Masaud Khaled, Galvin Audrey Dunn, De Loughry Gillian, Meachair Aisling O, Galea Sarah, Shorten George
Department of Anaesthesia, Cork University Hospital, Cork, Ireland.
Department of Anaesthesia and Intensive Care Medicine, University College of Cork, Cork, Ireland.
BMC Anesthesiol. 2024 Jul 16;24(1):239. doi: 10.1186/s12871-024-02622-6.
Psychological factors such as anxiety and mood appear to influence acute postoperative pain; however, there is conflicting evidence on the relationship between preoperative psychological parameters and the severity of postoperative pain. In the context of the 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.
The objectives were to examine the potential associations between predefined preoperative psychological parameters and (i) Self-reported pain scores at discharge from the postoperative acute care unit, (ii) Cumulative perioperative opioid consumption at four hours postoperatively and (iii) Self-reported pain as measured during the first seven days after surgery. Patients completed the following questionnaires during the three hours prior to surgery: the Spielberger State Trait Anxiety Inventory (STAI State and Trait), the Pain Catastrophizing Scale (PCS), the Cohen Stress Questionnaire (CSQ), the Hospital Anxiety and Depression Scale (HADS A and D), and the short-form McGill Pain Questionnaire. Postoperative pain experience was assessed using patient self-reports of pain (SF Magill Pain questionnaire on discharge from the postanaesthesia care unit and a pain diary for seven days postoperatively) and records of analgesic consumption.
Pre- to postoperative self-reported pain was significantly different with respect to the STAI State, Cohen score and PCS for both low and high values (p < 0.001), but only patients categorized as having low STAI Trait, HADS A, and HADS D values achieved significant differences (p < 0.001). A significant positive correlation was demonstrated between preoperative state anxiety (STAI) and the most severe pain reported during the first seven days postoperatively (r = 0.271, p = 0.013). Patients who were categorized preoperatively as having a "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 postoperatively); 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 postoperative pain based on self-reports during the first seven postoperative days (standardized β = 0.271, t = 2.286, p = 0.025).
Preoperative state anxiety, in particular, is associated with the severity of postoperative pain experienced by women undergoing initial breast cancer surgery. Formal preoperative assessment of anxiety may be warranted in this setting with a view to optimize perioperative analgesia and wellbeing.
焦虑和情绪等心理因素似乎会影响术后急性疼痛；然而，关于术前心理参数与术后疼痛严重程度之间的关系，证据并不一致。在乳腺癌初次手术的压力环境下，我们对计划接受初次乳腺癌手术的患者进行了一项前瞻性观察研究。
目的是研究预先定义的术前心理参数与以下方面之间的潜在关联：（i）术后急性护理病房出院时的自我报告疼痛评分；（ii）术后四小时的围手术期阿片类药物累计消耗量；（iii）术后前七天测量的自我报告疼痛。患者在手术前三个小时内完成了以下问卷：斯皮尔伯格状态特质焦虑量表（STAI状态和特质）、疼痛灾难化量表（PCS）、科恩压力问卷（CSQ）、医院焦虑和抑郁量表（HADS A和D）以及简短麦吉尔疼痛问卷。术后疼痛体验通过患者的疼痛自我报告（麻醉后护理病房出院时的SF麦吉尔疼痛问卷以及术后七天的疼痛日记）和镇痛药物消耗记录进行评估。
术前与术后自我报告的疼痛在STAI状态、科恩评分和PCS的高值和低值方面均存在显著差异（p < 0.001），但只有STAI特质、HADS A和HADS D值分类为低的患者有显著差异（p < 0.001）。术前状态焦虑（STAI）与术后前七天报告的最严重疼痛之间存在显著正相关（r = 0.271，p = 0.013）。术前被分类为所研究的每个心理参数（HADS A和D、STAI状态和特质以及PCS）“高值”的患者围手术期阿片类药物消耗量往往更大（术后长达四小时）；仅HADS D和HADS A的这种趋势具有统计学意义。使用线性回归模型，发现状态焦虑是术后前七天自我报告的术后疼痛的显著预测因素（标准化β = 0.271，t = 2.286，p = 0.025）。
特别是术前状态焦虑与接受初次乳腺癌手术的女性术后疼痛的严重程度相关。在此情况下，可能有必要进行正式的术前焦虑评估，以优化围手术期镇痛和患者的健康状况。
