Exercise is a key to managing chronic pain in older adults, but a thought pattern called catastrophizing may contribute to sedentary lifestyle choices, Penn State researchers say. 

When older adults with knee osteoarthritis self-reported more than the usual helplessness or hopelessness about their pain in the morning, they were less likely to be moderately or vigorously physically active later in the day — and the next day as well, investigators found. 

“Staying physically active is one of the most important self-management strategies for chronic pain patients,” said lead study author Lynn Martire, Ph.D. “However, many chronic pain patients avoid physical activities that they are actually capable of doing.”

Thought patterns like “the pain is terrible and is never going to get any better” or “I can’t stand the pain anymore” may lead to exercise avoidance, the researchers explained. This in turn can lead to depression and even worse pain, said Ruixue Zhaoyang, Ph.D.

The study results suggest that pain catastrophizing could be an important therapeutic target for pain interventions and treatment. Although catastrophic thinking can change from day to day, it can be modified by everyday activity behavior, Martire said.

Chronic pain affects 60% to 70% of older U.S. adults, the researchers said. They foresee a time when mobile technology allows just-in-time adaptive interventions that can help flip the switch to a more hopeful thought pattern when patients begin pain catastrophizing.

The study was published in the journal Pain.