Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery
Authors: Sokil Laura E. , Rogero Ryan , McDonald Elizabeth , Fuchs Daniel , Winters Brian S. , Pedowitz David I. , Daniel Joseph N. , Raikin Steven M. , Shakked Rachel J. 
Published: October 2019

Category: Opioid/Pain Management Introduction/Purpose: As one of the top prescribing groups of opioid pain medication, orthopaedic surgeons must tailor post- surgical pain control to minimize the potential for prescription opioid abuse. Patients generate an idea of their own pain threshold relative to others’ based on how they tolerate similar painful experiences, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual tolerance for pain stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self-reported pain tolerance and their actual prescription opioid medication usage after foot and ankle surgery. Methods: This is a retrospective follow-up of a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a multispecialty orthopaedic practice over a one-year period. Number of opioid pills dispensed, pills consumed at the first postoperative visit, patient demographic data, and procedural data were obtained. Patients were contacted via email or telephone postoperatively and asked to respond to the qualitative statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients also scored their quantitative pain threshold on a scale of 0-100 with 0 being “very pain intolerant” and 100 a “very high pain tolerance” and rated their expectations of postoperative pain and satisfaction with pain management on five-point Likert scales. Data was analyzed using various tests, including Spearman’s correlations and bivariate and multivariate analyses. Results: Of 700 patients responding, the average age was 50.8 years and 34.7% were male. There was a significant, weakly negative (p=0.003, r=-.112) correlation between a higher qualitative assessment of pain threshold and number of pills consumed; patients with higher perceived pain thresholds took fewer opioid pills after surgery. Logistic bivariate regression predicting the top 25% of opioid pill consumers showed that higher qualitative assessment of pain threshold was negatively predictive of being among the top 25% of opioid pill consumers (OR 0.839, p=0.041). Multivariate analyses among the total cohort demonstrated a significant, negative association (p=0.005) between qualitative assessment of pain threshold and opioid pill consumption, while past narcotic usage time positively predicted the top 25% of opioid pill consumers (OR 1.224, p=.006). Conclusion: Prediction of patients’ postoperative narcotic requirement is complex and dependent on many patient-derived and systemic factors, but our study has shown that there is a negative association between patients’ self-reported qualitative pain tolerance with postoperative opioid consumption after foot and ankle surgery. This study presents a useful preoperative strategy for clinicians to customize postoperative pain management, further educate patients on responsible use of opioid medication, and reduce overall opioid prescriptions.