Catastrophizing in Chronic Itch: Associations with Demographic, Clinical and Psychological Factors

Catastrophizing, defined as an overly negative evaluation of one's situation, is associated with worse disease outcomes in patients with chronic pain but remains unexplored in pruritus medicine. In this cross-sectional study, we included patients with chronic prurigo (CPG, n=50), chronic pruritus on nonlesional skin (CPNL, n=50) and chronic spontaneous urticaria (CSU, n=50) to investigate catastrophizing and determine possible associations with demographic and clinical factors. Patients completed validated questionnaires assessing catastrophizing (Itch-Cognition-Questionnaire), itch intensity, disease control, quality of life, anxiety, depression, stress and attention to itch. We recorded median [interquartile range] catastrophizing scores of 19.0 [11.0; 29.0] for CPG, 17.0 [11.8; 24.3] for CPNL and 10.0 [5.0; 18.3] for CSU patients. Catastrophizing correlated positively with itch intensity (r=0.382-0.678, p<0.001-0.006), quality of life impairment (r=0.554-0.716, p<0.001) and vigilance and awareness to itch (r=0.407-0.591, p<0.001-0.003) across patient groups. Linear regression analysis revealed a lower likelihood of catastrophizing in CSU patients (CSU: β=-5.905, p<0.001; CPG: reference), a positive association of catastrophizing with average itch intensity (β=1.119, p=0.008) and attention to itch (β=0.150, p<0.001), and a negative association with age (β=-0.095, p=0.004) and short disease duration (β=-5.797, p=0.049). Catastrophizing represents a pivotal cognitive process, which is associated with worse clinical outcomes in chronic itch patients.