Pain Catastrophizing and its Domains Significantly Impact Rheumatoid Arthritis Disease Activity, 2025, Currado et al

[voner]

Abstract​

This study aims to evaluate the impact of pain catastrophizing (PC) on disease activity in patients with rheumatoid arthritis (RA) and to explore, in the same participants, if this association is related or not with anxiety and depression, which have been related to catastrophization in patients with chronic pain. A multi-center, observational study has been conducted on 158 RA patients from six Rheumatology Clinics. Participants were assessed using the Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) and Disease Activity Score on 28 joints- C reactive protein (DAS28-CRP). Pain Catastrophizing, with its domains of Helplessness, Rumination and Magnification, was analyzed through Pain Catastrophizing Scale (PCS). Statistical analyses included univariable and multivariable regressions, to identify associations between disease activity and PC. Results revealed that higher PCS scores were significantly associated with increased CDAI, SDAI and DAS28-CRP values, indicating higher disease activity. Specifically, the domains of Rumination and Helplessness showed a strong correlation with disease activity, while Magnification did not. These associations persisted independently of anxiety and depression mood, as shown by multivariable regression analysis. Pain catastrophizing, particularly the domains of Rumination and Helplessness, significantly influences disease activity in RA patients, independent of mood disorders. These findings underscore the importance of addressing maladaptive cognitive perceptions of pain in the management of RA, to improve patient outcomes and facilitate disease remission.

open access: https://www.nature.com/articles/s41598-025-21749-1.pdf

 

[Jonathan Edwards]

God help us.
Pain is going to 'impact' disease activity scores because they include an assessment of pain.
If any newer members are interested in examples of just how bad most biomedical research seems to be these days (which the old lags need no reminding of) try this one.

 

[Utsikt]

Pain catastrophizing, particularly the domains of Rumination and Helplessness, significantly influences disease activity in RA patients, independent of mood disorders.

The good old trick of inferring one-way causality from correlation.

These findings underscore the importance of addressing maladaptive cognitive perceptions of pain in the management of RA, to improve patient outcomes and facilitate disease remission.

Good luck treating RA with CBT..

 

[InitialConditions]

At this stage we need to proscribe Scientific Reports.

 

[Yann04]

The good old trick of inferring one-way causality from correlation.

And measuring something non specific, and calling it a specific causal hypothesis (catastrophising).

For example, here is the scale they used to measure catastrophising (Pain Catasrophising Scale). It seems to me someone with awful pain could tick all of those and not be catastrophising. I doubt it’s a very good scale.

 

[Jaybee00]

The severe peer review this must have undergone….

Forget peer review… this should have been read by a non-peer with some common sense.

29 authors including 6 Francesca/o!

Is it 6 Francescii?

 

[Jonathan Edwards]

A small point. I never met a person with RA who emphasised their pain. Most were quite reticent about it. It had become a normal part of their life by the time they got to me. Most of the time they underplayed it, hoping that I would say things were not too bad or they didn't have chronic arthritis. Lupus patients often emphasised pain more because they had already met professionals who thought nothing much was wrong because there was nothing to see.

The lack of psychological insight of psychologists never ceases to amaze me.

 

[rvallee]

God help us.
Pain is going to 'impact' disease activity scores because they include an assessment of pain.
If any newer members are interested in examples of just how bad most biomedical research seems to be these days (which the old lags need no reminding of) try this one.

Seems to me to be pretty standard biopsychosocial, where they include bits of biology but screw it all up by misinterpreting associations out of bad questionnaires.

And yeah this is just embarrassing. Silly, even. They keep taking associations that run in an obvious direction, but argue that it must work the other way around. It just has to, because the most plausible explanation has been declared forbidden, or something like it.

It's actually far more embarrassing than most of the criticisms laid on LLMs, because humans are more than capable of working through the steps for why this is obviously wrong, and every LLM out there would even agree with the correction if they somehow got it wrong and started making post facto rationalizations.

 

[rvallee]

And measuring something non specific, and calling it a specific causal hypothesis (catastrophising).

For example, here is the scale they used to measure catastrophising (Pain Catasrophising Scale). It seems to me someone with awful pain could tick all of those and not be catastrophising. I doubt it’s a very good scale.

Those questions are so weird that it seems fit to question the sanity of a system that treats them seriously. Even propagandists would recoil at how they are comically biased to the point of being cringe.

 

[Sean]

The good old trick of inferring one-way causality from correlation.

And measuring something non specific, and calling it a specific causal hypothesis (catastrophising).

The term is so loaded with arbitrary causal attribution that it has become a major source of bias in and of itself.

Unfortunately this is not an isolated example in psych. If anything the entire field is heavily contaminated by this problem.

The lack of psychological insight of psychologists never ceases to amaze me.

It is genuinely astounding that the one psychological understanding they seem to be most resistant to acknowledging, or even simply lack completely, is into the psychology of the experimenter themselves, and why it is so fundamentally important to control for it.

I agree with @rvallee. We are way past the point where it can be ascribed to mere error or ignorance. It has been going on for so long, against all explicit evidence and warnings, including from within the profession itself, that it now cannot be interpreted as anything but conscious intent.

That's the problem.

 

[Yann04]

It takes quite an echo chamber to have a subfield where the “experts” are arguably more off than the laypeople. Yet here we are.

 

[Kiristar]

"Maladaptive conceptions of pain"

Good grief penfold.

Talk about gaslighting in the extreme. I bet if they ever experienced that much pain themselves their "conceptions" about it would soon change to be "maladaptive" too.

How about respecting the lived experience for once.

 

[rvallee]

"Maladaptive conceptions of pain"

Good grief penfold.

Talk about gaslighting in the extreme. I bet if they ever experienced that much pain themselves their "conceptions" about it would soon change to be "maladaptive" too.

How about respecting the lived experience for once.

Isn't RA known for being especially painful?

A reasonable person would immediately flag the fact that those concepts are absurd and harmful. And yet.

 

[Jonathan Edwards]

Isn't RA known for being especially painful?

It is known to be so painful that it is generally regarded by doctors as a catastrophe for the person.

 

[Evergreen]

Catastrophically bad.

And a multicentre study with a lot of authors, so this may be representative of rheumatology throughout Italy. They're working their way through all of the rheumatological disorders, it seems:

These results are in line with our previous data just published, in which we described that, in axSpA and PsApatients, PC specifically correlated with the number of tender joints, patient-reported pain, and patient global assessment, thus confirming its predominant impact on the subjective dimension of the disease activity scores, independently of inflammation

How on earth did it get published? I can only hope that some rheumatologists will object in a Matters Arising.

I'm not sure RA patients would be aware that this is how they're talked about. If most of us were getting treatment that helped, would we be on a forum dissecting literature? We'd probably just be living our lives.

It makes me think that people who have participated in a study should be sent a copy of publications that arise from it, and there should be a public space where they can share their thoughts, anonymously.

 

[Hoopoe]

Horrific testimony that we live in a society where expressing in how much pain you are is (almost?) considered a psychological disorder, at least by some.

The expression of pain is of course a request for help. Labelling requests for help a dysfunctional behaviour is disturbing. What does this say about society's willingness to respond to these requests? What does it say about the way society treats people who are in pain, sick, disabled, in crisis?

I understand that doctors find it difficult to listen to these expressions of pain, that they get worn out by them, that patients can have hope or expectations for pain relief that aren't realistic. But these things don't make expression of pain a dysfunctional behaviour.

Do doctors really want to send the message to patients that they cannot safely and openly communicate with healthcare professionals? Because that is the effect of these articles. Do doctors really want to work with patients who feel emotionally unsafe in their presence?

We need more psychologists who are on the side of patients, not against them.

 

[Lou B Lou]

I find the framing of pain as so subjective really scary. If pain is so very subjective then what's wrong with physical torture, in fact what's the point of physical torture?

I also think that pain specialists/psychologists/therapists/researchers/minimisers/gaslighters/etc should be required to have a twice yearly training in 'The Practical and Experiential'..... they could then participate in endless studies of them, before, during and after the bi-annual hefty kick on the shin, skin pinching, electric shock (or whatever the pain-inducing method is)

Studies such as .... 'Anticipatory Catastrophising in the Pain Profession', 'Fear and Loathing in Pain Training', 'Why are pain researchers leaving the profession?' etc.

 

[Evergreen]

I also think that pain specialists/psychologists/therapists/researchers/minimisers/gaslighters/etc should be required to have a twice yearly training in 'The Practical and Experiential'..... they could then participate in endless studies of them before, during and after the bi-annual hefty kick on the shin, skin pinching, electric shock (or whatever the pain-inducing method is) .... 'Anticipatory Catastrophising in the Pain Profession', 'Fear and Loathing in Pain Training', 'Why are pain researchers leaving the profession?' etc.

And accompany it with education of their family, hospital staff and the wider public that they just have a lower pain tolerance than the average population, and can be safely ignored when they say they are in pain.

 

[Turtle]

Can this be called an objective test?

And measuring something non specific, and calling it a specific causal hypothesis (catastrophising).

For example, here is the scale they used to measure catastrophising (Pain Catasrophising Scale). It seems to me someone with awful pain could tick all of those and not be catastrophising. I doubt it’s a very good scale.

With all those feelings words isn't that putting words in the patients mouth?

"I keep thinking how much it hurts"
"I anxiously want the pain to go away.

Has anyone of you ever used a sentence like this?

 

[rvallee]

Do doctors really want to send the message to patients that they cannot safely and openly communicate with healthcare professionals? Because that is the effect of these articles. Do doctors really want to work with patients who feel emotionally unsafe in their presence?

I have seen many random discussions on general forums, where there can't be any bias towards people disgruntled about medicine, that make it clear that a significant % already do, and the more health problems they have of the kind that medicine treats poorly, the more they do.

So here we have this roundabout problem where medicine forces a change in behaviour in patients for the worse, making them adapt their behaviours because physicians' emotions have to be managed very carefully, which they then evaluate, which in turn cause more changes in behaviours, all of which it seems eventually end up being asserted to be wrong. It's frankly a lot like dealing with a short-tempered boss or abusive spouse.

I have been doing for many years now. I definitely don't tell them everything, I know it will be use to hurt me. I also tell them things that aren't quite true, knowing that the truth will likely be used to hurt me. This is something that comes off often, especially about things like risky behaviour, where you better tell them if you use something because you don't if it can cause problems, except the profession seems to be doing everything it can to teach people to lie to them, in part by lying to us. Damned if you do, damned if you don't. Always damned.

So much that a radical change here would be to require health care professionals to only tell the whole truth. Technically they have the cute duty of candour, but it's just a bunch of cheap words. Small lies have been so normalized that no one even thinks about their consequences, so much that medium and large lies have also become normalized. A reflection of our societies, where lies and fraud dominate and ruin everything. It's even ruining medicine, and it's physicians doing it.