Predicting Risk for Opioid Misuse in Chronic Pain with a Single-Item Measure of Catastrophic Thinking

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Chronic pain patients are frequently treated with opioid medications in primary care, where brief measures of risk for opioid misuse have great utility. Catastrophic thinking is a clinically relevant and potentially modifiable factor associated with several chronic pain outcomes, including risk for opioid misuse. This study examined the utility of a single-item measure of pain-related catastrophizing in predicting risk of opioid misuse.


119 chronic pain patients completed the Coping Strategies Questionnaire catastrophizing item, Pain Catastrophizing Scale (PCS), and Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Area under the receiver operator curve (AUC) and linear regression were used to examine predictive utility of the catastrophizing item.


The catastrophizing item demonstrated a fair ability to discriminate those with high risk for opioid misuse on the SOAPP-R (AUC = 0.74), whereas the PCS demonstrated good discrimination (AUC = 0.85). The single item alone accounted for 30% of variance in SOAPP-R scores.


A single question assessing pain catastrophizing has utility for predicting risk for opioid misuse. In addition, it provides the primary care provider with information on a potentially modifiable risk factor that can be addressed within the context of a brief clinical visit.

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