Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Perception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>One hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p &lt; 0.001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Catastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.</jats:p></jats:sec>

High Pain Catastrophizing Scale predicts lower patient-reported outcome measures in the foot and ankle patient

“…Overall, our results correlate with a previous study from Dunn et al [17] that identified catastrophization, anxiety and depression as important players in modulating postoperative pain. Our results point in the same direction as Yakobov et al [23] who noted that pain catastrophization correlated significantly to the postoperative Health-Related Quality of Life (HRQoL) over other variables (demographic variables, co-morbid health conditions, baseline HRQoL, and postoperative reductions in pain, joint stiffness and physical disability).…”

“…As such, risk factor targeted preoperative intervention by psychologist could be used in high-risk patients to modulate post-operative perceived pain. [17] A series of multi-week intervention programs have been reported to decrease catastrophizing scores up to 40%. [18,19] Objectives This study analyses the association between patient's preoperative catastrophizing scale and their one year postoperative FAOS domain scores for patients undergoing a series of foot and ankle operative interventions.…”

Validation of a visual analogue scale for the evaluation of the postoperative anxiety: A prospective observational study

“…Pain and anxiety are closely interlinked; the latter modifies patients’ perceptions, accentuates postoperative pain and affects their quality of life and long‐term outcome (Cornwall & Donderi, ; Ploghaus et al, ). Pain and anxiety involve a complex combination of fear, apprehension, agitation and feeling of malaise associated with physical manifestations (Dunn et al, ). Pain management would therefore benefit from a multidimensional evaluation procedure.…”

Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale

“…Given its clinical and scientific relevance, a validation of a Swedish version of the PCS appears pertinent. For example, the PCS can be used in future studies to further assess catastrophizing as a potential predictor, moderator or mediator in a number of treatments for long‐standing pain, both medical and behavioral, such as surgery for low back pain, cognitive behavior therapy (CBT), and physiotherapy …”