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Psychological predictors of acute and persistent postsurgical pain in patients submitted to hysterectomy and to total knee and hip arthroplasty

Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Pain is a complex human subjective and idiosyncratic experience. After surgery, acute pain is the most common and expected problem. The development of persistent post-surgical pain (PPSP) is an undesirable but common adverse outcome after surgery. Surgery provides a unique opportunity to examine the influence and predictive nature of a variety of demographic, clinical and psychological factors on subsequent pain persistence. Psychological factors have emerged as consistent predictors of acute and persistent post-surgical pain. Factors identified to date include negative emotions, coping strategies and surgery-specific beliefs or expectations, suggesting that perceptual/cognitive, emotional, and behavioral factors play key roles in influencing post-surgical pain experience. The aim of this thesis was to explore and examine, prospectively, the joint role of demographic, clinical and psychological variables as predictors of the following outcomes: a) acute post-surgical pain; b) PPSP; c) post-surgical rescue analgesia provision; and, d) post-surgical anxiety. A consecutive sample of 203 women (age: 51.0 ± 9.22) undergoing hysterectomy for benign disorders and of 130 patients (age: 65.2 ± 7.97) scheduled for total knee and hip arthroplasty (TKA and THA), were evaluated in a single site prospective study with assessments 24h prior to surgery (T1), 48h (T2), and 4/6 months (T3) after surgery. In the five studies conducted, several demographic and clinical variables were evaluated. Psychological variables assessed were anxiety, depression, pain coping skills (e.g. pain catastrophizing), surgical fears, optimism and illness representations. Acute post-surgical pain, in the hysterectomy sample (study 1), was better predicted by an integrative model which included younger age, pre-surgical pain severity, pain due to other causes, pre-surgical anxiety and pain catastrophizing. The results indicated the full mediation role of pre-surgical pain catastrophizing between pre-surgical anxiety and post-surgical pain intensity, which is a novel finding. As pre-surgical anxiety increases, women tend to catastrophize more about pain and this seems to predict increased acute post-surgical pain intensity. Study 2 examined post-surgical rescue analgesia (RA) provision in an effort to understand the variables that influence clinical decisions on RA provision. The results indicated that RA provision may be influenced not only by clinical variables (e.g. post-surgical pain intensity) but also by patient presurgical fear, pain catastrophizing and post-surgical anxiety. These psychological factors are likely to influence patient-provider interactions. Study 3 investigated the predictors of PPSP among women submitted to hysterectomy, with age, pain due to other causes and type of hysterectomy emerging as predictors. Pre-surgical psychological factors, such as anxiety, emotional illness representations and pain catastrophizing, were found to be additional risk factors for PPSP. Postsurgical anxiety added to the prediction of PPSP. In arthroplasties (study 4), the model which predicted acute pain in hysterectomy could not be replicated and optimism was the only significant predictor of pain intensity 48 hours after surgery. In this sample, there was also a strong association between post-surgical anxiety and acute pain after surgery. Moreover, post-surgical anxiety was predicted by a similar model to the one found for the prediction of acute post-surgical pain. Pre-surgical optimism, emotional representations and pre-surgical anxiety were significant predictors of post-surgical anxiety (T2). After total knee and hip arthroplasty (Study 5), PPSP seems to be better predicted by pre-surgical (T1) and post-surgical anxiety, as well as by acute post-surgical pain intensity (T2). In conclusion, the five studies conducted highlight the role of psychological factors in crucial aspects of the surgical experience: a) acute and persistent post-surgical pain; b) rescue analgesia administration; and, c) post-surgical anxiety. These results have important implications for patient care at pre-surgery and during the post-surgery follow up. The data points to the need to assess psychological factors at different stages of the surgery process, and the important role of Health Psychologists within acute pain team services. These professionals can contribute to a multidisciplinary and systemic approach in acute pain management and control, which aims at preventing the development of persistent post-surgical pain.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W198411708
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