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Pain-related coping, particularly catastrophizing, plays a significant role in shaping pain responses. One way catastrophizing is hypothesized to amplify pain and disability is via its effect on patients' social environments (e.g., communal coping model), though empirical support is limited. The present study tested whether the association between catastrophizing and deleterious pain-related outcomes was mediated by patients' perceptions of significant others' responses to their pain in a sample of 1356 pain patients. Regression analyses showed that perceived significant other punishing responses partially mediated catastrophizing's relationship with pain-related disability, and with depressive symptoms. Further, several variables moderated the association between catastrophizing and perceived social responses to pain. Catastrophizing was more strongly associated with greater perceived solicitous responses for patients of relatively short pain duration. Also, higher catastrophizing was more strongly associated with perceived punishing responses among patients perceiving lower social support. In addition, the mediational effects of perceived punishing responses on catastrophizing's relationship with depressive symptoms, and with pain-related disability were only found in individuals reporting low levels of perceived social support. In sum, perceived social responses were found to play a small role in mediating the relationship between catastrophizing and pain-related outcomes, and these mediational effects may be strongest in particular patient subgroups. The present data suggest that interpersonal mechanisms may not constitute a primary route by which catastrophizing exerts its maladaptive effects on pain responses. The study and further understanding of what principal factors mediate catastrophizing's deleterious effects on pain will be important in illuminating the biopsychosocial model of pain.

Pain-related catastrophizing and perceived social responses: Inter-relationships in the context of chronic pain