Association of Preoperative Pain Severity and Pain Catastrophizing with Increased Risk for Prolonged Postoperative Opioid Use

Abstract

Prolonged postoperative opioid use (PPOU) is considered an unfavorable post-surgical outcome. Demographic, clinical, and psychosocial factors have been associated with PPOU, but methods to prospectively identify patients at increased risk are lacking. We sought to determine whether individual or a combination of several psychological factors could identify a subset of patients at increased risk for PPOU. We conducted a prospective cohort study of patients undergoing elective surgery at a single VA Medical Center. Participants were recruited from a preoperative anesthesia clinic where they were undergoing evaluation prior to elective surgery, and they completed a survey before surgery. The primary outcome was PPOU, defined as outpatient receipt of a prescribed opioid 31 to 90 days after surgery as determined from pharmacy records. Primary covariates of interest were pain catastrophizing, self-efficacy, and optimism. Additional covariates included social and demographic factors, pain severity, medication use, depression, anxiety, and surgical fear. Of 123 participants included in the final analyses, 30 (24.4%) had PPOU. In bivariate analyses, preoperative opioid use, preoperative NSAID use, and preoperative pain were significantly associated with PPOU. The combination of high pain catastrophizing and high preoperative pain (OR 3.32, 95% CI 1.41 - 7.79) was associated with higher odds of PPOU than either alone, and the association remained significant after adjusting for preoperative opioid use (OR 2.56, 95% CI 1.04 - 6.29). A combination of high pain catastrophizing and high preoperative pain has the potential to be a clinically useful means of identifying patients at elevated risk of PPOU. Grant support from AHRQ K12 HS023009.