Influence of catastrophizing on pain intensity, disability, side effects, and opioid misuse among pain patients in primary care

There is increasing concern among primary care practitioners (PCPs) regarding medication misuse and noncompliance while attempting to effectively manage chronic pain patients prescribed opioids for pain. The aim of this study was to investigate the effect pain catastrophizing has on self-reported pain intensity, disability, side effects, and opioid misuse in chronic pain patients prescribed opioids within primary care. Fifty-six PCPs and 253 chronic pain patients prescribed opioids or considered for opioid therapy were recruited into the study. All patients completed baseline measures, including the Pain Catastrophizing Scale (PCS) and were followed for 6months to monitor pain and opioid compliance. Patients were divided evenly based on median-split scores on the PCS and participated in phone interviews at 1 and 6months. The subjects repeated the baseline measures and completed measures of opioid compliance at the end of the study period. Patients who scored high on catastrophizing reported significantly greater pain intensity, activity interference, negative affect, and a higher percentage of medication-related adverse effects compared with those lower on the Pain Catastrophizing Scale at the start of the study and over a 6-month period (p<.01). In addition, those chronic pain patients classified as high pain catastrophizers reported significantly higher opioid misuse (p<.01). This study demonstrates the important role of pain catastrophizing among chronic pain patients who are prescribed opioid medication for pain within primary care. These findings support the benefits of carefully monitoring patients who are prescribed opioids in primary care and possible benefits of offering interventions to reduce pain catastrophizing.