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Catastrophizing by Patients with Chronic Pelvic Pain Varies with Symptom Distribution, Comorbidities

Key findings

  • This study evaluated catastrophizing in 184 patients presenting to a multidisciplinary treatment program for chronic pelvic pain
  • Higher scores on the Pain Catastrophizing Scale (PCS) correlated with scores on questionnaires about pelvic symptoms, anxiety and depression
  • The more pain comorbidities, the higher the PCS score (increase in score by 2.3 points for every comorbidity)
  • Treatment outcomes can be affected by maladaptive coping, so clinicians should maintain a high index of suspicion for catastrophizing in patients with chronic pelvic pain

"Catastrophizing" refers to the tendency of a person to amplify the perceived risk of a situation or sensation of pain and engage in excessive negative thinking. Catastrophizing has been linked to higher levels of pain in multiple conditions marked by chronic pain, including fibromyalgia, rheumatoid arthritis, osteoarthritis, spinal pain and male chronic prostatitis/chronic pelvic pain (CPP).

Urologist Elise J.B. De, MD, of the Department of Urology at Massachusetts General Hospital, and colleagues have found that catastrophizing is also related to generalized CPP. In Urology, they explain the implications for treatment.

Study Details

The study participants were 184 patients with CPP (87% female) who were referred from 11 specialties to a multidisciplinary pelvic pain group. They had an average of four (range, 1–14) pain comorbidities.

The participants completed five standardized questionnaires:

  1. Genitourinary Pain Index
  2. Patient Health Questionnaire for Depression and Anxiety
  3. Interstitial Cystitis Symptom Index
  4. Pelvic Floor Distress Inventory
  5. Pain Catastrophizing Scale (PCS, highest possible score 52)


A higher total number of pain comorbidities correlated with PCS score (increase in score of 2.3 points for every comorbidity). PCS score was positively correlated with higher scores on all other standardized questionnaires.

The 81 participants (44%) who were extreme catastrophizers (PCS score ≥30) scored significantly higher than non-extreme catastrophizers on all standardized questionnaires.

The number of pain comorbidities was not significantly different between extreme and non-extreme catastrophizers.

Relevance to Practice

It's unclear whether catastrophizing in patients with CPP is due to higher levels of pain and number of comorbidities or whether the opposite is true. Similarly, it isn't known whether catastrophizing amplifies pain or vice versa.

Regardless, clinicians should maintain a high index of suspicion for catastrophizing so they can identify patients with CPP whose treatment outcomes could be affected by maladaptive coping. It is also important to stay alert to pain beyond the pelvis, engaging other specialists as needed for care such as neurological evaluation, rheumatologic evaluation and cognitive behavioral therapy.

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