Study links pain 'catastrophising' to little exercise, more sedentary lifestyle

Pennsylvania [US], August 26 : Getting enough exercise plays a key role in chronic pain management. However, how people approach their pain can have a significant effect on whether they get enough physical activity - or if they spend more time sedentary.
In a study, a team led by Penn State researchers found that when people with knee osteoarthritis "catastrophised" -- feeling exaggerated helplessness or hopelessness -- about their pain more than usual, they were less likely to be physically active later in the day, contributing to a domino effect of sedentary behaviour followed by even more pain catastrophising.
According to the researchers, the results -- recently published in the journal PAIN -- have potential implications for pain management and wellness in older adults and suggest that pain catastrophising could be an important therapeutic target for interventions and pain treatment.
"Reducing daily pain catastrophising may help older patients to be more active and less sedentary on a daily basis. This could help improve their chronic pain condition, physical function, and overall health, and reduce the possibility of hospitalisation, institutionalisation, and healthcare costs in the long term," said Ruixue Zhaoyang, assistant research professor.
According to the researchers, chronic or persistent pain affects between 60 and 75 per cent of older adults in the US, making pain management strategies like engaging in enough physical activity an important part of many older adults' lives.
Zhaoyang said catastrophising about pain -- thought patterns like "the pain is terrible and is never going to get any better" or "I can't stand the pain anymore" -- may lead some older adults to avoid exercise in an effort to also avoid pain. But if exercise is put off for too long, it can lead to spirals of depression and even worse pain.
"Staying physically active is one of the most important self-management strategies for chronic pain patients. However, many chronic pain patients avoid physical activities that they are actually capable of doing. Our study focused on one critical psychological factor that may explain why patients avoid physical activity despite its importance for pain management: their catastrophic thinking about their pain," said Lynn Martire, professor of human development and family studies.
For the study, the researchers used data from 143 older adults with knee osteoarthritis. The participants kept daily diaries and wore accelerometers -- a wearable device for measuring physical activity -- for 22 days. Each morning, the participants would report how they felt about their pain that day and the accelerometer would gather information on physical activity and sedentary behaviour.
After analysing the data, the researchers found that on the mornings when participants catastrophised about their pain more than usual, they ended up engaging in less moderate to the vigorous physical activity later that day.
Additionally, the researchers found that catastrophising about pain in the morning leads to more time in sedentary behaviour the same and the following day, as well. In turn, more time spent sedentary leads to increased pain catastrophising on the following day.
"One particularly interesting finding is that the detrimental influence of catastrophising thinking about pain is independent of the pain experience itself. In other words, how patients think about their pain, rather than the level of experienced pain, had a more powerful impact on their daily physical activity," Zhaoyang said.
Martire said the results suggest that pain catastrophising can kick-start a potentially harmful cycle -- greater pain catastrophising in the morning leads to avoidance of physical activity, which in turn worsens catastrophising about pain on the following day.
The researchers added that these findings suggest that pain catastrophising could be a good target for interventions aimed at managing chronic pain and increasing physical activity.
"Our study demonstrated that patients' catastrophising thinking can change from day to day and can be modified by their everyday activity behaviour. Future interventions may get better results from using mobile technology to monitor patients' activity levels in everyday life and provide just-in-time adaptive interventions targeting patients' pain catastrophising to reduce their sedentary behaviour," Martire said.
The researchers added that while their study looked specifically at people with knee osteoarthritis, catastrophising can happen with any type of pain. They said the implications of their findings could potentially apply to pain management in patients with other types of chronic pain.