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Pain catastrophizing linked to opioid use, particularly for women, Stanford study shows

Discussion in 'Other Health News and Research' started by Kati, Jun 15, 2017.

  1. Kati

    Kati Patient in training

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    First let me do a little head banging here :bang-head::bang-head::bang-head:


    Pain catastrophizing linked to opioid use, particularly for women, Stanford study shows


    http://scopeblog.stanford.edu/2017/...-particularly-for-women-stanford-study-shows/

    And then this:
    Link to paper: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2633144

    Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System

    Abstract:

    Abstract
    Background: Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain.

    Methods: The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety.

    Results: Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men.

    Conclusions: Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically “subthreshold” levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.
     
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  2. Cheshire

    Cheshire Senior Member

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    Can't get used to this "catastrophizing" theory, that in fact implies that sufferers are just some kind of drama queen.
     
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  3. Snow Leopard

    Snow Leopard Hibernating

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    Sigh. The scores on pain questionnaires are not pain in itself. There are may biases that lead to variances on how pain and indeed pain-related behaviours are reported on questionnaires.
     
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  4. Gingergrrl

    Gingergrrl Senior Member

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    Let me add a few more :bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head:
     
  5. Skippa

    Skippa Senior Member

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    We applied the thumb screw and tightened, until each patient was screaming in agony. We then plotted the screams by decibel, randomly picked a level along the graph, and declared any screams above this level were "catastrophizing", and simply making their own pain worse.

    Probably.
     
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  6. sarah darwins

    sarah darwins I told you I was ill

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    You forgot "... and we found the women screamed 4% more often, and 2% more loudly. Some of the women were, in fact, quite shrill. Though that could have been the time of the month. You know what women are like."
     
    Last edited: Jun 16, 2017
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  7. trishrhymes

    trishrhymes Senior Member

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    I don't understand why they use the word 'catastrophizing' when what they seem to mean is focusing attention on the pain.

    It seems perfectly possible to me that there could be at least two reasons for women to be prescribed more opoids for pain after operations.

    First that we are biologically different, and that may include a difference in the experience of pain levels after an apparently identical injury or operation. We may need more pain relief because we are objectively experiencing more pain.

    My second idea is that women may, on average, be more forward thinking, wanting to have the drug on hand in case the pain worsens, whereas men may be more optimistic and hope they won't need it.
    (I'm extrapolating from my limited experience here, feel free to shoot me down in flames).

    I think of my recent fracture where I was given a dose of oral morphine in the emergency department, and asked if I wanted more to take home with me. Not knowing what the future held, I said yes, but only in the end took a few minimum doses, preferring the just manageable level of pain to the drugged feeling. Most of the drug is still in the bottle. Others might say no, and end up using lots of over the counter pain meds instead.

    While I do find distraction such as watching a video can help me focus less on mild to moderate levels of pain, I think this is common sense, not 'treatment for catastrophizing'. I hate the way sensible ideas about using distraction and the natural reaction to focus on pain some of the time is medicalised and psychologised.

    Also, a third possible reason - men may be internally 'catastrophizing' just as much as women, but not prepared to admit it to researchers.
     
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  8. sarah darwins

    sarah darwins I told you I was ill

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    I think that's what bugs us all, Trish, as victims of psychology's obsession with reductive labelling and abstract conceptualising.

    You look at the profile of the associate Prof. quoted in the article — Beth Darnall — and she's no lightweight. And she's probably doing some good work in the important area of pain management. And no one doubts that reducing opioid and other drug use where possible is a good thing. It's just kind of depressing that she's hitched her wagon to the 'catastrophizing' high concept.

    But then, her work is funded under the NIH R01 grant, the FOA for which assumed a BPS foundation for chronic conditions with pain:

    - https://grants.nih.gov/grants/guide/pa-files/PA-14-244.html

    I guess the grants is where the money's at, and everybody gotta eat.
     
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  9. TrixieStix

    TrixieStix Senior Member

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  10. Valentijn

    Valentijn The Diabolic Logic

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    Basically, these were probably the researchers' own patients from their pain clinic. So maybe the better question would be: "Why do we prescribe opioids more to women when they're in less pain?"

    I'm also having trouble reconciling the claims of more catastrophizing and meds for women, with more meds distributed at less catastrophizing. The implication would be, that of the patients receiving meds, women are catastrophizing less, not more.

    So it was basically a null result, but they chose to spin it in a sexist manner. Stanford should be ashamed of this study, not promoting it.
     
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  11. Skippa

    Skippa Senior Member

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    Actually, why is reducing opioid consumption always thought of as being "a good thing".?

    Properly managed, a 2 week course at a moderate dose, taken as needed, will result in minimal "complications".

    Opioids are, quite frankly, THE BEST pain meds we've got. They are freaking amazing for getting through pain. Furthermore, paracetamol and ibuprofen so easily cause problems of their own (low LD50 for paracetamol, stomach lining problems for profens).

    I wish, instead of pussying around and avoiding "the dreaded scourge" of addictive opioids, they would research the crap out of them and produce a hybrid with minimal addictive qualities.
     
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  12. sarah darwins

    sarah darwins I told you I was ill

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    I used the term "a good thing" but I meant that with reference to long-term opioid use. Obviously they're great drugs used right. American has particular problems with prescription drug addiction right now and reducing it is a hot-button issue (and a ready source of grant money).
     
  13. Snow Leopard

    Snow Leopard Hibernating

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    Are they really in less pain, or do they report lower scores for the same level as pain as men? ;)
     
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  14. Kick these arseholes in the balls/fud and let's see how THEY "catastophize" pain!

    Ye gods, these idiots somehow got a university education?!
     
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  15. barbc56

    barbc56 Senior Member

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    Oh for heavens sake!

    How many men would be able to tolerate giving birth without drugs? :lol:
     
  16. ScottTriGuy

    ScottTriGuy Stop the harm. Start the research and treatment.

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    Couple of things come to my mind that should be researched (and may have been, I dunno):

    The researchers should have lived experience with pain management in order to construct a quality study. The insight gained from personal experience (especially with pain I'd think) would be very helpful.

    From this, I'd also like to see a study of these researchers (though it would never get ethics approval): their approach / concept to pain before experiencing pain, and then their conceptualization after experiencing pain (say, for a week) - so pre and post surveys.

    I'd bet the results would be very interesting and influence how their research is designed and the hypothesis they construct. (Ditto for the psychobabblers who say ME is false illness belief - I wish they had to live with ME for just 24 hours, that's all it would take.)

    Also, has there been a study / research into the obvious and ongoing bias against females in research? In recruiting, in results, in theories? That would be illuminating as well and improve research.
     
  17. pattismith

    pattismith Senior Member

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    What a shame...I have nothing more to add.

    I use opioids by periods for 15 years. I do it with the lower dose I can, because of the bad effect it makes on the brain fog +addictive problems it brings, but I just wouldn't have survived without it....
     
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  18. trishrhymes

    trishrhymes Senior Member

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    This reminds me of the stage in my life when I was having babies (decades ago) and there was a woman in the UK who wrote books and ran groups to encourage women to have natural childbirth without using pain relief.

    I read her book and she described having had 5 children herself without any drugs, and that she did this by imagining the contractions as wonderful waves of energy, or some such crap.

    Once I'd had my babies I decided she was just lucky that she had a body that gave birth easily and with relatively little pain and was selling her 'success' as a virtue and a personal achievement, which left the rest of us feeling like failures and inadequate when we resorted to pain relief.

    And going back even further to my teens when I had very severe period pains (worse than labour), and my mother told me off for giving in to them even when I was lying on my bed writhing in agony and fainting and vomiting. Clearly she had less painful periods than me and judged me as being inadequate at gritting my teeth and getting on with things.

    My point is, no one can know how another person experiences pain, and therefore what level of pain relief they need.
     
  19. Old Bones

    Old Bones Senior Member

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    A segment on yesterday's radio program "The Current" on CBC (brought to my attention by my husband) is timely with respect to this discussion:

    How this men-only support group helps sufferers struggling with chronic pain and stigma

    http://www.cbc.ca/radio/thecurrent/...ggling-with-chronic-pain-and-stigma-1.4160704

    A full transcript, plus audio, is available. Most interesting were the comments of a chronic pain researcher, and how his perspective of pain changed when he became a chronic pain sufferer himself.

    "Richard Hovey's chronic pain began with a cycling accident three years ago. He went from being active and outgoing to someone who could barely get out of bed.

    "I spent so much time in health care and I still had expectations that I could come back and do what I was doing before," he says.

    "But virtually my life became pencilled in."

    'The pain itself is not necessarily the worst part ... it's the suffering of loss, of identity, work, socializing.'- Richard Hovey

    Hovey, a chronic pain researcher at McGill University's faculty of dentistry, belongs to the Chronic Pain Support Group of Montreal, which is running the pilot project.

    He studied chronic pain, but he didn't really understand it until his cycling accident changed everything. The group helped him work through what was happening."

    The full transcript includes some comments that apply to the expectations society places on men, and the challenges of living with any chronic (invisible) medical condition.

    "I mean there's a fair amount of stigma that goes along with living with chronic pain especially with the opiate debates that are going on. I mean you know the generalization that everybody is claiming they're in pain just to get drugs is unfair and incorrect. And I think it's very careful because you know pain for most of us is invisible. . . . Are you over that yet? It's on your head. Are you trying hard enough to get through this and actually just it's upsetting."




     
  20. Kati

    Kati Patient in training

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    The trouble with chronic pain too is that the doctors (and society) make a judgement:"you shouldn't be in so much pain" and that in general 'this type of pain is not that bad". The judgement is based on their own experience (Easy childbirth, straightforward surgery, or breaking a bone for instance) or the average experience of patients.

    Then there is pain people understand (passing a kidney stone, labor pain, post surgical pain) and pain that people don't understand or haven't studied much or where treatments are not effective (fibromyalgia, interstitial cystitis, chronic back pain).
     

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