Beliefs About Pain Can Predict Pre-Surgery Opioid Use, Johns Hopkins Study Finds

A pioneering study by Johns Hopkins Medicine suggests that the amount of opioid painkillers a person uses before elective spine surgery could be predicted by their belief in their capacity to handle pain, a concept known as “pain self-efficacy.” The findings have sparked interest as they offer a potential pathway to reduce post-surgery opioid use and improve recovery outcomes.

Patients prepping for spine surgery often use more prescribed opioids than those getting ready for other surgeries. Prior studies have also found that regular pre-surgery opioid use could lead to continued use after the procedure, potentially causing persistent pain and an elevated risk of opioid misuse. In light of these facts, the ability to predict and manage pre-surgery opioid use becomes crucial.

Richard Skolasky Jr., the senior author of the study and director of the Johns Hopkins Spine Outcomes Research Center, explains the team’s curiosity: “We wanted to find out if a patient’s belief in their capacity to handle their pain could predict their pre-surgery opioid use. If there is such a link, enhancing patients’ pain self-efficacy could be a way to reduce post-surgery opioid use.”

To investigate this, the team recruited 578 patients who were about to undergo spine surgery at a Johns Hopkins hospital. The participants were asked to complete the Pain Self-Efficacy Questionnaire (PSEQ), a tool that gauges a person’s confidence in their ability to perform tasks independently despite experiencing pain.

The researchers discovered that patients who scored less than 22 on the PSEQ were twice as likely to use opioids daily before surgery, even when their level of pain and disability were taken into account. This significant finding suggests that pain self-efficacy could be a valuable tool for healthcare professionals to predict patients’ pre-surgery opioid use.

Skolasky highlights the potential practical application of the findings: “Orthopaedic surgeons could use these scores to identify patients at risk of daily opioid use. By improving these patients’ pain self-efficacy through pre-surgery education and counseling, we could possibly decrease their reliance on opioids and boost their post-surgery quality of life.”

The team at Johns Hopkins is now eager to explore further how pain self-efficacy impacts postoperative recovery and other outcomes related to spine surgery.