Study: Women who fixate on chronic pain more likely to be prescribed opioids

Female chronic pain sufferers who negatively fixate on their symptoms report greater pain intensity and are more likely to have an opioid prescription than men with the same condition, according to a study conducted by researchers at the Stanford University School of Medicine and led by current Virginia Commonwealth University medical student Yasamin Sharifzadeh.

The study, titled “Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription,” was published earlier this month in the journal Anesthesiology. Sharifzadeh is first author on the paper and the senior author is Beth Darnall, Ph.D., clinical associate professor of anesthesiology, perioperative and pain medicine at Stanford.

“When it comes to opioid prescriptions, pain catastrophizing has a greater effect on the likelihood for having a prescription in women than it does in men,” Sharifzadeh said, referencing the clinical condition defined as a cascade of negative thoughts and emotions in response to actual or anticipated pain. Pain catastrophizing is associated with amplified pain processing, greater pain intensity and greater disability. Previous studies have shown that the condition may explain up to 20 percent of variance in chronic pain intensity and thus may influence other pain treatments, including opioid medications, but few studies had yet examined how pain catastrophizing relates to opioid prescription in chronic pain patients.

Sharifzadeh first sought to study the relationship between pain catastrophizing and opioid prescription as a third-year undergraduate student at Stanford, where the research was conducted. She started by examining clinical data from nearly 1,800 adult chronic pain patients that included information on average pain intensity and scoring on a pain catastrophizing scale, as well as current opioid prescription status. Using an advanced analytic approach, the researchers then characterized the relationships between pain intensity, pain catastrophizing and opioid prescriptions, seeking to understand the differences between those variables in men and women.

“In men, it is pain intensity that dictates whether or not they are prescribed opioids,” Sharifzadeh said. “However, in women, there is a more nuanced issue where relatively low levels of both pain catastrophizing and pain intensity are associated with opioid prescription. Pain catastrophizing and pain intensity are working together in determining if a woman has an opioid prescription.”

Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses and use them for longer time periods than men, according to the Centers for Disease Control and Prevention. Women also may become dependent more quickly than men.

“VCU School of Medicine students are encouraged to apply innovative research toward the ultimate goal of improving the quality of health care for humanity,” said Susan DiGiovanni, M.D., senior associate dean of medical education and student affairs at VCU School of Medicine. “Yasmin’s research on pain and opioid prescribing practices will do just that, helping to elucidate solutions to a nationwide public health crisis.”

While further research is necessary to replicate this study’s results, Sharifzadeh says the findings are applicable to physicians who treat chronic pain.

“If physicians are aware of these gender-specific differences, they can tailor their treatment,” she said. “When treating chronic pain patients — especially women — they should analyze pain in its psychological aspect as well as its physical aspect.”