Catastrophizing Can Worsen Arthritis Pain

Learn five ways to stop negative thinking that intensify pain.


Living with arthritis pain can feel like the glass is half empty. But negative thinking and expecting worse case scenarios can worsen pain. A person might think, “My fingers are getting swollen. Soon they’ll make it too hard to prepare the meals I love. I should just give up cooking entirely!”  This type of thinking is called catastrophizing. The individual predicts and obsesses over a negative event or situation. Then, he or she decides that if it does happen, it will lead to the worst possible outcome.  

 “Focusing on pain sensations, ruminating about your pain and feeling helpless make pain worse­,” says Claudia Campbell, PhD, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore, Maryland. “Pain can become all-consuming and can prevent you from doing the things you enjoy.”

Pain Levels and Remission Can Be Affected

Catastrophizing doesn’t just dampen your spirits. “Having these kinds of thoughts increase your level of pain,” Campbell explains. “On the other hand, if you can distract yourself, engage in relaxation exercises or take your mind off the pain, you can reduce the level of pain you experience.” 

Catastrophizing is also associated with poor prognosis outcomes, according to a 2017 study in Arthritis Care & Research that followed 209 patients with rheumatoid arthritis. The researchers found that people with higher levels of pain catastrophizing were less likely to achieve remission when compared with individuals who did not worry about their pain as much.

“It is very important to have balanced thinking about the threat caused by pain,” explains Hilde Berner Hammer, MD, PhD, author of the study and rheumatologist at the Diakonhjemmet Hospital in Norway. “If the patient is anxious, depressed or has catastrophic thinking, the feeling of pain will increase because of changes in the central nervous system.”

Dr. Hammer says physicians should consider pain catastrophizing as a reason for not achieving remission. “When catastrophizing is the cause of increased pain levels, the anxiety, depression and catastrophic thoughts should be dealt with and treated.”  

It’s also important not to blame yourself if you struggle with these emotions. “Unfortunately, there is a stigma around pain and catastrophizing. But it’s no one’s fault, no one wants to have thoughts that amplify their pain,” Campbell says. “We don’t think that people who catastrophize more only report more pain, but they actually experience more pain.”

Pain can have a detrimental effect on every aspect of a person’s life, including relationships with family and friends, their ability to function at work and in the home and enjoyment of hobbies. Catastrophizing is also tied to other negative outcomes, including increased sleep difficulties, chronic opioid use and increased health care utilization. It is imperative to stop the cycle of catastrophizing for your health and wellbeing.

Five Tips to Stop Catastrophizing

1. Catch up on your Zzzzs 

Sleep and pain are linked. If you get poor sleep you will probably have more pain; and if you are in pain, you are less likely to sleep well.

A 2017 study in Pain found that improving sleep quality significantly reduced pain catastrophizing in people with osteoarthritis and sleep problems.

“The combination of higher levels of catastrophizing and poor sleep compounds the pain experience,” explains Campbell. “There seems to be a vicious cycle that can really affect physiologic reactions, increasing the perception of pain.”  Here are some tips for improving sleep.

2. Modify your activities

Don’t let pain prevent you from doing the things you love. Talk to your doctor about which activities are safe for your arthritis and find creative ways to enjoy them. You may not be able to plant and tend a one-acre garden, but perhaps you can enjoy raised-bed gardening.

3. Practice mindfulness

Mindfulness is a form of meditation that teaches you to be present in the moment and stop allowing your thoughts to wander. It helps you pay attention to your thoughts and feelings about pain without judging them or making them the only focus.

Start by sitting quietly for 10 minutes a day. Focus on the sensation of your breath. When your mind starts to wander to other thoughts, simply return your attention back to your breath.

4. Stop black-and-white thinking  

Pain or comfort; joy or despair. Try not to think in absolutes. All-or-nothing thinking makes pain catastrophizing worse. It is understandable to feel down during difficult periods, but remind yourself to be resilient and focus on the good moments, too. Make a mental list of the activities you were able to enjoy or tasks you accomplished.

5. Talk to a professional

If you are struggling to keep negative thoughts at bay, make an appointment with a mental health provider. Goal-oriented treatments, like  cognitive behavioral therapy (CBT), can help you develop coping skills and change patterns of behavior that lead to negative feelings and thoughts and possibly depression.