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I have an aunt who is practically talking herself into a nursing home placement. She is very negative about everything. She can't seem to stop talking about her back pain. Is there some way to help her break out of this mindset where she seems stuck?

Your aunt may be engaging in an experience called pain catastrophizing. The is the tendency to think about pain, mull it over and over in her mind, and magnify her symptoms. Pain catastrophizing is made worse when the patient feels helpless about his or her pain. Pain catastrophizing gets started when there is chronic pain, psychologic distress, and physical disability. These factors can lead someone to feel fearful about movements that could possibly bring the pain on or increase the pain. Patients who hold back from communicating their pain often have higher levels of negative effects from the pain. In cases like your aunt (who doesn't hold back), she may actually feel better and function better for having expressed her fears, concerns, and upsets. It's the patients who sit and stew silently who have worse outcomes. Experts think it's possible that listening to patients in a way that makes them feel heard may be the key to reducing pain catastrophizing. It's possible that she feels underappreciated or that her pain is underestimated. Complaining loudly is just a way to gain others' understading of their pain and pain-related problems. Without a steam valve to express her fears, worries, or frustrations, her pain behaviors may only increase.

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