For patients with chronic musculoskeletal pain, catastrophizing is associated with an increased risk for prescription opioid misuse, a study has shown.
This finding suggests that "complementary interventions designed to reduce patients’ levels of anxiety and catastrophizing might contribute to decreasing risks for prescription opioid misuse in patients with chronic pain," said Marc O. Martel, Ph.D., of the department of anesthesiology at Harvard Medical School and the pain management center at Brigham and Women’s Hospital, Boston, and his associates.
Patients who catastrophize tend to ruminate about pain, magnify the threat level of pain, and experience helplessness when in pain. Patients with psychiatric disorders are at a greater risk for misusing prescription opioids, Dr. Martel and his colleagues said. In an effort to identify a possible relationship between catastrophizing and risk for the misuse of prescription opioids, the investigators assessed 115 patients treated at their pain center for at least 6 months for spinal musculoskeletal pain with or without radicular symptoms.
These study subjects completed the Screener and Opioid Assessment for Patients With Pain–Revised (SOAPP-R), a self-report questionnaire designed to assess the risk for opioid misuse; the Brief Pain Inventory (BPI), a measure of pain severity and interference with physical and emotional functioning; the Pain Anxiety Symptoms Scale (PASS), a 20-item tool that measures pain-related anxiety; the Beck Depression Inventory (BDI); the Pain Catastrophizing Scale (PCS), a 13-item measure of the thoughts and feelings patients experience when in pain; and quantitative sensory testing (QST), a measure of somatosensory function and pain sensitivity that uses calibrated noxious stimuli to gauge patients’ pain response. The investigators used thermal pain thresholds as an index of pain sensitivity.
Using regression analysis, the investigators found correlations between pain measures (the BPI), pain sensitivity, negative affect (on the PASS and BDI), and catastrophizing. Also, they found a significant negative correlation between thermal pain thresholds and scores on the Pain Catastrophizing Scale (P less than .05). High levels of catastrophizing were associated with high scores on the SOAPP-R, which indicates greater risk for prescription opioid misuse.
Also associated with high scores on the SOAPP-R were a heightened sensitivity to pain, increased pain severity, increased pain-related anxiety, and depressive symptoms. However, the strong association between catastrophizing and high SOAPP-R scores persisted after the data were controlled for those four factors, which is "perhaps the most important finding of our study," Dr. Martel and his associates said (Drug Alcohol Depend. 2013;132:335-41).
It has been suggested that heightened sensitivity to pain, also known as a low pain threshold, could be caused by dysfunction of peripheral or central pain processing, or dysfunction of opioid-mediated endogenous pain inhibitory systems. Such dysfunction might raise the risk of opioid craving and thus of opioid misuse, the investigators said.
In addition, anxiety might alter patients’ beliefs about their medication needs, and thus prompt them to overuse opioids. Pain patients who have high levels of anxiety also might overuse opioids as a way to alleviate or eliminate their psychological distress, they noted.
Previous research has linked catastrophizing to low self-efficacy beliefs, poor pain coping skills, greater impulsivity, and increased sensation seeking. All of those factors in turn raise the risk for prescription opioid misuse, Dr. Martel and his colleagues said.
Their study findings indicate that interventions aimed at decreasing pain patients’ anxiety and catastrophizing also would likely reduce their risk for misusing prescription opioids, they said.
This study was supported by the National Institutes of Health. No financial conflicts of interest were reported.