Psychosocial factors appear to predict postoperative pain: Interesting, but how can such information be used to reduce risk?

Abstract

Psychosocial factors have emerged as consistent predictors of acute and chronic postoperative pain, exerting at least moderate effects on these outcomes. Factors identified involve negative affectivity, stress and distress, and poor coping, suggesting that perceptual/cognitive, emotional, and behavioral factors play key roles in influencing postoperative pain. Building on research documenting such effects, we illustrate 2 pathways by which information on preoperative psychosocial factors (using pain catastrophizing as an example) can be used to advance research and clinical agendas. One pathway treats pain catastrophizing as an empiric marker of risk. We computed mean effect sizes (Cohen's D) linking pain catastrophizing to acute and chronic postsurgical pain and illustrate that a patient scoring above the median on a pain catastrophizing scale may incur twice the risk of developing chronic postsurgical pain than a patient below the median. The second pathway involves reducing the maladaptive patterns of pain-related thoughts and beliefs of a high pain catastrophizer via cognitive-behavioral therapies (CBT) to reduce the risk of chronic postoperative pain. By mapping effect sizes of CBT for reducing catastrophizing onto effect sizes of catastrophizing predicting pain, our calculations suggest that treating high catastrophizers with CBT may result in 50% fewer patients developing chronic postsurgical pain within this group. Thus, a definable and achievable amount of reduction in pain catastrophizing may translate into definable and achievable decreases in risk of chronic postoperative pain. Future research directions are outlined.