Re-thinking over-thinking pain: What can metacognition add to our understanding of pain catastrophising?

© 2016 The Australian Psychological Society Pain catastrophising is one of the most widely studied psychological constructs in pain science, given its association with increased pain intensity, disability, emotional distress, psychopathology, and pain-facilitating neurobiological changes in people with chronic pain. Yet despite being a key target in evidence-based biopsychosocial treatments, it is still not entirely clear what pain catastrophising is or how best to treat it. This paper argues that the contents of catastrophic thinking have been over-emphasised in incumbent cognitive behavioural interventions and that pain catastrophising is most usefully conceptualised as a form of repetitive negative thinking. However, what is missing from this view of pain-related rumination is an understanding of how higher order cognitive processes, such as metacognition, might moderate it. Spada and colleagues' paper in this issue of Clinical Psychologist begins to shed light on this subject, providing the first clear evidence that metacognitive beliefs about worry are strongly associated with pain catastrophising. These exciting results and their implications for future directions in pain research are discussed in the context of mounting calls for more theory-driven psychological interventions for chronic pain