Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Nursing

Supervisor

Webster, Fiona

Abstract

Background: Pain catastrophizing is a widely used concept; however, many have argued that it delegitimizes and decontextualizes patients’ pain experiences. Previous studies identified that patients and clinicians think the term is stigmatizing; however, nurses’ perceptions are underrepresented. Nurses offer a unique perspective that is critical to explore to foster positive change and improve patient outcomes. Objectives: This thesis aims to summarize the current literature on pain catastrophizing perspectives from clinicians and patients, analyze nurses’ perspectives, and uncover any underlying issues with the term itself. Methods: This thesis consisted of a two-stage design. The first study is a scoping review that followed Arksey and O’Malley’s methodology. The second study is a secondary analysis using survey data collected by Stanford University. Qualitative thematic analysis was used to analyze the open-ended survey responses from nurses. Findings: The scoping review included nine studies and identified six themes: (1) acceptance of pain catastrophizing, (2) inability to measure, (3) stigma, (4) cognitive processes, (5) renaming pain catastrophizing, and (6) perceptions of pain catastrophizing. The secondary analysis included open-ended survey responses from 136 nurses from which three themes were identified: (1) how nurses describe the term, (2) application of the term and patient responses, and (3) nurses’ recommendations for the future. Implications: Nurses play a critical role in humanizing health care by challenging the status quo, advocating, and promoting social justice. Future research on pain catastrophizing should use a qualitative approach to focus on patients’ and nurses’ perspectives. Conclusions: These findings shed light on the problematic nature of the term pain catastrophizing. We argue that it is a dehumanizing concept and contradicts the definition of pain developed by the International Association for the Study of Pain. These findings support that the term is not patient-centred, neglects the multifaceted nature of pain, and fails to acknowledge that pain is subjective. Pain is what the patient says it is, and we need to start respecting it as such.

Summary for Lay Audience

Doctors and nurses often use the term pain catastrophizing to refer to patients they suspect might be displaying an exaggerated response to the pain they are experiencing. However, many people disagree with the term for several reasons, not least of which is that the term is stigmatizing. Advocates of the term suggest that pain catastrophizing is not meant to shame patients but rather to understand how psychological factors might be impacting their experiences. The experience of pain is difficult to measure as there are no objective tests that can measure how much pain someone feels. Instead, care providers must rely on what patients tell them.

Given the many issues surrounding the term pain catastrophizing, this thesis includes two studies that explore how the term is operationalized, understood, and described by both patients and clinicians. The first study is a scoping review of the literature on how patients and clinicians understand the term. The second study is a secondary analysis of data from a large international survey developed by Stanford University to assess what care providers and patients think about the term. It is important to explore what nurses, in particular, think about the term because nurses care for patients with pain in many clinical settings. Nurses perform ongoing pain assessments, administer pain medication, and collaborate with the physician to ensure patients are receiving optimal pain management. They are also often the first point of contact for patients. The secondary analysis analyzes the answers given by nurses to answer the following question: how is the term pain catastrophizing interpreted and understood by nurses? This research aims to foster positive change through refinement of our understanding and use of this term. The responses from the nurses in this study have identified many problems with pain catastrophizing. This study also sheds light on important recommendations for nursing practice and future research.

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