Use of the Pain Catastrophizing Scale to Predict Other Patient-Reported Outcome Measures Among Plantar Fasciitis and Chronic Ankle Instability Patients

Abstract

Category: Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of three subscales - rumination, magnification, and helplessness - which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. The primary purpose of this study is to (1) compare baseline PCS scores with other baseline PROMs in patients with plantar fasciitis (PF) or chronic ankle instability (CAI). Methods: We retrospectively reviewed the records of 201 patients who reported at least one pre-treatment PCS subscore (rumination=200, magnification=199, helplessness=196, total=194) and were diagnosed with PF (n=116) or CAI (n=98) between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon's clinic. Forty-one (20.4%) patients underwent operative treatment by the primary surgeon and 29 (14.4%) were treated operatively prior to being seen by the primary surgeon. Demographics, comorbidities, treatments, other baseline patient-reported outcome measures (PROMs) (e.g., Visual Analogue Scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale-8 [SSS-8]), and postoperative outcomes were recorded. The average follow-up was 183.92 (range, 0-1,820) days, while the average follow-up duration for the patients treated operatively was 190.56 (range, 15-468) days. Results: The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (p<.001), SF-12 mental (p=.007), PDI total (p<.001), and SSS-8 (p<.001). Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (p=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination (p=.012), magnification (p=.006), helplessness (p=.008), and total (p=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores (p=.005; p=.003; p=.006; p=.003). Conclusion: Significant correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI could be at risk for poor treatment outcomes. PCS scores could be used to tailor treatments for such high-risk patients, as there is evidence regarding the positive impact of cognitive behavior therapy on high pain catastrophizers.