By Erik MacLaren, PhD
Pain catastrophising can be clustered into 4 groups with distinct trajectories over time and several clinical characteristics associated with these trajectories, according to results of a longitudinal, prospective, observational study presented at the 35th Annual Meeting of the American Academy of Pain Medicine (AAPM).
Pain catastrophising — a tendency by a patient to have an exaggerated negative orientation to pain — is common. It is a concern because it is associated with worse outcomes for patients. “Pain catastrophising is associated with higher persistent pain intensity and prolonged opioid use post-operatively,” noted lead author Alexandra Kane, BS, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, presenting this award-winning study here on March 9.
Kane and fellow investigators conducted a secondary analysis of 236 surgical patients at the Walter Reed National Military Medical Center, Bethesda, Maryland. The team found several preoperative clinical factors associated with particular catastrophising trajectories. In this patient population, the odds of a female having a “remitting” trajectory were 77% lower than for a male (P < .01), and the odds of experiencing a “remitting” trajectory were increased by higher measures of physical function, preoperatively.
Additionally, increased scores on measures of stress and social isolation preoperatively were associated with greater probabilities of having “unremitting” or “remitting” trajectories compared with “stable” trajectories.
The researchers identified 4 distinct pain catastrophising trajectories using an exploratory k-means algorithm: “unremitting”, which is high preoperatively and remains high over time (10%); “remitting,” which is high preoperatively but decreases significantly over time (25%); “worsening,” which is low preoperatively and rises over time (13%); and “stable,” which is low preoperatively and remains low over time (52%).
The authors concluded that pain trajectories are indeed dynamic over time, and that a significant proportion of patients experience a worsening trajectory that could benefit from mitigating treatment.
Patients in this study completed the Patient-Reported Outcomes Measurement Information System (PROMIS) scales, Pain Catastrophizing Scale (PCS), and Defense and Veterans Pain Rating Scale (DVPRS) both preoperatively, and at 1 month, 3 month, and 6 months after surgery.
Participants were 56% male, had an average age of 53 years ± 5.8 years, and comprised 40% military veterans, 30% active-duty military personnel, and 30% beneficiary family members.