Disease-Related, Nondisease-Related, and Situational Catastrophizing in Sickle Cell Disease and Its Relationship With Pain

Abstract

Catastrophizing is a potent psychological modulator of pain across several chronic pain populations; yet despite evidence that patients with sickle cell disease (SCD) catastrophize more than patients with other chronic pain conditions, previous research indicates that catastrophizing is not related to sickle cell pain after controlling for relevant covariates such as depression. Recent research suggests that pain-related catastrophizing should be assessed across pain contexts (eg, dispositional and situational). In this study, we measured disease-specific, general non-disease-related, and situational catastrophizing and assessed the relationship between these contextual dimensions of catastrophizing and laboratory and clinical pain among patients with SCD. Results revealed differential catastrophizing across pain contexts, with patients reporting greater catastrophizing about SCD-specific pain compared with non-SCD pain and laboratory pain. SCD-specific and non-SCD catastrophizing were associated with clinical pain outcomes, and situational catastrophizing with markers of central sensitization and laboratory pain. Further examination of the time course of laboratory responses revealed that increases in situational catastrophizing were associated with subsequent increases in laboratory pain sensitivity. Taken together, results show the relevance of catastrophizing in understanding pain in SCD, and suggest that context-specific anchors may be beneficial in predicting different aspects of the pain experience (eg, chronic pain, pain sensitization).

Perspective: Patients with SCD report greater catastrophizing about sickle cell-specific pain relative to other pains. Disease-specific and non-disease-related pain catastrophizing were associated with clinical pain, and situational catastrophizing predictive of subsequent laboratory pain. Evaluation of context-specific catastrophizing may more accurately predict different aspects of the pain experience.

Keywords: Sickle cell disease; central sensitization; chronic pain; pain catastrophizing; quantitative sensory testing.