When post surgical pain becomes chronic pain, the causes could be related to the type of surgery performed or from common psychological factors considered to be predictive of chronic post-op pain, such as anxiety, depression and pain catastrophizing. Research reported in The Journal of Pain showed that a combination of acute pain and anxiety and pain magnification, regardless of the type of surgical procedure, increases the risk for development of chronic pain. The Journal of Pain is the peer-reviewed publication of the American Pain Society.
For the study, a team of French researchers assessed the predictive value of chronic pain risk factors these factors in patients who had two different types of surgery: total knee arthroplasty (TKA) and breast cancer surgery. They compared the extent to which anxiety and depression predicted the prevalence and intensity of chronic post-operative pain three months following surgery. They hypothesized that despite differences in the two surgical procedures, there would be common affective or cognitive risk factors for progression to chronic post surgical pain.
For the study, patients scheduled for total TKA and mastectomy or lumpectomy filled out questionnaires a month ahead of surgery to provide demographic information and baseline ratings of anxiety or pain catastrophizing. On the day before surgery, patients were questioned in person about their pain status and intensity, anxiety levels and depression. Two days after surgery, the questions focused on pain status and patients subsequently were mailed surveys to rate their pain at three, six and 12 months following surgery. The article reported on the data obtained after two days and at three months.
Results showed that state anxiety is predictive of clinically meaningful post surgical pain after three months while pain magnification, an element of pain catastrophizing, predicts higher pain intensity levels.
The authors concluded that from a clinical perspective their results showed that a combination of acute pain and anxiety and pain magnification, regardless of the type of surgical procedure, increases the risk for development of chronic pain. They also found that half of the study subjects said they had clinically significant pain two days after surgery, despite taking high doses of analgesics. It was recommended that to minimize risks for developing chronic post-surgical pain clinicians should utilize optimal pain management treatments immediately after the procedure and screen all patients scheduled for surgery for state anxiety and pain magnification tendencies.
- Anne Masselin-Dubois, Nadine Attal, Dominique Fletcher, Christian Jayr, Aline Albi, Jacques Fermanian, Didier Bouhassira, Sophie Baudic. Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer. The Journal of Pain, 2013; 14 (8): 854 DOI: 10.1016/j.jpain.2013.02.013
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