Neurobiology of pain catastrophizing in burn survivors: identification and targeting of a critical treatment mechanism

The National Center for Complementary and Integrative Health awarded The Spaulding Rehabilitation Hospital Corporation $732,927 on September 1, 2026, under the Research and Training in Complementary and Integrative Health program (CFDA 93.213, Project Grant R01AT013875) to investigate the neurobiology of pain catastrophizing in burn survivors and identify how cognitive-behavioral therapy modulates the neural circuitry underlying catastrophizing.

The research identifies catastrophizing—negative cognitive-emotional processing—as a critical mechanism in chronic burn-injury pain. The funded work will establish the association between brain processing of catastrophizing and individual differences in pain intensity and interference among burn survivors, evaluate whether cognitive-behavioral therapy produces greater improvement in pain and catastrophizing compared to control intervention and reduces brain response to catastrophizing cues, and determine whether baseline brain fMRI response to catastrophizing cues predicts long-term pain outcomes. The study aims to foster personalization of therapy by identifying objective catastrophizing-linked biomarkers that may serve as therapeutic targets.

Work is performed at Charlestown, Massachusetts, with a period of performance from September 1, 2026, through June 30, 2031.

Abstract

Each year, approximately ½ million people in the U.S. Sustain and receive medical treatment for burn injuries. Pain is particularly prevalent (>50% of burn survivors) and disabling following burns, and both burn- related tissue injury as well as the procedures required for wound care can initiate severe and long-lasting chronic pain. As pain is known to be strongly modulated by negative affect, and catastrophizing in particular, the pain-reducing effects of many non-pharmacologic treatments appear to be due partially to their effects on cognitive-emotional processes such as catastrophizing. For example, studies of cognitive-behavioral therapy (CBT) frequently identify catastrophizing as a critical mechanistic variable, reductions in which are linked to improvements in pain, and CBT has been shown to improve pain in several studies with burn-injury survivors. Importantly, the neurobiology supporting catastrophizing in burn survivors is unknown and objective catastrophizing-linked biomarkers may serve as important therapeutic targets and/or predict long-term outcomes in these patients. Thus, our overall goal is to establish the role of catastrophizing in chronic burn- injury morbidity by identifying how the neural circuitry underlying catastrophizing can be modulated by CBT, and can predict pain outcomes - thus fostering future personalization for therapy. Our aims will investigate the association between brain processing of catastrophizing and individual differences in pain intensity and interference among burn-injury survivors. We will also evaluate whether CBT (compared to a control intervention) results in greater improvement in pain and catastrophizing, and reduced brain response to catastrophizing cues. Finally, our proposal will determine whether baseline brain fmri response to catastrophizing cues (after controlling for patient-reported catastrophizing scores) predicts improvement in pain outcomes following CBT, and whether changes in brain catastrophizing response mediate changes in pain endpoints. This study will significantly advance our mechanistic understanding of improvements in pain interference following CBT in burn injury survivors, and help predict which patients will best respond to CBT therapy.