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Acute pain, anxiety raise chronic pain risk after surgery

Wednesday August 21, 2013
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After surgery, a combination of acute pain and anxiety and pain magnification increases the risk of development of chronic pain, according to a study.

French researchers assessed the predictive value of chronic pain risk factors in 89 patients who had total knee arthroplasty and 100 women who had mastectomy or lumpectomy. 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 the differences in the two surgical procedures, there would be common affective or cognitive risk factors for progression to chronic post-surgical pain.

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.

Published in the peer-reviewed publication of the American Pain Society, the article reported on the data obtained after two days and at three months.

Results showed that state anxiety (apprehension or fear about a particular situation or activity) 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 the study subjects said they had clinically significant pain two days after surgery, despite taking high doses of analgesics.

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, according to the researchers.

Read the study abstract from the August issue of The Journal of Pain: http://bit.ly/19kHhTH.


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