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Research ArticleOriginal Research

Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care

Eriko Onishi, Jennifer A. Lucas, Tetsuhiro Maeno and Steffani R. Bailey
The Journal of the American Board of Family Medicine March 2023, jabfm.2022.220311R2; DOI: https://doi.org/10.3122/jabfm.2022.220311R2
Eriko Onishi
From the Department of Family Medicine, Oregon Health & Science University, Portland, OR (EO, JAL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Japan (TM).
MD, MCR
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Jennifer A. Lucas
From the Department of Family Medicine, Oregon Health & Science University, Portland, OR (EO, JAL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Japan (TM).
PhD
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Tetsuhiro Maeno
From the Department of Family Medicine, Oregon Health & Science University, Portland, OR (EO, JAL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Japan (TM).
MD, PhD
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Steffani R. Bailey
From the Department of Family Medicine, Oregon Health & Science University, Portland, OR (EO, JAL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Japan (TM).
PhD
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    Figure 1.

    Odds ratios between high pain catastrophizing/high opioid expectation and opioid related awareness and beliefs.

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    Table 1.

    Patient Demographics (n = 108)

    n (%)Total*
    Gender108
    Women67 (62.04)
    Men40 (37.04)
    Other1 (0.93)
    Age108
    18 to 2911 (10.19)
    30 to 3928 (25.93)
    40 to 4924 (22.22)
    50 to 5917 (15.74)
    60 to 6919 (17.59)
    70 to 796 (5.56)
    ≥ 803 (2.78)
    Ethnicity104
    Hispanic6 (5.77)
    Non-Hispanic95 (91.35)
    Prefer not to answer3 (2.88)
    Race107
    Black9 (8.41)
    White80 (74.77)
    Asian7 (6.54)
    Native American2 (1.87)
    Pacific Islander0
    Other7 (6.54)
    Prefer not to answer2 (1.87)
    Education107
    No High School10 (9.35)
    Completed High School or General Educational Development42 (39.25)
    Completed College42 (39.25)
    Completed Graduate Degree13 (12.15)
    • ↵* Total number of patients may not equal 100% due to missing answers.

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    Table 2.

    Adjusted Odds of Opioid Epidemic Awareness Scores/Opioid Side effect and Risk Awareness Scores/Opioid and Pain-Control Belief Scores by Patient Characteristics (n = 107)

    Patient CharacteristicsOpioid-Related Awareness and Beliefs
    Opioid Epidemic Awareness Score: 4 or above OR (95% CI)Opioid Side effect Awareness Score: 6 or above OR (95% CI)Opioid and Pain-Control Belief Scores: 3 or above OR (95% CI)
    Pain Catastrophizing Score
    1 to 2 (ref)
    ≥ 3
    0.26 (0.10–0.67)0.38 (0.15–0.96)2.40 (0.89–6.47)
    Opioid Rx Expectation*
    0 to 2 scenarios (ref)
    ≥ 3 scenarios
    0.33 (0.12–0.88)0.86 (0.33–2.20)1.90 (0.78–6.08)
    Education
    Completed High School or lower (ref)
    Completed College or higher
    1.66 (0.70–3.93)1.39 (0.61–3.17)0.46 (0.20–1.06)
    Age
    18 to 39 (ref)
    40 to 59
    ≥ 60

    1.16 (0.41–3.26)
    1.18 (0.39–3.58)

    1.03 (0.39–2.75)
    0.82 (0.29–2.34)

    1.55 (0.56–4.22)
    1.14 (0.39–3.31)
    Gender
    Men (ref)
    Women
    0.97 (0.39–2.42)2.14 (0.89–5.14)1.67 (0.66–4.13)
    • ↵* Patients expecting opioid prescriptions out of 4 different acute pain scenarios.

    • Abbreviations: OR, odds ratio; CI, confidence interval.

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    Appendix Table 1.

    Distribution of Opioid Epidemic Awareness and Score

    Opioid Epidemic Issue AwarenessN (%) Aware
    Increase in opioid addiction80 (74.07)
    Increase in opioid overdoses75 (69.44)
    Increase in opioid deaths72 (66.67)
    Opioids are being over-prescribed53 (49.07)
    Opioids are being under-prescribed16 (14.81)
    Opioids are easily obtained on the street52 (48.15)
    Other issues17 (15.74)
    No answers marked/missing18 (16.67)
    Median Score (min-max)4 (0 to 7)
    • View popup
    Appendix Table 2.

    Distribution of Potential Opioid Side effects and Risks Awareness and Scores

    Potential Opioid Side effects and Risks AwarenessYes
    N (%)
    No
    N (%)
    Not Sure
    N (%)
    Addiction64 (79.01)15 (18.52)2 (2.47)
    Legal Problems47 (58.75)26 (32.50)7 (8.75)
    Increased use of illicit drugs47 (58.02)22 (27.16)12 (14.81)
    Impaired Memory43 (53.09)20 (24.69)18 (22.22)
    Personal or relationship problems55 (67.90)18 (22.22)8 (9.88)
    Decreased in intelligence32 (40.00)26 (32.50)22 (27.50)
    Decreased in energy57 (70.37)13 (16.05)11 (13.58)
    New or worsening health problems50 (61.73)19 (23.46)12 (14.81)
    Increase in stress, anxiety, or depression56 (69.14)17 (20.99)8 (9.88)
    Disrupted sleep49 (60.49)21 (25.93)11 (13.58)
    Other side effects53 (68.83)10 (12.99)14 (18.18)
    Missing/Not answered35 (32.41)
    Median score (min-max)6 (0 to 11)
    • View popup
    Appendix Table 3.

    Opioids and Pain-Control Beliefs and Scores

    Rate Your Level of agreement about the following. Please circle one word for each question. *†Strongly
    Disagree +
    Disagree
    N (%)
    Agree +
    Strongly Agree
    N (%)
    Not Sure
    N (%)
    a) I am afraid to use opioids because of their side effects.52 (50.00)40 (38.46)12 (11.54)
    b) I believe opioid use is safe when used for short-term pain (up to several weeks).14 (13.46)70 (67.31)20 (19.23)
    c) I believe opioid use is safe when used for long-term pain (duration over 3 months).52(50.49)24 (23.30)27 (26.21)
    d) I could become addicted to opioids if I take them regularly.15 (24.51)58 (56.86)19 (18.63)
    e) I could become dependent on opioids if I take them regularly. (I will have withdrawal symptoms if I try to stop the opioid.)25 (24.27)56 (54.37)22 (21.36)
    f) I believe opioids are safe when prescribed by doctors or dentists.34 (33.01)47 (45.63)22 (21.36)
    g) I believe opioid overdose is always on purpose.70 (67.31)15 (14.42)19 (18.27)
    h) I believe all pain should be treated with opioids if non-opioids medications are not effective for short term pain (up to several weeks).37 (35.58)27 (25.96)40 (38.46)
    i) I believe all pain should be treated with opioids if non-opioids medications are not effective for long term pain (duration over 3 months).39 (37.50)17 (16.35)48 (46.15)
    j) I believe that doctors and dentists often do not treat pain adequately.29 (27.88)39 (37.53)36 (34.62)
    k) I believe that doctors and dentists often do not provide enough pills when prescribing opioids.59 (56.19)17 (16.19)29 (27.62)
    l) I believe that doctors and dentists should do a better job of thoroughly explaining opioid side effects before prescribing them.13 (12.50)67 (64.40)24 (23.08)
    Median Score (min-max)3 (0 to 11)
    • ↵* Total number of patients surveyed (108) may not match due to some sections missing answers.

    • ↵† Questions ‘a’, ‘d’, and ‘e’ were reverse-scored, and question ‘l’ was removed from the analysis, as it was considered to be neutral.

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The Journal of the American Board of Family     Medicine: 38 (1)
The Journal of the American Board of Family Medicine
Vol. 38, Issue 1
January-February 2025
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Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care
Eriko Onishi, Jennifer A. Lucas, Tetsuhiro Maeno, Steffani R. Bailey
The Journal of the American Board of Family Medicine Mar 2023, jabfm.2022.220311R2; DOI: 10.3122/jabfm.2022.220311R2

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Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care
Eriko Onishi, Jennifer A. Lucas, Tetsuhiro Maeno, Steffani R. Bailey
The Journal of the American Board of Family Medicine Mar 2023, jabfm.2022.220311R2; DOI: 10.3122/jabfm.2022.220311R2
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Keywords

  • Catastrophization
  • Cross-Sectional Studies
  • Family Medicine
  • Logistic Regression
  • Motivation
  • Opioids
  • Pain
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