizing and come up with an alternative that might better reflect what is really going on. So instead of saying, "This pain has ruined my day," try, "I'm disappointed that I can't do what I wanted to do today."

3.     Do not minimize the pain or symptoms either. I've heard plenty of people describe something really painful and then say, "but it's fine." If it is not fine, do not try to pretend it is fine. That is not healthy either. Things do not have to be all good or all bad. Pain can be moderately severe, and when they are moderately severe, it is good to acknowledge that too. The goal should be a realistic sense of the severity of pain and not simply to pretend everything that happens is positive or okay.

4.     Know that it takes time and practice to get good at this. You are changing brain habits. You need time to practice. Remember, awareness is 1st step; You need to keep reflecting on your thoughts, recall your prior experiences and outcomes, catch your thoughts that do not serve you. 

5.     Pain catastrophizing can be tackled and overcome, allowing you to gain real reductions in persistent pain. Many types of therapy can help; it's about finding what you feel will work for you. Counseling to deal with anxiety and depression can help reduce the feelings of helplessness that come with pain catastrophizing. CBT or cognitive behavior therapy helps you to replace negative catastrophizing thoughts and behaviors with positive thoughts and behaviors; Life coaching also is very helpful in changing thoughts and influencing behavior change. Therapy and coaching can help you to realize that a negative thought about your pain is just a thought; that thought doesn't have to progress into catastrophizing but at the same time doesn't need to be pushed aside. It allows you to think something negative and then move on, taking power away from the thought and not allowing it to influence your behavior.

6.     Medications – If your catastrophic thinking is related to
another existing mental health condition, medication may be a practical choice.
SSRIs and other antidepressants have been helpful tools in conjunction with
therapy.

7.     Also, reducing stress and the fear-pain cycle are also helpful with reducing the symptoms, thus reducing the need to catastrophize. As I discussed in the earlier episodes, understanding that most chronic pain is neuroplastic may take away the pain, and teaching you that chronic pain isn't something to worry about builds confidence and tackles catastrophizing. 

8.     If you find yourself afraid of movement of any activity that can potentially induce pain, the graded exposure therapy tackles negative beliefs and fears about pain in a gradual yet head-on way, aiding patients to face the activities that they fear a step at a time to remove the fear. Also, it can be beneficial to find a physical therapist who understands the psychology of pain and graded exposure, which may be trained in CBT or mindfulness. 

Bottom line, with the proper treatment and guidance, pain and symptom catastrophizing can be overcome; your pain does not have to control your life!

 Thank you for listening! I will see you next week!