Persistent and disabling pain is the hallmark of osteoarthritis, rheumatoid arthritis, fibromyalgia, and various other rheumatologic conditions. However, disease severity (as measured by 'objective' indices such as those that employ radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely between individuals with ostensibly similar conditions (for example, grade 4 osteoarthritis of the knee). Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This Review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae across a number of rheumatic diseases. Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity, and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with rheumatologic disorders. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions.
Catastrophizing, the tendency to ruminate about and magnify pain, and depression, a more general mood disorder, are common in patients with chronically painful rheumatic conditions
Catastrophizing and depression are risk factors for a number of adverse long-term pain-related outcomes such as physical disability, increased severity of pain, enhanced pain sensitivity and others
Catastrophizing and depression are complex biopsychosocial constructs that act through a variety of pathways, including behavioral, cognitive, and neurophysiological pathways
Catastrophizing and depression represent important targets of pain treatment, and could be instrumental in helping to tailor pain-management strategies to individual patients
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This work was supported by NIH grants AR 051315 (R. R. Edwards), AT 004641 (M. T. Smith and J. A. Haythornthwaite) and AG 034982 (R. R. Edwards), and by awards from the American College of Rheumatology (R. R. Edwards) and Arthritis Foundation (R. R. Edwards).
The authors declare no competing financial interests.
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Edwards, R., Cahalan, C., Mensing, G. et al. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 7, 216–224 (2011). https://doi.org/10.1038/nrrheum.2011.2
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