Background <p>Pain catastrophizing has been linked to poorer patient-reported pain outcomes for orthopedic surgery, but its effect on perioperative pain and narcotic use is poorly understood. Our purpose was to determine if pain catastrophizing has a negative effect on perceptions of perioperative pain and narcotic use in patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis (IS).</p> Methods <p>A retrospective, IRB-approved review of prospectively collected data of IS patients undergoing PSF. Patients were considered PCs when they scored above the 75<i>th</i> percentile in the PCS (total score ≥ 30). Inpatient narcotic consumption was calculated as morphine equivalent per Kg (mEq/Kg).</p> Results <p>Five hundred seventeen patients (411F, 106M) underwent PSF for IS. Forty-five (8.7%) patients were pain catastrophizers (PCs). PC patients had significantly lower pain, appearance, and mental scores. PCs scored slightly higher on VAS pain scores (2.20 vs 1.92, <i>p</i> = 0.015) in the first 24&#xa0;h only. There were no differences in opioid use between PC vs. non-PC cohorts for inpatient (2.01 vs 2.14&#xa0;mEq/Kg, <i>p</i> = 0.4), discharge (5.6 vs 5.87&#xa0;mEq/Kg, <i>p</i> = 0.3), or total narcotics (7.61 v 8.01&#xa0;mEq/Kg, <i>p</i> = 0.2). Fifty-five patients out of five hundred seventeen requested narcotic refills with no difference in refill rates between cohorts (<i>p</i> = 0.7076).</p> Conclusion <p>We found that pain catastrophizers had lower pre-operative SRS-30 scores across all domains except satisfaction. We found no association between pain catastrophizing and increased opioid use in either the inpatient stay or post-discharge. While pain catastrophizing has been associated with lower pre- and post-operative pain scores, it does not appear to predispose to higher narcotic utilization perioperatively.</p> Level of evidence <p>II: retrospective comparative study.</p>