Pain Catastrophizing Moderates Relationships Between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System

Overview

Journal Anesthesiology

Specialty Anesthesiology

Date 2017 Jun 15

PMID 28614083

Citations 34

Authors

Yasamin Sharifzadeh

Ming-Chih Kao

John A Sturgeon

Thomas J Rico

Sean Mackey

Beth D Darnall

Affiliations

Soon will be listed here.

Abstract

Background: Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain.

Methods: The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety.

Results: Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men.

Conclusions: Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically "subthreshold" levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.

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References

Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer M . Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008; 9(10):883-91. DOI: 10.1016/j.jpain.2008.05.005. View

Hudson T, Edlund M, Steffick D, Tripathi S, Sullivan M . Epidemiology of regular prescribed opioid use: results from a national, population-based survey. J Pain Symptom Manage. 2008; 36(3):280-8. PMC: 4741098. DOI: 10.1016/j.jpainsymman.2007.10.003. View

Severeijns R, Vlaeyen J, den Hout M, Weber W . Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001; 17(2):165-72. DOI: 10.1097/00002508-200106000-00009. View

Osman A, Barrios F, Kopper B, Hauptmann W, Jones J, ONeill E . Factor structure, reliability, and validity of the Pain Catastrophizing Scale. J Behav Med. 1998; 20(6):589-605. DOI: 10.1023/a:1025570508954. View

Papaioannou M, Skapinakis P, Damigos D, Mavreas V, Broumas G, Palgimesi A . The role of catastrophizing in the prediction of postoperative pain. Pain Med. 2009; 10(8):1452-9. DOI: 10.1111/j.1526-4637.2009.00730.x. View

Banka T, Ruel A, Fields K, Yadeau J, Westrich G . Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty. HSS J. 2015; 11(1):71-5. PMC: 4342398. DOI: 10.1007/s11420-014-9418-4. View

Janda A, As-Sanie S, Rajala B, Tsodikov A, Moser S, Clauw D . Fibromyalgia survey criteria are associated with increased postoperative opioid consumption in women undergoing hysterectomy. Anesthesiology. 2015; 122(5):1103-11. DOI: 10.1097/ALN.0000000000000637. View

Choi S, Reise S, Pilkonis P, Hays R, Cella D . Efficiency of static and computer adaptive short forms compared to full-length measures of depressive symptoms. Qual Life Res. 2009; 19(1):125-36. PMC: 2832176. DOI: 10.1007/s11136-009-9560-5. View

Sullivan M, Lynch M, Clark A . Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain. 2005; 113(3):310-315. DOI: 10.1016/j.pain.2004.11.003. View

10.

Imai K, Keele L, Tingley D . A general approach to causal mediation analysis. Psychol Methods. 2010; 15(4):309-34. DOI: 10.1037/a0020761. View

11.

Osman A, Barrios F, Gutierrez P, Kopper B, Merrifield T, Grittmann L . The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med. 2000; 23(4):351-65. DOI: 10.1023/a:1005548801037. View

12.

Granot M, Ferber S . The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: a prospective study. Clin J Pain. 2005; 21(5):439-45. DOI: 10.1097/01.ajp.0000135236.12705.2d. View

13.

Campbell C, McCauley L, Bounds S, Mathur V, Conn L, Simango M . Changes in pain catastrophizing predict later changes in fibromyalgia clinical and experimental pain report: cross-lagged panel analyses of dispositional and situational catastrophizing. Arthritis Res Ther. 2012; 14(5):R231. PMC: 3580543. DOI: 10.1186/ar4073. View

14.

Edelen M, Reeve B . Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement. Qual Life Res. 2007; 16 Suppl 1:5-18. DOI: 10.1007/s11136-007-9198-0. View

15.

Martel M, Jamison R, Wasan A, Edwards R . The association between catastrophizing and craving in patients with chronic pain prescribed opioid therapy: a preliminary analysis. Pain Med. 2014; 15(10):1757-64. PMC: 4160420. DOI: 10.1111/pme.12416. View

16.

Unruh A . Gender variations in clinical pain experience. Pain. 1996; 65(2-3):123-67. DOI: 10.1016/0304-3959(95)00214-6. View

17.

Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen N . Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain. 2006; 125(1-2):172-9. DOI: 10.1016/j.pain.2006.06.009. View

18.

Lovejoy T, Dobscha S, Turk D, Weimer M, Morasco B . Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. J Rehabil Res Dev. 2016; 53(1):25-36. DOI: 10.1682/JRRD.2014.10.0230. View

19.

Keefe F, Brown G, Wallston K, Caldwell D . Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy. Pain. 1989; 37(1):51-56. DOI: 10.1016/0304-3959(89)90152-8. View

20.

Campbell C, Weisner C, LeResche L, Ray G, Saunders K, Sullivan M . Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010; 100(12):2541-7. PMC: 2978198. DOI: 10.2105/AJPH.2009.180646. View