The incidence of chronic pain is epidemic and contributes to millions of dollars in lost wages, disability payments, and health care costs. Besides the enormous economic impact, the emotional suffering that persons with chronic pain experience is substantial and contributes to problems in all areas. In attempting to cope with unrelenting pain, individuals often experience myriad negative emotions such as anxiety, anger, and frustration, which is compounded by attempts to escape the pain. In particular, pain catastrophizing is associated with high levels of reported pain severity and disability, and leads to poor adaptation to living with chronic pain. This paper specifically targets the cognitive psychological processes (pain-related thoughts, attitudes, and beliefs) shown to be important predictors of satisfactory adjustment to chronic painful conditions. In particular, I examine the role of catastrophic thinking and provide specific suggestions for the targeted treatment of catastrophizing.

Introduction

The filtered light from the window blinds felt like swords stabbing me through my closed eyes. My body was doing the sweaty shakes, and the muscles surrounding my skull had turned to steel bands, growing tighter by the minute…. I had been juggling a heavy professional travel schedule and was walking into delivering my first lecture for a class a colleague had cajoled me into teaching. It required new preparation, and was totally out of my field, but the single seductive phrase of "You'd be great at this, Bev" sold me on taking it. This was a multi-disciplinary seminar taught to a select group of very bright undergraduates. I had met them the week before, handed out the syllabus, and promptly left town for a professional meeting, during which I ate and drank too much, exercised very little, and consumed virtually no water, but huge quantities of caffeine. The first lecture of the semester had been handed off to my graduate teaching assistant, whom I had not met. I was now going to attempt to take the reins. I opened my notebook, smiled at these new and precocious faces, and suddenly detected a tiny spot of light in my right field of vision. Although barely perceptible, it was familiar enough - the beginnings of a migraine aura. "Not now!" I snarled at my brain. I tried closing my eyes, as a test to see if IT was really there. IT was. "I can't have a migraine now," I whispered to my inner self. These kids didn't know anything about me, except that I had skipped out on their first two classes. What would they think if I suddenly packed up and left again? How would I establish credibility? Here it was, the first of the semester, and I was already shirking the responsibilities I had agreed to in taking on this class. I began berating myself for taking on this class, and for taking on too many travel commitments, knowing it was my own fault that my body was rebelling. The spot in my visual field was growing. I had thirty minutes to abort the migraine or suffer the consequences. I excused myself and chugged a Midrin, came back to the classroom and decided to begin the lecture - poor choice. My vision started to scintillate. I talked, without the benefit of my notes, with one eye squinted closed, for another 10 minutes and took a 2nd Midrin - usually enough to make me goofy for the rest of the day. I continued talking. The sweats came. The vomiting was soon to follow. I had to get out of there. Feeling like a complete fool, I confessed to my class that I was having a migraine and had to cut class short, knowing they were thinking, "What a loser!" Surely, they would be dropping the class in droves, moving to a more competent professor's section, one whose intellect was worthy of their presence. I called my husband to come and rescue me and spent the next 8 hours lying in bed when I wasn't vomiting in the bathroom. continued

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