Introduction:The Pain Plan was developed collaboratively and implemented a unique systematic approach to reduce opioid usage in elective spine surgery. Methods: This was a retrospective cohort study comparing patients who underwent elective spine surgery before and after Pain Plan implementation. The Pain Plan was implemented on May 1, 2019. The experimental group comprised patients over the subsequent 1-year period with a Pain Plan (n = 319), and the control group comprised patients from the previous year without a Pain Plan (n = 385). Outcome variables include hospital length of stay (LOS), inpatient opioid use, outpatient opioid prescription quantities, number of clinic communication encounters, and communication encounter complexity. Patients were prospectively divided into three surgical invasiveness index subgroups representing small-magnitude, medium-magnitude, and large-magnitude spine surgeries. Results: There was a statistically significant decrease in hospital LOS (P = 0.028), inpatient opioid use (P = 0.001), and the average number of steps per communication encounter (P = 0.010) for Pain Plan patients and a trend toward decreased outpatient opioid prescription quantities (P = 0.052). No difference was observed in patient-reported pain scores. Statistically significant decreases in inpatient opioid use were seen in large-magnitude (50% reduction, P , 0.001) and medium-magnitude surgeries (49% reduction, P , 0.001). For smallmagnitude surgeries, there was no difference (1.7% reduction, P = 0.99). The median LOS for large-magnitude surgeries decreased by 38% (20.5-hour decrease, P , 0.001) and decreased by 34% for medium-magnitude surgeries (17-hour difference, P = 0.055). For small-magnitude surgeries, there was no significant difference (P = 0.734). Outpatient opioid prescription quantities were markedly

Low back pain (LBP) is a leading cause of physical restriction in the United States and around the world, with an estimated lifetime prevalence rate of 38.9% reported among the general population globally. 1 The Pain Catastrophizing Scale (PCS) is a 13-item, self-report instrument used to quantify pain experiences, 2 and it was developed to facilitate research on the mechanisms by which pain catastrophizing influences the experience of pain. 3 Respondents are asked to reflect on a previous episode of pain and indicate to what degree they experienced thoughts or feelings consistent with (1) rumination, (2) magnification, and (3) helplessness. 2,3 Items on the PCS were drawn from previous research related to catastrophic pain. 3 Research demonstrates that the PCS is a valid measure for the functional evaluation of individuals with LBP. The clinically derived PCS total score has demonstrated excellent test-retest reliability and internal consistency. 2,4,5 Additionally, the PCS has been shown to be useful in differentiating between patients experiencing pain in outpatient settings and individuals living in the community without pain. 6 The PCS is free to use and can be administered and scored in <5 minutes, making it a clinically useful and low-burden instrument to incorporate in routine clinical practice.

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