Role of Psychological Factors in Postoperative Pain Control and Recovery with Patient-Controlled Analgesia

Department of Anesthesiology, Stanford University, Palo Alto, California.
Clinical Journal of Pain (Impact Factor: 2.53). 04/1994; 10(1):57-63; discussion 82-5. DOI: 10.1097/00002508-199403000-00008
Source: PubMed


We examined the extent to which preoperative state and trait anxiety, general need to control, need to control analgesia, expectations regarding postoperative pain, and demographic variables predict the severity of postoperative pain, discomfort, anxiety, duration of recovery, and patient-controlled analgesia (PCA) behaviors.
Preoperative and outcome variables were analyzed using Pearson product-moment correlations and forward stepwise multiple linear regression.
This study was conducted at a university hospital in preoperative and postoperative settings.
Ninety-nine consecutively consenting ASA physical status I-II women (age 46 +/- 11 years, 70% caucasian, 28% Afro-American, 2% Hispanic) undergoing simple hysterectomy procedures with no known cancer were included in the study.
Standardized general anesthesia, surgery, and PCA therapy was conducted.
The McGill Pain Questionnaire (MPQ), patient requests and delivered analgesic medication, visual analog scales (VAS) for pain and anxiety, time to oral medications and hospital discharge, and Likert scale measurements of overall pain and discomfort were utilized.
Older patients generally reported less pain, but used the same amount of analgesic medication as younger patients. Preoperative trait anxiety correlated with increased PCA requests, but not with postoperative pain. In contrast, preoperative state anxiety correlated positively with postoperative pain and with shorter time to hospital discharge. The patients' need for control was positively correlated with the Present Plan Index scale of the MPQ, with morphine requirement, and with PCA requests.
Psychological factors do influence postoperative recovery and pain control in women receiving PCA therapy after abdominal hysterectomy, and attention to individual patient differences may lead to improved postoperative outcomes.

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    • "quality of life, and medical utilization (e.g. Auerbach, 1973; Timberlake et al., 1997; Maranets & Kain, 1999; Anderson & Masur, 1983; Perry, Parker, White, & Clifford, 1994; Kain, Sevarino, Alexander, Pincus, & Mayes, 2000; Thomas, Heath, Rose, & Flory, 1995; Bachiocco, Rucci, & Carli, 1996; Caumo et al., 2001). As a result, a growing area of interest has focused on the effects of preoperative anxiety-reducing interventions (Anderson & Masur, 1983). "
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    ABSTRACT: Patients anticipating surgical procedures experience significant anxiety, resulting in adverse outcomes and increased expenditures. Research has investigated the impact of anxiety-reducing interventions, frequently the provision of surgical information, with inconsistent results. The present study (N = 98) examined preference for information, or monitor-blunter coping style, and the impact of a pre-surgical phone call from an anesthesiologist on anxiety in which treatment group participants (n = 51) dictated the amount of information received. Monitors were hypothesized to desire more information than blunters, and changes in anxiety for monitors/blunters were hypothesized to be moderated by length of call. Monitors and blunters demonstrated equal call durations and anxiety levels remained equivalent across groups. Findings and implications for future research are discussed.
    Full-text · Article · May 2005 · Journal of Clinical Psychology in Medical Settings
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    • "Cohen). postoperative pain andlor analgesic consurnption [2] [3] [4] [5] [6] [7] [8]. In other sfudies, however, no association has been found between preoperative anxiety and pain or analgesic consumption [3,9 -l5]. "
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    ABSTRACT: The aim of the present study was to predict postoperative pain and morphine consumption based on preoperative psychosocial factors. One hundred and twenty-two women completed measures of distress and coping 1 week before major abdominal gynecological surgery by laparotomy. Forty-eight hours after surgery, measures of pain and negative affect (NA) were completed, and morphine consumption was recorded from a patient-controlled analgesia pump. Four weeks after surgery, measures of pain and NA were completed. Multivariate analyses revealed that preoperative self-distraction coping (P=.039) positively predicted postoperative pain levels in the hospital, after accounting for the effects of age, concurrent NA, and morphine consumption. Emotional support (P=.031) and religious-based coping (P=.036) positively predicted morphine consumption in the hospital, after accounting for the effects of age, concurrent NA, and pain levels. Preoperative distress (P<.04 to .008) and behavioral disengagement (P=.034), emotional support (P=.049), and religious-based coping (P=.001) positively predicted pain levels 4 weeks after surgery, after accounting for the effects of age and concurrent NA. The results suggest that preoperative psychosocial factors are associated with postoperative pain and morphine consumption.
    Full-text · Article · Feb 2005 · Journal of Psychosomatic Research
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    • "Individual differences in anxiety and emotional states were also found as important determinants of postoperative pain reports, analgesic demand and satisfaction with PCA (Jamison et al., 1993; Thomas et al., 1995; Yang et al., 2000, de Bruin et al., 2001). For example, among women after abdominal hysterectomy, preoperative trait anxiety correlated with increased PCA requests but not with postoperative pain reports (Perry et al., 1994). It was suggested that adding responsibility such as control to anxious individuals might increase their reaction to pain (Weisenberg et al., 1985). "
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    ABSTRACT: Postoperative patients received one of the three, alternative pain-management treatments: patient-controlled analgesia (PCA); perceived PCA (PPCA without actual control) and continuous intravenous infusion of analgesics (CII). Pain reports, morphine consumption and satisfaction of the groups were compared, and influences of individual differences in preferences for control and trait anxiety were tested. The main findings were: (1) PCA patients consumed less morphine and reported more pain and somewhat higher satisfaction; (2) PPCA patients were intermediate between the other two groups in pain reports and morphine consumption and lowest in satisfaction and (3) individual differences did not moderate the effects of PCA. The findings were interpreted as indicating that the main effect of PCA is increased pain tolerance, and that a bio-psycho-social framework is most appropriate to explain these effects.
    Full-text · Article · Dec 2003 · Psychology and Health
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