Patients who magnify pain more likely to expect opioids, study shows

Research may help providers address “pain catastrophizing” as part of patient-centered care

A recent study published in the Journal of the American Board of Family Medicine shows that patients who described a pain experience in more exaggerated terms or magnified their pain had higher expectations of being prescribed opioids in acute pain scenarios. The findings could aid providers in reducing unnecessary opioid exposure.

Pain catastrophizing refers to an exaggerated negative cognitive and emotional reaction or response to actual or anticipated pain, which may include active rumination on pain, a feeling of helplessness, and magnification of the pain. It has been recognized as a predictor of a number of pain-related outcomes (e.g., pain severity, pain-related activity interference, disability, depression, frequent use of the health care system). Assessing and treating pain-catastrophizing thoughts could avoid unnecessary opioid prescriptions for acute pain and provide holistic patient care. 

The study, led by Eriko Onishi, M.D., M.C.R., OHSU family medicine assistant professor, used an in-clinic survey to assess patients’ anxiety and average pain intensity over the previous week. Patients ranked their pain on the Pain Catastrophizing Scale (“1 = Never feel this way” to “5 = Always feel this way”), and described their history of opioid use.

Onishi then presented the patients with acute pain situations using four scenarios: 1) a sprained ankle, 2) a root canal procedure, 3) a cast placement for a broken arm, and 4) acute back pain. Patients indicated their levels of agreement that they would expect their doctors or dentists to prescribe opioids for their acute pain control in each scenario.

The majority of participants (71%) agreed or strongly agreed that they would expect an opioid to be prescribed in at least one of the four different scenarios. Patients who had a pain catastrophizing score of three and above had more than three times greater odds of expecting opioids than those with a pain catastrophizing score of two and below.

Studies show that patient opioid expectations can influence prescribers’ decision to prescribe opioids. Over the last two decades in the United States, opioids have been prescribed routinely for any acute pain conditions mainly governed by subjective pain level assessment and also influenced by patient expectations and satisfaction.

By addressing pain catastrophizing, providers may be able to reduce patient expectations of opioid prescribing.

“Studies have examined patient factors associated with receipt of opioids,” the paper says. “However, to our knowledge, none have examined the patient characteristics associated with the expectation of provision of opioids.”

The study concludes that evidence-based guidelines for acute pain control for specific medical conditions, including specific opioid indications and nonopioid treatments, are needed to provide standards of care across health care settings. These guidelines could lead to reduced overall exposure of opioids among patients and appropriate expectations of opioid prescriptions among patients with acute pain.

Read the full paper on the

Coauthors: Jennifer Lucas, Ph.D., and Steffani Bailey, Ph.D., with OHSU Family Medicine, and Tetsuro Maeno, M.D., Ph.D., with University of Tsukaba (Japan) Department of Primary Care and Medical Education. Funding: none.