Psychological cognitive disorder can lead to development of persistent post-surgical pain

Patients with a psychological cognitive disorder known as catastrophizing are more likely to develop persistent, chronic pain after surgery, according to new research presented at the ANESTHESIOLOGY™ 2014 annual meeting. Pain catastrophizing occurs when a patient has an irrational and illogical focus on pain, perceiving that it is worse than it actually is.

"There has been considerable evidence that psychological factors can lead to the development of persistent post-surgical pain," said Asokumar Buvanendran, M.D., lead author and professor, department of anesthesiology, Rush University Medical Center, Chicago. "Pre-surgical evaluation of these factors, including catastrophizing, could help to identify patients having elective surgery who might benefit from treatment of this cognitive disorder to prevent the development of chronic pain."

To evaluate the relationship between catastrophizing and chronic post-surgical pain, the authors conducted a systematic literature review and meta-analysis of seven studies totaling 661 patients. All of the studies focused on total-knee replacement surgery, which has a moderate (10 to 20 percent) incidence of chronic postoperative pain.

The analysis found that patients who had higher levels of pain catastrophizing before surgery had more chronic pain. However, the authors note that many of the studies reviewed only examined the effect of catastrophizing in isolation and did not factor in other elements such as preoperative pain or additional psychological factors.

Consequently, the authors conducted their own prospective study that included pre-surgical baseline levels of pain in "catastrophizers" and those not afflicted with the condition. Sixty-two patients having total-knee replacement surgery were examined for pain and catastrophizing levels before and up to six months after surgery.

Again, results showed that patients identified as high catastrophizers were more likely to have higher pain scores postoperatively, even when pre-surgical baseline pain scores were considered.

"Treatment of chronic postoperative pain continues to be an ongoing challenge," said Dr. Buvanendran. "Examining pain catastrophizing and other psychological factors, such as anxiety or depression could lead to preemptive therapies to lessen the risk or burden of chronic post-surgical pain, which could ultimately reduce health care costs."