THE RISK OF SEVERE PAIN AFTER THE SURGERY DEPENDS ON THE PREOPERATIVE PSYCHOLOGICAL CONDITION OF PATIENTS

Authors

  • G. V. Boiarkina State Institution “Crimea State Medical University named after S.I. Georgievsky” Department of Emergency Medicine and Anesthesiology, Head of the Chair: A.A. Babanin, MD, PhD, Simferopol,

DOI:

https://doi.org/10.14739/2310-1210.2013.6.20542

Keywords:

surgery, pain, anxiety, depression

Abstract

Background

Good pain control after surgeries is important to prevent different negative outcomes.  Despite the overwhelming rationale for the effective postoperative pain control, the clinical reality is still far from satisfactory. However, many factors must be considered before deciding on the type of pain therapy to be provided to the surgical patient. Thus, many clinical researches confirm the interrelation between psychological status and the level of postoperative pain syndrome. Nevertheless, the prognostic value of psychological scales relative to the severe pain after the surgery has not been evaluated yet and new researches in this direction can be of significant scientific and practical importance.

AIM

The aim of this study was to evaluate the predictive value of scales, characterising the preoperative psychological condition of patient relative to the intensity of pain after the surgery.

Materials and Methods

The observational study has been conducted, which included 100 consecutive patients undergoing major urological surgeries with lumbotomic access. The level of preoperative anxiety and depression was assessed using the HADS and PHQ-9 scales. Pain after the surgery was assessed using a questionnaire in which patients were asked to mark the worst pain within the first 24 hours after the surgery (0-10 score). Relative risk (RR), Odds Ratio (OR), Likelihood Ratio (LR) and Positive predictive value (PPV) for each scale and scales combinations have been calculated.  Differences in patients groups were considered statistically significant at p <0.05.

Results and Discussion

Out of 100 patients, 62 (62%) experienced severe pain after the surgery. It has been determined, that the risk of severe pain after the surgery was increased in patients with clinical manifestations of anxiety and depression according to HADS scale (OR = 1,91; 95% CI 1,40-2,61 and OR = 1,57; 95% CI 1,18-2,07 respectively) and depression according to PHQ-9 scale (OR = 2,01; 95% CI 1,30-3,11) compared with groups of patients without psychological disorders (p<0,01). The PHQ-9 had the highest sensitivity – 77,5% and scale combinations – HADSanxiety and HADSdepression had the highest specificity – 93,3%. The maximal PPV was observed in scales combinations HADSanxiety and PHQ-9 – 87,6% (95% CI 72,0–94,1);  HADSanxiety and HADSdepression – 92,5% (95% CI 73,2–97,6).

Conclusions

The risk of severe pain occurrence increased in patients with high level of preoperative anxiety and depression. In order to improve the effectiveness of postoperative analgesia, it is advisable to continue the search of other factors, affecting individual pain perception.  

Author Biography

G. V. Boiarkina, State Institution “Crimea State Medical University named after S.I. Georgievsky” Department of Emergency Medicine and Anesthesiology, Head of the Chair: A.A. Babanin, MD, PhD, Simferopol

Department of Emergency Medicine and Anesthesiology, Head of the Chair: A.A. Babanin, MD, PhD, Simferopol

References

Pain intensity on the fi rst day after surgery: a prospective cohort study comparing 179 surgical procedures / H.J. Gerbershagen, S. Aduckathil, A.J. van Wijck [et al.] // Anesthesiology. – 2013. – Vol. 118. – № 4. – Р. 934–944.

Catastrophizing: a predictive factor for postoperative pain /

R.S. Khan, K. Ahmed, E. Blakeway [et al.] // Am J Surg. – 2011. – Vol. 201. – № 1. – P. 122–131.

Altman D.G. Diagnostic tests 1: sensitivity and specifi city /

D.G. Altman, J.M. Bland // BMJ. – 1994. – Vol. 308. – № 6943. – P. 1552.

Altman D.G. Diagnostic tests 2: predictive values / D.G. Altman, J.M. Bland // BMJ. – 1994. – Vol. 309. – № 6947 – P. 102.

Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged / J.L. Apfelbaum, C. Chen, S.S. Mehta, T.J. Gan // Anesth Analg. – 2003. – Vol. 97. – №2 – P. 534–540.

Bedian A.G. On the Use of the Coeffi cient of Variation as a Measure of Diversity / A.G. Bedeian, W. Kevin // Mossholder Organizational Research Methods. – 2000. – Vol. 3. – № 3. – P. 285–297.

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How to Cite

1.
Boiarkina GV. THE RISK OF SEVERE PAIN AFTER THE SURGERY DEPENDS ON THE PREOPERATIVE PSYCHOLOGICAL CONDITION OF PATIENTS. Zaporozhye Medical Journal [Internet]. 2014Jan.29 [cited 2024Dec.24];15(6). Available from: http://zmj.zsmu.edu.ua/article/view/20542

Issue

No. 6 (2013): Zaporozhye medical journal

Section

Original research

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