Understanding Pain Catastrophising – and How to Break the Cycle

If you’re living with pain, you might recognise thoughts like:

• “This pain will never go away.”
• “What if this gets worse?”
• “I won’t be able to do the things I love again.”

If that sounds familiar, you’re not weak, dramatic, or doing anything wrong. You’re human and this pattern even has a name. It’s called pain catastrophising, and understanding it can be a powerful first step toward feeling more in control of your pain.

What is pain catastrophising?

Pain catastrophising describes a pattern of negative, exaggerated thoughts about pain. Research shows it’s made up of three main components:

1. Rumination “I can’t stop thinking about it.” Your mind keeps returning to the pain, replaying it again and again, even when you’re trying to rest or focus on something else.
2. Magnification “What if this means something serious?” Pain starts to feel threatening. Normal sensations can feel alarming, and activity may feel risky or unsafe.
3. Helplessness “There’s nothing I can do.” You feel stuck, powerless, or hopeless, as if pain is in charge and you’re just along for the ride.

These patterns are measured using the Pain Catastrophising Scale (PCS), a validated tool used in both research and clinical practice to understand how thoughts and emotions interact with pain (Sullivan et al., 1995; Pocovi & Correa, 2025).

Why does catastrophising make pain feel worse?

Pain doesn’t just come from tissues like muscles, joints or nerves, your brain and nervous system plays a huge part. When pain is interpreted as a threat, your nervous system goes into protection mode meaning:

• muscles tense
• breathing becomes shallow
• attention focuses on pain
• fear of moving increases

This can amplify pain signals, reduce confidence in movement, and lead to avoidance, which often prolongs pain rather than protecting you. The important thing to know is this:

Catastrophising doesn’t mean the pain isn’t real. It means your nervous system is working overtime to protect you.

3 evidence-based ways to reduce pain catastrophising

These strategies come from pain science, psychology and approaches such as CBT and ACT and they’re practical, NOT “just think positive”.

1. Step back from your thoughts – Pain often triggers automatic stories like “This is never going away” or “Something must be seriously wrong.” Instead of arguing with these thoughts, try noticing them – “Ah, there’s my brain predicting again.” Research shows that recognising thoughts as predictions (not facts) reduces stress and stops them from controlling behaviour.

2. Calm your body with curiosity – Your body and brain are deeply connected. When your heart races or muscles tighten, the brain may read this as danger and this can result in increasing fear and pain. Helpful tools include:

• slowing your breath
• noticing sensations without trying to “fix” them
• gently facing small amounts of discomfort in a safe way

This teaches the nervous system – “I can handle this,  it’s uncomfortable, not dangerous.” Over time, this improves tolerance and reduces fear around pain.

3. Reduce future-focused fear and return to the present Catastrophising loves the future: “What if I’m like this forever?” Instead, bring attention back to now:

• What can I see around me?
• Can I notice my breath?
• What is the next small step I can take?

This isn’t meditation, it’s attention training and research shows it reduces the spiral into “what if” thinking.

How goPhysio helps with pain catastrophising

At goPhysio, we don’t just treat body parts, we support people in pain. Here’s how we help break the pain–fear cycle:

• Education that makes sense – We explain pain in a way that’s reassuring, evidence-based, and empowering, helping you understand what’s happening without fear.
• Confidence-building movement – We help you identify what can be done safely, even if it’s at a low level to start with and gradually build from there.
• Goal-focused rehabilitation – Instead of chasing pain levels alone, we focus on what matters to you, whether that’s walking, sport, work, sleep, confidence, quality of life.
• Whole-person care – We recognise that thoughts, stress, beliefs, and emotions all influence recovery and we work with them, not around them.

A reassuring takeaway

If you’re stuck in cycles of worry, fear, or frustration about pain, it doesn’t mean you’re broken. It means your nervous system is trying (a little too hard) to protect you. With the right support, understanding and guidance, that system can learn to calm down. And that’s where recovery really begins.

If you’d like help understanding your pain or building confidence in movement again, our team at goPhysio is here to support you every step of the way.