Opioid Use, Catastrophizing Predict Difficulty With Pain in Oncology Inpatients

Among inpatients with cancer, pain catastrophizing and history of opioid use predicted difficulty managing pain, according to results of a study published in Pain.

Investigators conducted a prospective study to evaluate potential predictors of worse daily pain and greater daily opioid administration among patients with cancer presenting to the emergency department (ED) with pain requiring hospitalization.

This prospective observational cohort study was conducted at Brigham and Women’s Hospital in Boston, MA. Patients (n=111) with cancer who presented at the ED with pain responded to a questionnaire that included the Patient-Reported Outcomes Measurement Information System (PROMIS) short form, Pain Catastrophizing Scale (PCS), and the 4-item Perceived Stress Scale (PSS-4). Pain outcomes during hospitalization were evaluated on the basis of demographic, clinical, and psychological characteristics reported at baseline.

Of the patients studied (mean [SD] age, 57.9 [ 13.9] years; 54% women; 85% White; 49% with private insurance), 64% had stage IV cancer and 80% had metastatic disease. Additionally, 48.6% were diagnosed within the past year, 83% had received chemotherapy, 70% had received cancer treatment in the previous 6 weeks, 32% had surgery in the past 3 months, and 43% used opioids in the outpatient setting. The most common types of cancer were colorectal (21%), ovarian (13%), lung (12%), and pancreatic or liver (10%) cancers.

The median pain score on hospitalization day 0 was 3.0 points (n=102) and on day 1 was 7.3 points (n=109). The median pain score remained relatively stable until the last day of data collection, day 15 (median, 8.0 points; n=10). For each patient, average pain score per day had a large amount of interindividual variability but ranged between 3.4-5.0 points on average.

Most patients (87%) received opioids during hospitalization. The average daily dose was 20 (SD, 159.9) morphine milligram equivalents (MME), which varied over time from 28.6 (SD, 55.7) MME on day 1 to 116 (SD, 300.6) MME on day 12.

In the multivariate analyses, the predictors for average daily pain included outpatient opioid use (b, 1.4; P <.001), precancer history of chronic pain (b, 0.8; P =.022), pain catastrophizing (b, 0.1; P =.001), and time since surgery (b, -0.2; P =.016). Daily opioid use was associated with outpatient opioid use (b, 32.8; P <.001), metastatic disease (b, 16.2; P =.038), anxiety (b, 3.7; P =.030), pain catastrophizing (b, 1.6; P =.049), and depression (b, -4.9; P =.028).

At the end of the study, 87.6% of patients were discharged to home, 6.1% to hospice, 4.4% to a skilled nursing facility, and 2 patients had in-hospital mortality. A new prescription of opioids was distributed to 17% of patients at discharge. The only predictor for new opioid prescription was advanced disease (c², 12.6; P =.006).

These findings may not be generalizable for a more diverse patient population.

Study authors concluded that “Greater psychological distress, especially pain catastrophizing, as well as pain and opioid use history, predicted greater difficulty with pain management among hospitalized cancer patients, suggesting that early assessment of patient-level characteristics may help direct consultation for more intensive pharmacologic and nonpharmacologic interventions.”