Pain catastrophizing and its association with functional disability and psychological distress in patients with chronic low back pain: a retrospective study

Chronic low back pain (CLBP) is a leading cause of disability worldwide, with growing recognition of the role of psychological factors in its persistence and severity. Pain catastrophizing-a maladaptive cognitive-emotional response to pain-has been linked to greater pain intensity and poor functional outcomes. However, evidence from real-world clinical settings remains limited.

This retrospective study included 392 patients with CLBP treated at Dazhou Dachuan District People's Hospital between January 2018 and December 2023. Pain intensity, catastrophizing, depressive and anxiety symptoms, kinesiophobia, sleep quality, and disability were assessed using standardized scales (NRS, PCS, PHQ-9, GAD-7, TSK-11, PSQI, and ODI). Spearman correlation and multivariable linear regression analyses were performed to identify factors associated with functional disability, and a conceptual mediation model was tested to evaluate the indirect effect of depression. Mediation testing was conceptual and based on cross-sectional associations within a retrospective dataset; therefore, temporal ordering and longitudinal mediation cannot be inferred.

Pain catastrophizing was strongly correlated with ODI scores (ρ = 0.68, p < 0.001) and remained an independent predictor of disability after adjustment for pain intensity, depression, anxiety, and demographics (β = 0.62, p < 0.001). Depressive symptoms partially mediated the relationship between catastrophizing and disability. Patients in higher PCS quartiles showed progressively worse ODI scores (p < 0.001).

Pain catastrophizing is a robust independent predictor of functional disability in patients with CLBP, and its effect is partly mediated by depressive symptoms. Routine psychological screening and targeted cognitive-behavioral interventions may improve functional outcomes and quality of life in this population. Given the retrospective design, these findings should be interpreted as associations rather than evidence of causality.