Higher pain intensity may be associated with more condition-specific healthcare utilization and use of opioids in patients with musculoskeletal pain, according to study results published in the Journal of Pain.

The study included 283 military service members receiving initial care for a musculoskeletal injury. Patients were asked to complete a region-specific disability measure; rate their pain and level of catastrophizing using a numeric pain rating scale and a Pain Catastrophizing Scale (PCS), respectively; and indicate the distribution of their symptoms using a body pain diagram.

The researchers examined the predictive capabilities of pain intensity and disability on healthcare utilization and cost in the year following the initial evaluation. They examined data on healthcare cost and healthcare use for one year before and after the initial visit to the musculoskeletal care clinic from the Military Health System Data Repository (MDR).

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Pain intensity was found to predict all outcomes, including visits for index musculoskeletal pain conditions (direct effect: β=0.273; 95% CI, 0.034-0.512), incident opioid use (β=0.380; 95% CI, 0.054- 0.706), chronic opioid use (β=0.366; 95% CI, 0.041-0.692), condition-specific medical costs, and total overall medical costs. Disability only predicted incident opioid use in this cohort (β=0.481; 95% CI, 0.072-0.0886).

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No mediation effects were detected for either opioid use outcome. However, pain catastrophizing was found to partially mediate the relationship between pain intensity and number of healthcare visits. Pain catastrophizing and spatial distribution of symptoms were found to fully mediate the relationship between pain intensity and both cost outcomes.

“These results provide a foundation for future causal mediation analyses, give health care systems direction for developing value-based care pathways, and help to identify important characteristics that could elevate risk of low value care,” noted the researchers.

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Lentz TA, Rhon DI, George SZ. Predicting opioid use, increased health care utilization and high costs for musculoskeletal pain: what factors mediate pain intensity and disability? [published online June 12, 2019]. J Pain. doi:10.1016/j.jpain.2019.06.004