Pain referents used to respond to the pain catastrophizing scale

Pain catastrophizing has emerged as a highly important construct in pain research. The Pain Catastrophizing Scale (PCS) is a widely used self-report measure used to determine a person's level of pain catastrophizing, assumed to be associated with an ongoing, recalled or anticipated pain experience. In practice, instructions for self-reporting catastrophizing typically do not provide a specific pain referent, even when assessing patients with chronic pain. Researchers have noted that it is not known what type of pain participants are referring to when responding to a catastrophizing questionnaire.

In the current study, 182 presumably healthy undergraduate students completed the PCS followed by a query regarding the pain referent used to complete the scale. In addition, they were asked if they have ever experienced chronic pain and to list their worst pain experience.

The most commonly used primary referents included pain due to acute injury (26.4%), headache (18.0%) and general physical pain (11.5%). The type of primary referent and the number of referents did not influence the catastrophizing scores. However, the catastrophizing scores were influenced by the context of the primary pain referent, i.e., whether the primary pain referent was non-chronic worst pain, both chronic and worst pain, chronic pain or unrelated to either chronic or worst pain. Notably, a larger than expected proportion of participants reported having experienced chronic pain (44.5%; n = 81).

The examination of pain referents while responding to a catastrophizing measure would add to our understanding of a person's pain experience and related catastrophic cognitions.