components: (i) rumination: a focus on threatening information both internal and
external (‘I can feel my neck click whenever I move’); (ii) Magnification: overestimating
the extent of the threat (‘The bones are crumbling and I will become paralysed’); and
(iii) Helplessness: underestimating personal and broader resources which might mitigate
the danger and disastrous consequences (‘Nobody understands how to fix the problem
and I just can’t bear any more pain’). Catastrophizing has been linked to both the
onset of pain and the development of longer-term pain problems (Sullivan et al. 2001).
For example, in the prospective study described above by Linton et al. (2000), the authors
measured baseline levels of pain catastrophizing. The results showed some small associ-
ations between this and the onset of back pain by follow-up. Crombez et al. (2003)
developed a new measure of catastrophizing to assess this aspect of pain in children.
Their new measure consisted of three subscales reflecting the dimensions of catastro-
phizing, namely rumination, magnification and helplessness. They then used this meas-
ure to explore the relationship between catastrophizing and pain intensity in a clinical
sample of 43 boys and girls aged between 8 and 16. The results indicated that catastro-
phizing independently predicted both pain intensity and disability regardless of age and
gender. The authors argued that catastrophizing functions by facilitating the escape from
pain and by communicating distress to others.
Meaning
Although at first glance any pain would seem to be only negative in its meaning,
research indicates that pain can have a range of meanings to different people. For
example, the pain experienced during childbirth although painful, has a very clear cause
and consequence. If the same kind of pain were to happen outside of childbirth then
it would have a totally different meaning and would probably be experienced in a
very different way. Beecher (1956), in his study of soldiers’ and civilians’ requests for
medication, was one of the first people to examine this and asked the question: ‘What
does pain mean to the individual?’ Beecher argued that differences in pain perception
were related to the meaning of pain for the individual. In Beecher’s study, the soldiers
benefited from their pain. This has also been described in terms of secondary gains
whereby the pain may have a positive reward for the individual.
Self-efficacy
Some research has emphasized the role of self-efficacy in pain perception and reduction.
Turk et al. (1983) suggest that increased pain self-efficacy may be an important factor
in determining the degree of pain perception. In addition, the concept of pain locus
of control has been developed to emphasize the role of individual cognitions in pain
perception (Manning and Wright 1983; Dolce 1987; Litt 1988).
Attention
There has also been research exploring the impact of attention on pain. Much work
shows that attention to the pain can exacerbate pain whereas distraction can reduce the
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