Pre-operative psychological factors influence analgesic consumption and self-report of pain intensity following breast cancer surgery

Abstract

Abstract Background: Psychological factors such as anxiety and mood appear to influence acute post-operative pain; however, the evidence on the relationship between pre-operative psychological parameters and the severity of post-operative pain is conflicting. Given the particularly stressful setting of initial surgery for breast cancer we conducted a prospective observational study of patients who were scheduled to undergo initial breast cancer surgery.Methods: The objectives were to examine the potential associations between pre-defined pre-operative psychological parameters with i. Self-reported pain scores at discharge from the post-operative acute care unit, ii. Cumulative perioperative opioid consumption at four hours post-operatively and iii. Measures of self-reported pain during the first seven days after surgery. Patients completed the following questionnaires during the three hours prior to surgery: Spielberger’s State Trait Anxiety Inventory (STAI State and Trait), Pain Catastrophizing Score (PCS), Cohen Stress Questionnaire (CSQ), Hospital Anxiety and Depression scale (HADS A and D), and the short form McGill Pain Questionnaire. Post-operative pain experience was assessed using patient self-report of pain (SF Magill Pain questionnaire on discharge from the post-anaesthesia care unit, and a pain diary for seven days postoperatively) and record of analgesic consumption.Results: A significant positive correlation was demonstrated between pre-operative state anxiety (STAI) and the most severe pain reported during the first seven days post-operatively. Patients who were categorized pre-operatively as “high value” for each of the psychological parameters studied (HADS A and D, STAI State and Trait and PCS), tended to have greater perioperative opioid consumption (up to four hours post-operatively ); this trend was statistically significant for HADS D and HADS A only. Using a linear regression model, state anxiety was found to be a significant predictor of post-operative pain based on self-report during the first seven post-operative days (standardized β = 0.271, t = 2.286, p = 0.025).Conclusion: Our findings that pre-operative state anxiety, in particular, is associated with the severity of the post-operative pain experience in women undergoing initial breast cancer surgery. Formal pre-operative assessment of anxiety may be warranted in this setting with a view to optimizing perioperative analgesia and wellbeing.