Abstact (English)
Context: Catastrophizing is a coping strategy that involves rumination, pessimism, the feeling of helplessness, and a tendency to magnify or exaggerate the value of the threat or pain sensation. The link between catastrophizing and non-malignant pain is well documented and catastrophizing has been shown to be a predictor of pain intensity, as well as increased consumption of analgesics. Based on a systematic literature review, it is our assessment that the relationship between catastrophizing and opioid scaling, in palliative patients with cancer, has not been investigated in previous studies.
Objective: In this study, we wanted to investigate whether catastrophizing may be a predictor of opioid scaling and pain intensity in terminal patients admitted to hospices, which has not been previously investigated.
Method: In a prospective multi-centre cohort study of 6 hospices in Denmark, data on catastrophizing, the incidence of neuropathic pain and change in opioid dose were collected via questionnaires and medical records. Participants were hospice patients admitted January 15 to April 30, 2020, with the inclusion criteria 1) cancer diagnosis, 2) age over 18, and 3) able to speak and understand Danish. Patients were excluded, based on staff assessment, if they were not cognitively able to participate in the study. 45 patients were included in the study.
Results: Statistical analysis was performed using SPSS 25.00 for univariate and multiple regression analysis. The results showed that a higher pain catastrophizing score (PCS) at hospitalization was significantly associated with a higher opioid dose at hospitalization (P = 0.010), but not with a greater increase in opioid dose during hospitalization (or a maximum of 7 days). Furthermore, there was significant correlation between PCS and worst pain intensity at hospitalization (P = 0.010) as well as the average pain intensity over the previous 4 weeks prior to hospitalization (P = 0.011). No relationship was found between catastrophizing and worst pain intensity after 7 days.
Conclusion: The study shows that catastrophizing is not a predictor of opioid scaling and pain intensity in terminal patients during hospice hospitalization, but also that catastrophizing is a predictor of opioid scaling and pain intensity in hospice patients prior to hospice hospitalization. The results of this study indicate that non-pharmacological interventions, aimed at catastrophizing in patients with cancer, earlier in the palliative course, may help improve and nuance pain management, as well as reduce opioid scaling and hence side effects of over-treatment, before and during hospice hospitalization.