Catastrophic Thinking and Pain Alleviation after Lower Extremity Surgery

Carl Nunziato, Amirreza Fatehi, Matthew Driscoll, Karl Koenig, David Ring, David Laverty

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


OBJECTIVES: Requests for opioid pain medication more than a few weeks after surgery are associated with greater symptoms of depression and cognitive biases regarding pain such as worst-case thinking and fear of painful movement. We sought factors associated with patient desire for more opioid medication and satisfaction with pain alleviation at suture removal after lower extremity surgery.

DESIGN: Cross sectional study.

SETTING: Enrollment occurred at 1 of 4 orthopaedic offices in an urban setting.

PATIENTS/PARTICIPANTS: At suture removal after lower extremity surgery, 134 patients completed questionnaires measuring catastrophic thinking, ability to reach goals and continue normal activities in spite of pain, symptoms of depression, and magnitude of physical limitations.

MAIN OUTCOME MEASUREMENTS: Psychological factors associated with questionnaire-reported patient desire for another opioid prescription, satisfaction with postoperative pain alleviation, and the self-reported number of pills remaining from original opioid prescription.

RESULTS: In logistic regression, smoking and greater catastrophic thinking were independently associated with desire for opioid refill (R2 = 0.20). Lower satisfaction with pain alleviation was associated with greater catastrophic thinking (R2 = 0.19). The size of surgery (large vs. medium/small procedure) was not associated with pain alleviation or satisfaction with pain alleviation.

CONCLUSIONS: The association between unhelpful cognitive bias regarding pain and request for more opioids reinforces the importance of diagnosing and addressing common misconceptions regarding pain in efforts to help people get comfortable.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)E89-E95
JournalJournal of orthopaedic trauma
Issue number3
StatePublished - Mar 1 2021


  • catastrophic thinking
  • low self-efficacy
  • opioid pain medication
  • pain alleviation
  • satisfaction
  • Analgesics, Opioid
  • Cross-Sectional Studies
  • Humans
  • Catastrophization
  • Pain Measurement
  • Lower Extremity/surgery
  • Pain, Postoperative/diagnosis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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