Physiological Psychology, Otto-Friedrich University Bamberg, Germany.
Pain Center, Friedrich-Alexander University Erlangen, Germany.
Eur J Pain. 2018 Jan;22(1):191-202. doi: 10.1002/ejp.1115. Epub 2017 Sep 20.
Psychological variables and acute post-operative pain are of proven relevance for the prediction of persistent post-operative pain. We aimed at investigating whether pain-specific psychological variables like pain catastrophizing add to the predictive power of acute pain and more general psychological variables like depression.
In all, 104 young male patients undergoing thoracic surgery for pectus excavatum correction were studied on the pre-operative day (T0) and 1 week (T1) and 3 months (T2) after surgery. They provided self-report ratings (pain-related: Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale = PASS, Pain Vigilance and Awareness Questionnaire = PVAQ; general psychological: Screening for Somatoform Symptoms, State-Anxiety Inventory-X1, Center for Epidemiologic Studies Depression Scale = CES-D). Additional predictors (T1) as well as criterion variables (T2) were pain intensity (Numerical Rating Scale) and pain disability (Pain Disability Index).
Three months after surgery, 25% of the patients still reported clinically relevant pain (pain intensity ≥3) and over 50% still reported pain-related disability. Acute post-operative pain as well as general psychological variables did not allow for a significant prediction of persistent post-operative pain; in contrast, pain-related psychological variables did. The best single predictors were PASS for pain intensity and PVAQ for pain disability.
Pain-related psychological variables derived from the fear-avoidance model contributed significantly to the prediction of persistent post-operative pain. The best possible compilation of these measures requires further research. More general psychological variables may become relevant predictors later in the medical history.
Our results suggest that pain-specific psychological variables such as pain anxiety and pain hypervigilance add significantly to the prediction of persistent post-operative pain and might even outperform established predictors such as acute pain and general psychological variables. Clinicians might benefit from the development of time-economic screening tools based on these variables.
心理变量和急性术后疼痛已被证明与持续性术后疼痛的预测有关。我们旨在研究疼痛特异性心理变量（如疼痛灾难化）是否可以增加急性疼痛和更一般的心理变量（如抑郁）的预测能力。
共有 104 名年轻男性患者因漏斗胸矫正而行胸腔手术，在术前（T0）、术后 1 周（T1）和 3 个月（T2）进行了研究。他们提供了自我报告评分（疼痛相关：疼痛灾难化量表、疼痛焦虑症状量表=PASS、疼痛警觉和意识问卷=PVAQ；一般心理：躯体症状筛查、状态焦虑量表-X1、抑郁量表=CES-D）。其他预测因素（T1）和标准变量（T2）是疼痛强度（数字评分量表）和疼痛残疾（疼痛残疾指数）。
术后 3 个月，25%的患者仍报告有临床相关的疼痛（疼痛强度≥3），超过 50%的患者仍报告有疼痛相关的残疾。急性术后疼痛以及一般心理变量不能对持续性术后疼痛进行显著预测；相反，疼痛相关的心理变量可以。最佳的单一预测因素是 PASS 对疼痛强度和 PVAQ 对疼痛残疾。
源自恐惧回避模型的疼痛相关心理变量对持续性术后疼痛的预测有显著贡献。这些措施的最佳组合需要进一步研究。更一般的心理变量在医疗史的后期可能成为相关的预测因素。
我们的结果表明，疼痛特异性心理变量，如疼痛焦虑和疼痛警觉过度，对持续性术后疼痛的预测有显著贡献，甚至可能优于急性疼痛和一般心理变量等既定预测因素。临床医生可能受益于基于这些变量的省时筛选工具的开发。
