Catastrophising and Pain Disability — MRCPsych Paper B MCQ

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HardLiaison PsychiatryCatastrophising and Pain DisabilityMRCPsych Paper B

An adult with chronic musculoskeletal pain has pain-related disability that is disproportionate to the demonstrable physical impairment. In a biopsychosocial formulation, which factor has the best-established relationship with disability and is central to the fear-avoidance model of chronic pain?

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Correct answer: D — Greater pain catastrophising and fear-avoidance

Explanation lettering: D = shown as B · B = shown as D

B is correct. Pain catastrophising involves magnifying the threat of pain, rumination and perceived helplessness. In the fear-avoidance model, catastrophic appraisal generates pain-related fear, avoidance of activity and subsequent disuse, reinforcing disability even when physical impairment does not worsen. Meta-analytic evidence demonstrates a robust association between pain-related fear and disability; catastrophising is also associated with and can prospectively predict disability, although longitudinal evidence is of limited certainty. Pain intensity (A) contributes to suffering but does not by itself explain disproportionate disability. Depression (D) may worsen functioning and should be assessed and treated, but it is not the defining cognitive-affective mechanism in this model. Neuroticism (C) and sex (E) may show population-level associations but are neither sufficiently specific nor central to the fear-avoidance pathway.

Reference: Shimada S, Doorenbos AZ, Goldstein E, Wi D. A Systematic Review of Pain Catastrophizing and Chronic Musculoskeletal Pain. Pain Management Nursing. 2026;27(1):e72-e84. https://pubmed.ncbi.nlm.nih.gov/40858413/