Pain acceptance predicts healthcare utilization in women with chronic pelvic pain

Background: Chronic pelvic pain (CPP) in women is common and costly, and little is known about patient characteristics predicting healthcare utilization within this population. The present study examined the role of pain acceptance and pain catastrophizing, assessed prior to treatment initiation, in predicting future uptake of medical and surgical interventions specifically for pain management. Methods: Our sample comprised women referred to a tertiary gynecological center. Baseline pain catastrophizing and pain acceptance scores were compared across each major medication class and surgery type, as well as across the total number of medication classes and the total number of surgery types using analysis of variance (ANOVA). We then performed multivariable analyses for the association between pain catastrophizing and pain acceptance and treatment utilization by controlling for potential confounders. Results: Three hundred eighteen patients met inclusion criteria. Pain catastrophizing was associated with increased likelihood of neuromodulator prescription, while pain acceptance was associated with reduced likelihood of neuromodulator prescription and fewer medication classes prescribed. Overall, no associations between pain catastrophizing and surgeries were observed, while pain acceptance was significantly associated with lower risk of hysterectomy/oophorectomy. Conclusion: Pain acceptance was a robust predictor of number of medication classes prescribed and use of radical surgeries even when controlling stringently for confounders. It is worth considering routine assessment of pain acceptance early in treatment of CPP to identify those more at-risk of higher treatment utilization, and potentially mitigate this through engagement with appropriate behavioral therapies.