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Associations between pain coping and opioid use: One-month follow-up results of a prospective study in a cohort of traumatic injury patients

Jordan C. Smith, BS, Christopher R. Nicholas, PhD, Scott J. Hetzel, MS, Bri M. Deyo, MPH, Randall T. Brown, MD, PhD


Objective: To examine associations between Pain Catastrophizing Scale (PCS) scores and daily opioid dosage in traumatic injury patients.

Design: This was a prospective cohort study with patient assessments at baseline and 1-month following discharge.

Setting: Study visits were conducted at a Regional Level I Trauma Center and by phone at follow-up.

Patients: Forty-nine injured inpatients completed baseline PCS. A subsample of 23 patients continued to take prescribed opioid medication at 1-month postdischarge and were included in the current analyses.

Main Outcome measured: Associations between baseline PCS and morphine equivalent daily dose (MEDD) at 1-month follow-up.

Results: Controlling for baseline MEDD, baseline PCS score was positively associated with MEDD at 1-month postdischarge (β = 0.577 [0.399, 1.535]; p = 0.002; R2 of PCS = 0.395).

Conclusions: In the current sample of traumatic injury inpatients, findings indicated that a baseline measure of pain catastrophizing predicts ongoing opioid medication use and dosage at 1-month postdischarge from an inpatient trauma unit.


opioids, pain catastrophizing, trauma, injury

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Rudd RA: Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR. 2016; 65: 1445-1452. doi:10.15585/mmwr.mm655051e1.

Beaudoin FL, Straube S, Lopez J, et al.: Prescription opioid misuse among ED patients discharged with opioids. Am J Emerg Med. 2014; 32(6): 580-585. doi:10.1016/j.ajem.2014.02.030.

Holman JE, Stoddard GJ, Higgins TF: Rates of prescription opiate use before and after injury in patients with orthopaedic trauma and the risk factors for prolonged opiate use. J Bone Joint Surg Am. 2013; 95(12): 1075-1080. doi:10.2106/JBJS.L.00619.

Sullivan MJL: PCS–The Pain Catastrophizing Scale–User Manual. Montreal, Quebec: McGill University, 2009. Available at Accessed July 12, 2017.

Severeijns R, Vlaeyen JW, van den Hout MA, et al.: Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001; 17(2): 165-172.

Martel M, Wasan A, Jamison R, et al.: Catastrophic thinking and increased risk for prescription opioid misuse in patients with chronic pain. Drug Alcohol Depend. 2013; 132: 335-341. doi:10.1016/j.drugalcdep.2013.02.034.

Brown RT, Deyo B, Riley C, et al.: Screening in trauma for opioid misuse prevention (STOMP): Study protocol for the development of an opioid risk screening tool for victims of injury. Addict Sci Clin Pract. 2017; 12: 28-37.

Löwe B, Decker O, Müller S, et al.: Validation and standardization of the generalized anxiety disorder screener (gad-7) in the general population. Med Care. 2008; 46(3): 266-274. doi:10.1097/MLR.0b013e318160d093.

Martin A, Rief W, Klaiberg A, et al.: Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006; 28(1): 71-77. doi:10.1016/j.genhosppsych.2005.07.003.

Tan G, Jensen MP, Thornby JI, et al.: Validation of the brief pain inventory for chronic nonmalignant pain. J Pain. 2004; 5(2): 133-137. doi:10.1016/j.jpain.2003.12.005.

Burton AK, Waddell G, Bartys S, et al.: Screening to identify people at risk of long-term incapacity: A conceptual and scientific review. Disabil Med. 2003; 3(3): 72-83.

Forsythe ME, Dunbar MJ, Hennigar AW, et al.: Prospective relation between catastrophizing and residual pain following knee arthroplasty: Two-year follow-up. Pain Res Manag. 2008; 13(4): 335-341.

Sullivan MJ, Stanish W, Waite H, et al.: Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain. 1998; 77(3): 253-260.

Valdes AM, Warner SC, Harvey HL, et al.: Use of prescription analgesic medication and pain catastrophizing after total joint replacement surgery. Semin Arthritis Rheum. 2015; 45(2): 150- 155. doi:10.1016/j.semarthrit.2015.05.004.

Granot M, Ferber SG: The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. Clin J Pain. 2005; 21(5): 439-445.

Papaioannou M, Skapinakis P, Damigos D, et al.: The role of catastrophizing in the prediction of postoperative pain. Pain Med Malden Mass. 2009; 10(8): 1452-1459. doi:10.1111/j.1526-4637.2009.00730.x.

Jacobsen PB, Butler RW: Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. J Behav Med. 1996; 19(1): 17-29.

Helmerhorst GTT, Vranceanu A-M, Vrahas M, et al.: Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. J Bone Joint Surg Am. 2014; 96(6): 495-499. doi:10.2106/JBJS.L.01406.

Holman JE, Stoddard GJ, Horwitz DS, et al.: The effect of preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: A surgeon-based comparative cohort study. J Orthop Trauma. 2014; 28(9): 502-506. doi:10.1097/BOT.0000000000000085.

Quartana PJ, Campbell CM, Edwards RR: Pain catastrophizing: A critical review. Expert Rev Neurother. 2009; 9(5): 745-758. doi:10.1586/ERN.09.34.



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