The International Association for the Study of Pain (International Association for the Study of Pain, IASP) defines the pain as “An unpleasant, sensory and emotional experience associated with real or potential tissue damage”.
There is talk of chronic pain when it lasted over time, losing its alarm function, with possible consequences on the quality of life of the person. In fact, pain can involve important repercussions on well -being: an increase in the number of access and visits required to the health system, alterations in sleep, psychological and emotional suffering of variable intensity, up to anxious and/or depressive symptoms situations that require targeted psychological interventions.
By virtue of this chronic pain has often been the subject of study in psychological research. Several factors have been detected that play a role in the development and maintenance of chronic pain, including specific distortions and cognitive beliefs: many research have detected how catastrophisation, generally understood as the tendency to evaluate the meaning of an event in an excessively worse way of what it should be in terms of perceived threat, is one of the factors that most influences the perception of pain by the person, as well as any consequences in terms of disability in terms of disability. Presented and emotional suffering, psychological distress, levels of anxiety and depression.
The beliefs relating to the advancement, the fear related to the anticipation of pain and the catastrophisation would then influence the avoidance and the selective attention oriented towards body sensations, maintaining or aggravating the problem, with also significant consequences in terms of personal autonomy.
The treatment of chronic pain, so that it is effective, should therefore generally include an integrated multispeciale approach, which therefore does not limit itself to a purely medical-somatic taking charge, but which also includes the evaluation and treatment of the psychological factors detected by the research.
Cognitive-behavioral therapy offers suitable tools both for work on the consequences of chronic pain in terms of anxiety, depression and alterations of sleep, and for the treatment and management of the mechanisms listed above, to break the vicious circles that maintain and aggravate the problem, in order to improve the quality of life of the person and the adherence to possibly prescribed medical therapies.
Cognitive-behavioral interventions-oriented towards pain usually include the cognitive renovation of catastrophic cognitions on pain in order to replace them with more functional beliefs, as well as, depending on the specific assessment of the case, the use of faces in the face of landscape, coping affirmations, relaxation techniques and the modification of the daily routine to manage the problem in a more functional way.
In a recent article published on Clinical Psychologist (“Re-thinking Over-Thinking Pain: What can metacognition Add to Our Undersanding of Pain Catastrophising?”), The author, Robert Schütze, also proposes to consider other variables, in addition to those considered in cognitive-behavioral models.
Schütze comments on the data of a study conducted and published by Spada and colleagues (“Beliefs Meta-Cognitive About World and Pain Catastrophizing AS MediaTors Bethaeen Neuroticism and Pain Behaviour“), which proposed to evaluate, in a sample of 308 people, the relationship between neuroticism, metacognitive beliefs, pain catastrophisation and pain behavior.
The results detected a connection between metacognitive beliefs relating to concern, behaviors and catastrophisation. In particular, positive metacognitive beliefs about concern (for example “Concerning me is useful”) they mediated the relationship between neuroticism and catastrophisation.
Negative metacognitions (for example “My concern is dangerous for me”), on the other hand, the report between catastrophisation and maladative behaviors relating to pain, including avoidance.
Schütze refers to the Wells metacognitive therapy model (MCT), already considered effective for problems of anxiety and depression: the Wells model does not focus on the contents of our thoughts, as standard cognitive-behavioral therapy does, but on the processes: in particular brooding and rumination.
We therefore work with specific techniques on the attention we give to our thoughts, which influences the emotional consequences that we experience and which in turn is influenced by the beliefs we have on our thoughts: the so -called, and already mentioned, metacognitions, which can be both positive and negative.
Schütze opens the way to the possible conceptualization of a cognitive-staining syndrome (CAS) related pain, similar to that already postulated by Wells for other emotional disorders and which could include attentive processes and specific maladative behaviors of chronic pain.
It also underlines that if negative metacognitive beliefs about uncontrollability and threat of median concern the relationship between catastrophisation and maladative behaviors, these could be central to understanding and changing the perseverative thought relating to pain.
Schütze himself underlines the need for other research in order to explore these processes and possibly articulate a real metacognitive model for the catastrophisation of pain, but indicates how these results open the way to hypothesize that they could become themselves target of equal relevance compared to the above mentioned factors already known and subject to treatment in cognitive-behavioral protocols.
The author concludes by underlining that it is possible that a metacognitive model of pain catastrophisation will be able to emerge from the experimentation of a form of metacognitive therapy oriented towards chronic pain; But it also underlines that metacognitive therapy hardly can become the new treatment of election for this problem: this could however further improve the understanding that we already have treatment mechanisms that are used effectively in cognitive-behavioral therapy and offer additional strategies to be used, to better calibrate the interventions according to specific cases.
