To examine the relationship between catastrophic thinking and postural stability in individuals with chronic non-specific neck pain (CNSNP); to assess the moderating role of pain duration and intensity; and to investigate the mediating role of fear-avoidance beliefs.

Cross-sectional observational study.

Outpatient musculoskeletal and pain rehabilitation clinics.

Eighty-six adults aged 18–65 years with CNSNP (mean age: 45.3±10.5 years) were recruited via purposive sampling.

Primary outcomes included postural stability parameters—centre of pressure path length, sway velocity, range of movement in the anterior-posterior and mediolateral directions, and sway area—measured using computerised posturography. Catastrophic thinking was assessed using the Pain Catastrophizing Scale (PCS). Secondary measures included the Neck Disability Index (NDI) to evaluate disability, the Visual Analogue Scale (VAS) to measure pain intensity, the Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-related beliefs, and the Short Form-36 (SF-36) Health Survey to evaluate quality of life. Pain duration and intensity were analysed as moderating variables, and fear-avoidance beliefs were examined as a potential mediator.

Moderate positive correlations were found between PCS scores and COP path length (r=0.41, p=0.014), sway velocity (r=0.38, p=0.022) and sway area (r=0.43, p=0.011). Participants with high PCS scores demonstrated significantly worse postural stability than those with low PCS scores. Pain duration (β=0.35, p=0.004) and intensity (β=0.42, p=0.006) significantly moderated this relationship. Fear-avoidance beliefs were statistically identified as a partial mediator of the association between catastrophic thinking and postural stability (indirect effect=0.22; 95% CI 0.10 to 0.35).

Catastrophic thinking is linked to reduced postural stability in individuals with chronic non-specific neck pain, with pain characteristics and fear-avoidance beliefs potentially influencing this association. These results underscore the importance of psychological factors in balance and support the need for further longitudinal research to inform comprehensive management strategies.