Patient “Catastrophizing” Associated with Expectations of Opioid Prescriptions for Acute Pain Control

Article Figures & Data

Table 1.

Patient Demographics (n = 108)

	Total*N (%)	Clinic A^†N (%)	Clinic B^‡N (%)	P Value^§
Gender	108	54 (50.00)	54 (50.00)	.47
Female	67 (62.04)	35 (32.41)	32 (29.63)
Male	40 (37.04)	18 (16.67)	22 (20.37)
Other	1 (0.93)	1 (0.93)	0
Age, years	108	54 (50.00)	54 (50.00)	.41
18 to 29	11 (10.19)	7 (6.48)	4 (3.70)
30 to 39	28 (25.93)	15 (13.89)	13 (12.04)
40 to 49	24 (22.22)	15 (13.89)	9 (8.33)
50 to 59	17 (15.74)	8 (7.41)	9 (8.33)
60 to 69	19 (17.59)	6 (5.56)	13 (12.04)
70 to 79	6 (5.56)	2 (1.85)	4 (3.70)
≥ 80	3 (2.78)	1 (0.93)	2 (1.85)
Ethnicity	104	54 (51.92)	50 (48.08)	.80
Hispanic	6 (5.77)	3 (2.88)	3 (2.88)
Non-Hispanic	95 (91.35)	50 (48.08)	45 (43.27)
Prefer not to answer	3 (2.88)	1 (0.96)	2 (1.92)
Race	107	53 (49.53)	54 (50.47)	.45
Black	9 (8.41)	4 (3.74)	5 (4.67)
White	80 (74.77)	39 (36.45)	41 (38.32)
Asian	7 (6.54)	5 (4.67)	2 (1.87)
Native American	2 (1.87)	2 (1.87)	0
Pacific Islander	0	0	0
Other	7 (6.54)	2 (1.87)	5 (4.67)
Prefer not to answer	2 (1.87)	1 (0.93)	1 (0.93)
Education	107	54 (50.47)	53 (49.53)	.005
No HS	10 (9.35)	3 (2.80)	7 (6.54)
Completed HS or GED	42 (39.25)	15(14.02)	27 (25.23)
Completed college	42 (39.25)	30 (28.04)	12 (11.21)
Completed graduate degree	13 (12.15)	6 (5.61)	7 (6.53)

Table 2.

Distribution of Anxiety Score, Pain Intensity, Pain Duration Pain Catastrophizing Scores and Opioid Use Duration (n = 108)

	Total*N (%)	Clinic A^†N (%)	Clinic B^‡N (%)	P Value^§
Average anxiety score in the past 7 days^‖ (mean, 7.74)	108	54 (50.00)	54 (50.00)	.021
Below 7	56 (51.85)	34 (31.48)	22 (20.37)
8 and over	52 (48.15)	20 (18.52)	32 (29.63)
Average pain intensity in the past 7 days^¶ (mean, 3.49)	108	54 (50.00)	54 (50.00)	.015
0	26 (24.07)	15 (13.89)	11 (10.19)
1 to 4	43 (39.81)	27 (25.00)	16 (14.81)
5 to 6	17 (15.74)	7 (6.48)	10 (9.26)
7 to 10	22 (20.37)	5 (4.63)	17 (15.74)
Pain duration	107	54 (50.47)	53 (49.53)	.14
Not in pain	37 (34.6)	22 (20.56)	15 (14.02)
Less than 1 week	10 (9.35)	7 (6.54)	3 (2.80)
1 to 4 weeks	14 (13.08)	6 (5.61)	8 (7.48)
4 to 12 weeks	11 (10.28)	3 (2.80)	8 (7.48)
More than 3 months	33 (30.84)	14 (13.03)	19 (17.76)
Not sure	2 (1.87)	2 (1.87)	0
Pain catastrophizing scores** (mean = 2.17)	108	54 (50.00)	54 (50.00)	.06
1 to 2	75 (69.44)	42 (38.89)	33 (30.56)
3 to 5	33 (30.56)	12 (11.11)	21 (19.44)
Duration of opioid use last time prescribed	87^††	44 (50.57)	43 (49.43)	.16
Prescribed but never taken opioids	3 (3.45)	2 (2.30)	1 (1.15)
Less than 1 week	39 (44.83)	26 (29.89)	13 (14.94)
1 to 4 weeks	17 (19.54)	5 (5.75)	12 (13.79)
1 to 3 months	5 (5.75)	1 (1.15)	4 (4.60)
>3 months	7 (8.05)	3 (3.45)	4 (4.60)
I take opioids only when I need them for my chronic medical problem(s)	6 (6.90)	2 (2.30)	4 (4.60)
I take opioids regularly for my chronic medical problem(s)	7 (8.05)	3 (3.45)	4 (4.60)
Other	3 (3.45)	2 (2.30)	1 (1.15)

↵* Total number of patients may not match due to missing answers.
↵† Clinic A: Serving a high proportion of patients with private insurance.
↵‡ Clinic B: A federally qualified health center.
§ Comparison between Clinic A and B.
↵‖ PROMIS-29 Profile v2.0 Anxiety instrument.
¶ PROMIS-29 Profile v2.0 Pain Intensity instrument.
** Measurement of Pain Catastrophizing Thinking assessment using two-item measure.
†† Among those who had ever been prescribed opioids (n = 88; data missing on one patient).

Table 3.

Number of Scenarios Expecting Opioid Prescription by Clinic and Patient Demographics (n = 108 Patients)

Expected Opioids in…	0 ScenarioN (%)	1 ScenarioN (%)	2 ScenariosN (%)	3 ScenariosN (%)	4 ScenariosN (%)
Total	31 (28.70)	28 (25.93)	21 (19.44)	14 (12.96)	14 (12.96)
Clinic
Clinic A*	18 (16.67)	14 (12.96)	10 (9.26)	8 (7.41)	4 (3.70)
Clinic B^†	13 (12.04)	14 (12.96)	11 (10.19)	6 (5.56)	10 (9.26)
P value	.446
Gender
Female	22 (20.37)	16 (14.81)	13 (12.04)	9 (8.33)	7 (6.48)
Male	9 (8.33)	12 (11.11)	7 (6.48)	5 (4.63)	7 (6.48)
Other	0	0	1 (0.93)	0	0
P value	.591
Age, years
18 to 29	5 (4.63)	2 (1.85)	2 (1.85)	2 (1.85)	0
30 to 39	8 (7.41)	7 (6.48)	6 (5.56)	3 (2.78)	4 (3.70)
40 to 49	7 (6.48)	8 (7.41)	4 (3.70)	3 (2.78)	2 (1.85)
50 to 59	0	8 (7.41)	4 (3.70)	2 (1.85)	3 (2.78)
60 to 69	8 (7.41)	1 (0.93)	2 (1.85)	3 (2.78)	5 (4.63)
70 to 79	1 (0.93)	2 (1.85)	2 (1.85)	1 (0.93)	0
Over 80	2 (1.85)	0	1 (0.93)	0	0
P value	.378
Education
No HS Degree	2 (1.87)	2 (1.87)	3 (2.80)	1 (0.93)	2 (1.87)
HS degree or GED	9 (8.41)	10 (9.35)	10 (9.35)	6 (5.61)	7 (6.54)
College degree	17 (15.89)	8 (7.48)	7 (6.54)	6 (5.61)	4 (3.74)
Graduate degree	3 (2.88)	8 (7.48)	1 (0.93)	0	1 (0.93)
P value	.196
Race
White	26 (24.76)	15 (14.29)	19 (18.10)	10 (9.52)	10 (9.52)
Non-White	4 (3.81)	12 (11.43)	2 (1.90)	3 (2.86)	4 (3.81)
P value	.030

Table 4.

Adjusted Odds of Expecting Opioid Prescriptions in at Least 3 out of 4 Acute Pain Scenarios by Patient Characteristics (n = 93)

	OR (95% CI)
Pain catastrophizing score
1 to 2	Ref
≥ 3	3.73 (1.12-12.46)
Anxiety score
< 8	Ref
≥ 8	2.28 (0.77-6.78)
Pain intensity
0 to 4	Ref
5 to 10	0.34 (0.08-1.51)
Pain duration
0 day (not in pain) to 3 month	Ref
> 3 months	1.06 (0.28-4.02)
Opioid use duration
0 day to 3 months*	Ref
>3 months or regular use^†	2.68 (0.60-11.97)
Education
Completed high school or lower	Ref
Completed college or higher	0.73 (0.25-2.11)
Age, years
18 to 39	Ref
40 to 59	0.84 (0.21-3.30)
≥ 60	1.14 (0.30-4.42)
Race
Non-White	Ref
White	0.54 (0.15-1.90)
Gender
Male	Ref
Female	0.73 (0.25-2.13)

↵* This category includes patients who have never been prescribed opioids and those who reported use of opioids for ≤ 3 months.
↵† This category includes patients who reported using opioid for >3 months and/or using opioids regularly or as needed for a chronic medical condition.
OR, odds ratio; Cl, confidence interval.