Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery

Abstract

Background:Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use.Methods:This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days’ supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration.Results:Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days’ supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = −1.25 [95% CI, −2.38 to −0.12]; p = 0.03) were associated with greater 12-month postsurgical days’ supply of opioids. Presurgical opioid days’ supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = −0.17 [95% CI, −0.24 to −0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization.Conclusions:Greater presurgical days’ supply of opioids and pain catastrophizing accounted for greater postsurgical days’ supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Variables associated with nonresponders to high‐frequency (10 kHz) spinal cord stimulation

“…Furthermore, we found that the nonresponders with clinically relevant high levels of kinesiophobia at baseline had more severe disability status, greater pain intensity, pain catastrophizing, and more opioid use at baseline, compared to responders. Similar findings denoting a correlation between these factors have also been reported in the surgical and nonsurgical population 114,123,128–133,135,136,145–147 …”

“…A total score PCS >30 indicates clinically relevant level of catastrophizing which has been to correlate strongly with the success of musculoskeletal chronic pain and spine surgery outcomes. [112][113][114][115][116][117] Of note, the nonresponders had overall a higher total PCS at baseline with a mean of 28.52 points, in contrast to 22.13 with the responders groups, although this did not meet statistical significance. Our findings agree with Haddanny et al 100 that found a higher mean average in PCS total scores in nonresponders compared to responders.…”

“…Our study found a statistically significant difference between the two groups with higher median PCS total score suggesting clinically relevant pain catastrophizing in the nonresponders compared to responders. A total score PCS >30 indicates clinically relevant level of catastrophizing which has been to correlate strongly with the success of musculoskeletal chronic pain and spine surgery outcomes 112–117 . Of note, the nonresponders had overall a higher total PCS at baseline with a mean of 28.52 points, in contrast to 22.13 with the responders groups, although this did not meet statistical significance.…”

“…Similar findings denoting a correlation between these factors have also been reported in the surgical and nonsurgical population. 114,123,[128][129][130][131][132][133]135,136,[145][146][147]…”

Editorial Comment: Selected Proceedings From the Society of Military Orthopaedic Surgeons 2021 Annual Meeting

“…The negative effects of the opioid epidemic on a military population were also on display at this year's SOMOS meeting, and SOMOS members continue to look for novel strategies for effective and opioid-sparing perioperative analgesia. Unfortunately, patients with musculoskeletal injuries and diseases in the military are just as susceptible to the dangers of the opioid epidemic as civilians, and our multidisciplinary teams are working toward identifying those patients at most risk for long-term opioid tolerance and dependence, as well as the modifiable factors that we as surgeons can identify and mitigate against [4,13].…”