The extensive literature on the potent role negative thoughts about pain have on the experience of pain and pain-related suffering has documented associations with important neurobiological processes involved in amplifying nociceptive signals. We focus this review on pain catastrophizing (pCAT)- appraisals of pain as threatening, overwhelming, and unmanageable- and review the evidence that these thoughts are learned in childhood through experience and observation of others, particularly caretakers and parents. For children who have learned pCAT, repeated exposures to pain over time activate pCAT and likely contribute to further amplification of pain through changes in the neurobiological pain regulatory systems, which overlap with those regulating the stress response. We propose that repeated pain and stress exposures throughout childhood, adolescence, and into adulthood alter the neurobiology of pain via a repetitive positive feedback loop that increases risk for heightened pain sensitivity over time with repeated exposures. At some point, often precipitated by an acute episode of pain and possibly influenced by allostatic load, pCAT contributes to persistence of episodic or acute pain and exacerbates pain-related suffering. This developmental trajectory is not inevitable, as the impact of pCAT on pain and pain-related suffering can be influenced by various factors. We also present future directions for work in this area.

中文翻译：

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当想到痛苦会导致痛苦时：痛苦灾难化的例子。


关于疼痛的消极想法对疼痛体验和与疼痛相关的痛苦的强大作用的大量文献记录了与放大伤害感受信号所涉及的重要神经生物学过程的关联。本综述的重点是疼痛灾难化 （pCAT） - 将疼痛评估为威胁性、压倒性和无法控制的 - 并回顾了这些想法是在童年时期通过他人（特别是看护人和父母）的经验和观察习得的证据。对于已经学习 pCAT 的儿童，随着时间的推移反复暴露于疼痛会激活 pCAT，并可能通过神经生物学疼痛调节系统的变化进一步放大疼痛，这些系统与调节压力反应的系统重叠。我们建议，在整个童年、青少年期和成年期，反复的疼痛和压力暴露会通过重复的正反馈循环改变疼痛的神经生物学，随着时间的推移，反复暴露会增加疼痛敏感性增加的风险。在某些时候，通常由急性疼痛发作诱发，并可能受到异体负荷的影响，pCAT 会导致阵发性或急性疼痛的持续存在，并加剧与疼痛相关的痛苦。这种发展轨迹并非不可避免，因为 pCAT 对疼痛和疼痛相关痛苦的影响会受到各种因素的影响。我们还提出了该领域工作的未来方向。