Surgeon identification of pain catastrophizing versus the Pain Catastrophizing Scale in orthopedic patients after routine surgical consultation

Background: A high level of pain catastrophizing has negative influences on outcomes in many surgical disciplines. Our purpose was to determine whether surgeons are able to accurately identify high catastrophizing in orthopedic patients after routine clinical consultation.
Methods: In this prospective study, English-literate patients aged 18 years or older were assessed by 1 of 11 orthopedic surgeons. Patients completed the Pain Catastrophizing Scale (PCS), and the surgeon rated each patient as having a high or low level of catastrophizing after the clinical encounter. We calculated accuracy and agreement of surgeon assessment with the PCS at a cut-off score of 30 (score ≥ 30 = high level of catastrophizing) and used multivariate testing to determine whether patient age or sex, surgeon experience or subscores of the PCS (rumination, magnification and helplessness) influenced surgeon accuracy.
Results: Among 203 patients (109 women and 94 men), the mean PCS score was 18.4 (standard deviation 12.9), with no sex difference and no significant correlation to patient age. Of the 40 patients who scored 30 or more on the PCS, 22 (55%) were not identified as having high levels of catastrophizing by their surgeon. Accuracy was 0.72, and agreement was 0.2. Female patients were more likely than male patients to be identified as high catastrophizing regardless of PCS score (odds ratio 2.0, 95% confidence interval 1.04–4.0).
Conclusion: Surgeons were not able to accurately identify patients with high levels of pain catastrophizing during routine initial consultation. In considering which patients may most benefit from interventions to improve coping and reduce catastrophizing, explicitly measuring pain catastrophizing will be required.