"Pain is What the Patient Says it is": A Secondary Analysis of Nurses’ Reflections on the Term Pain Catastrophizing
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.