Pain Related Psychological Factors Influence Postoperative Opioid Use After Ambulatory Hand Surgery

Abstract

Grant support received from: 2016 AFSH Residents and Fellows Fast Track Grant Consulting Fee: Medartis (Fufa) Contracted Research: Medatis (Fufa) Pain related psychological factors, including pain catastrophization and dispositional mindfulness, have been shown to influence patient pain levels and outcomes after orthopedic surgery. Less is known about the relationship between these factors and postoperative opioid use after hand surgery. The purpose of this study is to examine the association between preoperative pain catastrophization and mindfulness and postoperative opioid use in patients undergoing ambulatory hand surgery. Patients undergoing ambulatory hand surgery at our institution between May 2017 and January 2018 were prospectively enrolled in an ongoing clinical trial. Procedures (Figure 4-1) were separated into 2 tiers based on anticipated postoperative pain. Patients completed the Pain Catastrophizing Scale (PCS) and Mindfulness Attention Awareness Scale (MAAS) preoperatively (Figure 4-2A). Patients completed a pain medication diary for 2 weeks postoperatively and were contacted on postoperative days 3, 8, and 15 to review their medication usage and pain levels. Spearman’s correlations and Mann Whitney U tests were performed to evaluate the association between PCS/MAAS scores and postoperative opioid use, average patient-reported pain levels, and refill rates (Figure 2B). A total of 71 patients (57% male), mean age 60.2, were included in the analysis (46.4% tier 1 procedures, 53.5% tier 2 procedures). The average total number of opioids used at 2 weeks postoperatively across all procedures was 6.78 pills (range 0-49). Age and sex were not associated with postoperative opioid use. Tier 2 procedures were associated with increased postoperative opioid use, higher average postoperative week 1 pain, and higher refill rates (P = .05) (Figure 4-2B). •Patients demonstrating higher pain catastrophizing scores preoperatively used more opioids postoperatively after a range of ambulatory hand surgeries.•In the setting of the opioid epidemic, hand surgeons should be aware of pain-related psychological factors that can influence postoperative opioid use.•Further studies evaluating predictors of postoperative opioid use may help identify patients for preoperative pain education and pain coping/reduction techniques.Figure 4-2APain Catastrophizing and Mindfulness Attention Awareness Scale Scores (†: PCS= Pain Catastrophizing Scale. Range of scale is 0-52; MAAS= Mindfulness Attention Awareness Scale. Range of scale is 1-6.)View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4-2BAssociation between PCS/MAAS Score and Postoperative Pain and Opioid use (€= Median [range] for continuous variables, Number of patients [% of cohort] for categorical variables, ρ= Spearman’s correlation coefficient; *= significant P values are defined as <.05Show full caption; ♮= Median [Range])View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) ; ♮= Median [Range]) This research was supported by a Residents & Fellows Fast Track Grant from the American Foundation for Surgery of the Hand.