Patients Who Catastrophize Pain Experience Increased Pain after Ureteroscopic Laser Lithotripsy with Stent Placement

Abstract

Purpose:

Pain after ureteroscopic laser lithotripsy with stent placement (URSLL+stent) varies widely between patients. Although stent-specific factors are known to influence symptoms, patient-specific factors remain elusive. The pain catastrophizing scale (PCS) is a validated questionnaire quantifying the degree to which an individual catastrophizes painful stimuli. This study aimed to determine whether PCS score is associated with pain after URSLL+stent.

Materials and Methods:

We performed a prospective study of patients undergoing URSLL+stent. Patients completed the PCS preoperatively and were labeled as catastrophizers (CAT), noncatastrophizers (NON), or intermediate catastrophizers (INT). Primary outcome was visual analog scale (VAS) pain score, and secondary outcomes included ureteral stent symptom questionnaire scores, total analgesic pills taken, pain-related health care encounters, and need for opioids.

Results:

In total, 100 patients were enrolled, with 94 patients included in the final analysis. Median VAS in postanesthesia care unit was significantly higher for CAT and INT than NON (5.00 vs 5.00 vs 2.00, respectively, p = 0.042). Median VAS on postoperative day (POD)#1 was significantly higher for CAT than INT or NON (5.42 vs 3.0 vs 3.0, p = 0.018), but this difference disappeared by POD#10. CAT used more total tablets of prescribed medications (24.0 vs 15 vs 15 for CAT, INT, and NON, respectively, p = 0.002) and were more likely to require additional prescriptions, including opioids (22.6% vs 12.9% vs 0% for CAT, INT, and NON, respectively, p = 0.008). CAT also generated more unplanned health care encounters (25.8% vs 16.1% vs 3.1% for CAT, INT, and NON, respectively, p = 0.024).

Conclusion:

The PCS is a simple, rapid, and cost-free tool that allows urologists to identify patients at risk of poor pain tolerance after URSLL+stent. Further studies are necessary to determine what interventions would best serve patients who catastrophize their pain.