Anxiety and Depression Can Exacerbate Post-Operative Pain

A study in the British Journal of Pain suggests that anxiety and depression before surgery can significantly influence the amount of pain a patient feels after surgery. The findings are potentially important because they add to the evidence that the subjective experience of pain is worth considering, both before and after a pain intervention.

This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of 304 Caribbean patients. Patients were excluded if they underwent emergency surgery or had local anesthetic procedures or sedation-analgesia not involving an anesthetist, refused to participate in the study, or were unable to perform pain scales on their own.

Patients’ preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS). Researchers also recorded a preoperative “expected” pain score. After surgery, pain scores were assessed at 4 and 24 hours and the maximum pain score over the first day after surgery were recorded.

The overall prevalence of pre-surgery anxiety and depression was 43% and 27%, respectively, based on the HADS scores. Following surgical procedures, 3.9% of participants had no pain, 8.9% had “mild pain,” 22.7% had “moderate” pain, and 64.5% had “severe pain. In all, 70% of patients with anxiety experienced severe pain, compared to 60% without anxiety. Age, gender, ethnicity and type of anesthesia did not impact postoperative pain scores.

“In this study, older patients had lower HADS anxiety scores as well as expected pain scores,” the researchers observed. “The inverse relationship of age in the perception of postoperative pain has been reported in many studies, higher pain scores being associated with a younger age. This may possibly be attributed to the attitudes towards surgery, with easier acceptance of its reality as well as the probable prior exposure to the healthcare system in general. However, the age of the patients did not have any influence on the HADS depression scores as well as observed pain scores in this study…”

Interestingly, educational level of patients influenced both the expected and observed maximum pain scores in this study. The role of education levels in pain experience, along with racial and cultural factors, remains controversial.

“With a high prevalence of anxiety and depression in this study as well as their significant influences on postoperative pain, it may be worthwhile evaluating patients for these mood disorders during their preoperative assessment,” the researchers concluded. “Interventions may then be used, where possible, to address these disorders, with the aim of decreasing postoperative pain. These assessments should be done formally using tools such as the HADS questionnaire or any other similar and relevant screening tools.”