Pain Catastrophizing Scale

Clinical intent

Pain catastrophizing is characterized by the tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain, as well as by a relative inability to prevent or inhibit pain-related thoughts in anticipation of, during, or following a painful event.[1,2]

Pain catastrophizing affects how individuals experience pain. Sullivan et al 1995 state that people who catastrophize tend to do three things, all of which are measured by this questionnaire.

1. They ruminate about their pain (e.g. "I can´t stop thinking about how much it hurts")
2. They magnify their pain (e.g. "I´m afraid that something serious might happen")
3. They feel helpless to manage their pain (e.g. "There is nothing I can do to reduce the intensity of my pain")

As such, the PCS was developed to help quantify an individual's pain experience, asking about how they feel and what they think about when they are in pain. Compared to other ways of measuring pain-related thoughts, this questionnaire is unique in that the individual does not need to be in pain while completing it.

It is one of the most widely used instruments for measuring catastrophic thinking related to pain, and is used extensively in clinical practice and in research.[2] The Adult Version is available in English and 20 other languages.

Calculation

Subscale scores

The PCS subscales are computed by summing the responses to the following items:

Total score

The PCS total score is computed by summing responses to all 13 items.

Clinical interpretation

Individuals who score high on measures of pain catastrophizing report:

• More intense pain (Sullivan et al., 1995, 2006)
• More severe depression and anxiety (Keefe et al., 1989; Martin et al., 1996)
• Show higher levels of pain behaviour and disability (Sullivan et al., 1998, 2000, 2006; Keefe et al., 2000; Sullivan and Stanish, 2003)
• Consume more analgesic medication (Bedard et al., 1997; Jacobsen and Butler, 1996)
• Have more prolonged stays when hospitalized (Gil et al., 1992).

References

[1] Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychological assessment. 1995 Dec;7(4):524.
[2] Quartana PJ, Campbell CM, Edwards RR. Pain Catastrophizing: A Critical Review. Expert Rev Neurother, 2009: 9(5); 745-58.
[3] The Development of the Pain Catastrophizing Scale: http://sullivan-painresearch.mcgill.ca/pcs.php