Evaluation of How Depression and Anxiety Mediate the Relationship between Pain Catastrophizing and Prescription Opioid Misuse in a Chronic Pain Population

Arteta, Javier; Cobos, Briana; Hu, Yueqin; Jordan, Krista; Howard, Krista

doi:10.1111/pme.12886

Cited by 57 publications

(64 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prior studies have shown that chronic pain is an independent risk factor for increased postoperative opioid use [7, 10, 11], while other studies have shown that anxiety is also linked to an increase in use of opioids [12, 13]. Although our results did not show a statistically significant difference in those with and without anxiety, depression or chronic pain, participants with these health conditions seemed to be less likely to think they were overprescribed opioids.…”

Section: Discussioncontrasting

confidence: 83%

Opioid use following gynecologic and pelvic reconstructive surgery

et al. 2017

View full text Add to dashboard Cite

Introduction/Hypothesis Opioid use, addiction, and overdose are a growing epidemic in the United States. Our objective was to determine if the amount of opioids prescribed following gynecologic and pelvic reconstructive surgery was insufficient, adequate, or in excess. We hypothesized that we were overprescribing postoperative opioids. Methods Participants who were at least 18 years old and underwent gynecologic and/or pelvic reconstructive surgery from April through August 2016 were eligible to participate. Routine practice for pain management is to prescribe 30 tablets of opioids for major procedures and 10-15 tablets for minor procedures. At the two-week postoperative visit, participants completed a questionnaire that asked about the number of tablets prescribed and used, postoperative pain control experience, and relevant medical history. Fisher’s exact test was used to compare data. Results Sixty-five participants completed questionnaires. Half (49.1%) reported being prescribed more opioids than needed, while 2 (3.5%) felt the amount was less than needed. Though not significant, participants who underwent major surgeries were more likely to report being prescribed more than needed (53.5%) compared with participants who underwent minor surgeries (35.7%; p=0.47). Though not significant, participants with anxiety were less likely to report being prescribed more tablets than needed compared to participants without anxiety (44.4% vs. 57.1%; p=0.38). This was also true of participants with depression compared to those without depression (37.5% vs. 58.3%); p=0.17), and those with chronic pain compared to those without chronic pain (33.3% vs. 60.0%; p=0.10). Conclusions Our current opioid prescription practice for postoperative pain management may exceed what patients need.

show abstract

Section: Discussioncontrasting

confidence: 83%

Opioid use following gynecologic and pelvic reconstructive surgery

et al. 2017

View full text Add to dashboard Cite

show abstract

“…21 Given the positive associations found between catastrophizing and the aforementioned opioid responses and behaviors, it would follow that a similar association might exist for catastrophizing and receipt of opioid prescription in a larger civilian chronic pain population. However, to our knowledge, this latter relationship is unexplored.…”

Section: Introductionmentioning

confidence: 95%

“…It has been found that in individuals with chronic non-cancer pain, the presence of co-morbid mental health diagnoses, particularly mood disorders, predicts the likelihood of opioid prescription, 21 the degree of opioid use, 11 and the likelihood of aberrant opioid use (e.g., opioid abuse or dependence). 22 Consequently, we sought to characterize the relationship between pain catastrophizing and opioid prescription independent of the influences of these and other factors, including age, 11 sex, 23 and pain intensity, 16,24 known to be relevant to opioid use and pain catastrophizing, such as symptoms of anxiety and depression.…”

Section: Introductionmentioning

confidence: 99%

Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

“…All of these behavioral comorbidities are strongly associated with chronic opioid use, misuse, and dependence (Turk et al 2008 ; Becker et al 2008 ; Goldner et al 2014 ; Gross et al 2016 ; Arteta et al 2016 ; McAnally 2017 ) and in fact have been shown repeatedly to be the most robust predictors (Martins et al 2012 ; Katz et al 2013 ; Blanco et al 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

McAnally

2017

Perioper Med

View full text Add to dashboard Cite

The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative “acute-on-chronic” pain and fueling worsened chronic pain and opioid dependence.Besides worsened postoperative pain, a growing body of literature, reviewed herein, indicates that preoperative opioid use is associated with significantly worsened surgical outcomes, and severely increased financial drain on an already severely overburdened healthcare budget. Conversely, there is evidence that preoperative opioid reduction may result in substantial improvements in outcome. In the era of accountable care, efforts such as the Enhanced Recovery After Surgery (ERAS) protocol have been introduced in an attempt to standardize and facilitate evidence-based perioperative interventions to optimize surgical outcomes. We propose that addressing preoperative opioid reduction as part of a targeted optimization approach for chronic pain patients seeking surgery is not only logical but mandatory given the stakes involved. Simple opioid reduction/abstinence however is not likely to occur in the absence of provision of viable and palatable alternatives to managing pain, which will require a strong focus upon reducing pain catastrophization and bolstering self-efficacy and resilience.In response to a call from our surgical community toward that end, we have developed a simple and easy-to-implement outpatient preoperative optimization program focusing on gentle opioid weaning/elimination as well as a few other high-yield areas of intervention, requiring a minimum of resources.

show abstract

Evaluation of How Depression and Anxiety Mediate the Relationship between Pain Catastrophizing and Prescription Opioid Misuse in a Chronic Pain Population

Cited by 57 publications

References 45 publications

Opioid use following gynecologic and pelvic reconstructive surgery

Opioid use following gynecologic and pelvic reconstructive surgery

Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription

Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

Contact Info

Product

Resources

About