By Jane Lewis
Pain catastrophising and gender appear to moderate the relationship between pain intensity and opioid prescription, according to new research published in Anesthesiology.
Few studies have examined how pain catastrophising – described as a ‘maladaptive response to pain that amplifies chronic pain intensity and distress’ – relates to opioid prescription in outpatients with chronic pain, wrote the researchers. They investigated this in a retrospective observational study of 1794 patients (63% women) with chronic pain presenting for initial medical evaluation at a large pain treatment centre and who had completed an electronic patient survey. Most patients (57%) were prescribed at least one opioid medication. Using advanced analytics, the researchers demonstrated a significant interaction and effects of pain intensity and pain catastrophising on opioid prescription (p<0.04), while modelling revealed that opioid prescription was more common at lower levels of pain catastrophising for women than for men.
‘Our findings suggest that even relatively low levels of negative cognitive and emotional responses to pain may have a greater impact on opioid prescribing in women,’ the researchers concluded, adding that ‘women may be more likely to influence provider prescribing patterns through behavioral cues during the medical visit.’
‘This study covers a large dataset, but overall it has some significant limitations,’ commented Dr Meredith Craigie, anaesthetist and specialist pain medicine physician at the Royal Adelaide Hospital. It is important to bear in mind that the study was conducted in the USA, she added, ‘where there are very different attitudes to opioid prescription and a very different remuneration system that influences opioid prescription’ than in Australia.
According to Dr Craigie, a major flaw in the study is the ‘lack of acknowledgement of the fact that doctors do the prescribing, not patients.’ She noted that the authors did not explore the complex interactions that occur in the consulting room and the interpersonal relationship between doctors and their patients that may impact the decision of whether to prescribe and what to prescribe, and the threshold for prescribing.
‘The study really only tells us that doctors prescribe differently for men and women, and pain catastrophising may influence prescribing for white, married, middle-aged women – their main cohort,’ she said. The issue of how doctors might make better informed decisions about opioid prescribing or what the alternatives might be was not approached, she added.
Anesthesiology 2017; 127: 136-146.