The Impact of Kinesiophobia and Pain Catastrophizing on Pain
Written by Philip Van Dyke, PT, DPT, CSCS
When you’re educating a patient about his or her diagnosis and the pain that he or she is experiencing, what is your approach? There is not one right way to go about this, but there are ways that this can be done that can potentially increase the patient’s perception of pain and derail your treatment efforts.
Pain is a hot topic in the world of physical therapy right now. However, there is a great deal of complexity in how pain is exhibited, experienced, and modulated. Two ways in which the perception of pain can be increased in our patients are kinesiophobia and pain catastrophizing. Kinesiophobia is the irrational fear that movement will cause further injury. Pain catastrophizing is a slightly different, but likely interrelated, construct that involves the belief that pain will increase and that he or she is unable to deal with it. These two constructs are well established as being strongly related to increased pain in many different populations being treated for many different types of injuries. The following are just a few examples of studies that demonstrate the impact of pain catastrophizing and kinesiophobia on different body regions.
· Domenech et al. (2014) found that changes in catastrophizing accounted for 48% of the variance in changes in pain following treatment for anterior knee pain. While not as strong of a correlation, kinesiophobia also accounted for some variance in the changes in pain following treatment.
· Das De et al. (2013) found similar results in patients being treated for upper extremity injuries/pathologies, with catastrophic thinking and kinesiophobia being large contributors to variance in disability (measured by the DASH).
· Picavet et al. (2002) reported an association with pain catrastrophizing and kinesiophobia at baseline to the development of chronic low back pain regardless of the presence of low back pain at baseline. However, the 95% confidence intervals for both of these measures fell below 1, so the results were not particularly strong.
So how do we assess for levels of pain catastrophizing and kinesiophobia in our patients. Well, it just so happens, that there are self-report outcome measures for assessing both of these constructs.
· The Pain Catastrophizing Scale (PCS) is a 13-item self-report measure that measures levels of rumination, magnification, and helplessness.
· The Tampa Scale of Kinesiophobia (TSK) is a 17-item self report measure that attempts to quantify the irrational fear of movement or re-injury.
It’s great to include these self-report scales in our assessment of a patient, but we also need to consider how we may affect the levels of kinesiophobia and pain catastrophizing by how we communicate with our patients. Traditionally, our profession has explained pain to patients by attributing it to the suspected anatomical pathology. It is true that tissue damage can send nociceptive signals to the brain, but how that nociception is then experienced is entirely up to the brain and how much danger it perceives. So, if a patient perceives movement as a potential danger, explaining that the pain is caused by some sort of anatomical pathology or injury is likely to going to perpetuate that irrational fear and increase his or her pain.
Rather than potentially worsening our patients’ pain by how we communicate with them, why not educate them about the nature of pain. I don’t think this is something that is covered in great depth in physical therapy curricula, but there are a couple of good books that I am aware of that can help us to be able to better explain it and can be suggested to patients for them to read. Painful Yarns, by Lorimer Moseley, a book that I recently finished, explains the science of pain through multiple anecdotes and analogies. While I have not read it yet, Explain Pain, by David Butler, is another easy-to-read book that describes how pain works in a patient-friendly manner. There are also numerous other resources out there to learn more about pain.
The good news for us is that the evidence seems to show that kinesiophobia and pain catastrophizing decrease over the course of physical therapy treatment along with reduction in pain and disability. It is very difficult, at this point, to determine whether the decrease in disability is causing less kinesiophobia and pain-catastrophizing or vice versa. Regardless, we should strive to help our patients achieve their optimal physical potential and reinforce that with our patient education.
- Das de S, Vranceanu AM, Ring DC. Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability. J Bone Joint Surg Am. 2013;95(1):76-81.
- Doménech J, Sanchis-alfonso V, Espejo B. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2295-300.
- Hartigan EH, Lynch AD, Logerstedt DS, Chmielewski TL, Snyder-mackler L. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther. 2013;43(11):821-32.
- Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156(11):1028-34.
- Verwoerd AJ, Luijsterburg PA, Koes BW, El barzouhi A, Verhagen AP. Does Kinesiophobia Modify the Effects of Physical Therapy on Outcomes in Patients With Sciatica in Primary Care? Subgroup Analysis From a Randomized Controlled Trial. Phys Ther. 2015;95(9):1217-23.