Highlights
- •Pain intensity and disability predict 12-month pain-related utilization and costs.
- •Mediation effects are outcome-specific, and more consistent for cost outcomes.
- •Baseline pain intensity may drive volume of health care, including opioid use.
- •Elevated catastrophizing and symptom distribution may drive higher cost service use.
Abstract
This study determined the predictive capabilities of pain intensity and disability
on health care utilization (number of condition-specific health care visits, incident,
and chronic opioid use) and costs (total condition-specific and overall medical costs)
in the year following an initial evaluation for musculoskeletal pain. We explored
pain catastrophizing and spatial distribution of symptoms (ie, body diagram symptom
score) as mediators of these relationships. Two hundred eighty-three military service
members receiving initial care for a musculoskeletal injury completed a region-specific
disability measure, numeric pain rating scale, Pain Catastrophizing Scale, and body
pain diagram. Pain intensity predicted all outcomes, while disability predicted incident
opioid use only. No mediation effects were observed for either opioid use outcome,
while pain catastrophizing partially mediated the relationship between pain intensity
and number of health care visits. Pain catastrophizing and spatial distribution of
symptoms fully mediated the relationship between pain intensity and both cost outcomes.
The mediation effects of pain catastrophizing and spatial distribution of symptoms
are outcome specific, and more consistently observed for cost outcomes. Higher pain
intensity may drive more condition-specific health care utilization and use of opioids,
while higher catastrophizing and larger spatial distribution of symptoms may drive
higher costs for services received.
Perspective
This article examines underlying characteristics that help explain relationships between
pain intensity and disability, and the outcomes of health care utilization and costs.
Health care systems can use these findings to refine value-based prediction models
by considering factors that differentially influence outcomes for health care use
and cost of services.
Key Words
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Article info
Publication history
Published online: June 12, 2019
Accepted:
June 1,
2019
Received in revised form:
May 29,
2019
Received:
February 7,
2019
Footnotes
Research funding: Dr. Lentz received support for this project from the Foundation for Physical Therapy with Promotion of Doctoral Studies (PODS I & II) Awards. The National Center for Complementary and Integrative Health provided funding through UG3AT009790 (Dr. George for manuscript planning and writing) and UG3AT009763 (Dr. Rhon for manuscript planning and writing) awards.
Conflicts of interest: The authors declare no conflicts of interest.
Disclosures: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Madigan Army Medical Center, Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, Department of Defense, or the U.S. Government.
Identification
Copyright
© 2019 by United States Association for the Study of Pain, Inc.
