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Clin J Pain. 2019 Apr 3. doi: 10.1097/AJP.0000000000000713. [Epub ahead of print]

The Mediating Effect of Pain Catastrophizing on PTSD Symptoms and Pain Outcome.

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Mayo Clinic, Rochester, MN: 200 First Street SW, Rochester, MN 55905, USA.
Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI: 235 Wealthy Street SE, Grand Rapids, MI, 49503, USA.
Michigan State University College of Human Medicine, Grand Rapids, MI: 15 Michigan Street NE, Grand Rapids, Michigan, 49053, USA.



Co-prevalence of chronic pain and post-traumatic stress disorder (PTSD) negatively impacts the course of both disorders. Patients diagnosed with both conditions report greater pain, affective distress and disability when compared to those with either chronic pain or PTSD alone. While the prevalence and complexity of the comorbidity is widely acknowledged, there is a dearth of research examining potential mechanism variables that might account for the relationship between chronic pain and PTSD. The current study utilizes a series of mediation analyses to examine if pain catastrophizing mediates the relationship between PTSD symptomatology and chronic pain outcome.


203 treatment seeking participants admitted to a three-week interdisciplinary pain rehabilitation program completed a battery of psychometrically validated measures of pain severity, pain interference, pain catastrophizing, depressive symptoms and PTSD symptoms at program admission.


A series of multiple parallel mediation analyses revealed that pain catastrophizing fully mediated the relationships between PTSD symptoms and pain outcome (i.e., pain severity and pain interference) above and beyond the influence of depressive symptoms.


Results suggest that pain catastrophizing may represent an important cognitive mechanism through which PTSD symptoms influence the experience of chronic pain. Psychosocial treatment approaches that directly target tendency to catastrophize in response to pain may hold the potential to have salutary effects on both chronic pain and PTSD.

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