Anxiety Before Surgery Foretells Chronic Pain After Surgery

The combination of acute pain and anxiety plus pain magnification, no matter what the type of surgical procedure, increases the risk of developing chronic pain, new research shows.

In cases of post surgical pain turning into chronic pain, causes can be linked either to the type of surgery performed, or common psychological issues such as anxiety, depression and pain catastrophizing.

In this study, reported in The Journal of Pain, researchers assessed chronic pain risk factors’ predictive value in patients with two different types of surgery: total knee arthroplasty (TKA, also known as knee replacement) and breast cancer surgery.

Rating Anxiety and Pain Catastrophizing

Researchers made a comparison between the extent to which anxiety and depression predicted the commonness and intensity of chronic post-operative pain three months following surgery. It was hypothesized that in spite of differences in the two surgical procedures, there would be common affective or cognitive risk factors for progression to chronic post surgical pain.

Patients who were scheduled for TKA and mastectomy or lumpectomy surgery filled out questionnaires one month before the surgery to provide baseline ratings of anxiety or pain catastrophizing. Then the day prior to surgery, patients were questioned in person about their pain status and intensity, anxiety levels and depression. Two days following surgery, there were questions focusing on pain status. Patients subsequently were mailed surveys to rate their pain at three, six and 12 months following surgery.

The resulting data showed state of anxiety being predictive of clinical post surgical pain after three months while pain magnification, an element of pain catastrophizing, predicts higher pain intensity levels.

Conclusions and Recommendations

The conclusion the authors reached was that the results showed, from a clinical perspective, 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.

Recommendations were that to minimize risks of developing chronic post-surgical pain, medical practitioners should use the best pain management treatments immediately following the surgery, as well as to screen all patients scheduled for surgery for state anxiety (as opposed to trait anxiety) and pain magnification tendencies.

Original Study:

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

photo: Shelley James, Wellcome Images