Recent studies have indicated that chronic pain after surgical intervention is more common than previously assumed.
Several demographic and somatic predictors of long-term unfavorable outcome have been identified.
However, little is known about the contribution of psychologic risk factors.
Dr Peters Madelon and colleagues from the Netherlands identified somatic and psychologic predictors of pain, global perceived recovery, and quality of life 6 months after surgical intervention.
|Operations of longer than 3 hours increased the risk for pain|
|Annals of Surgery|
The researchers conducted a prospective cohort study of 625 patients undergoing elective surgery in 2003.
Psychologic questionnaires were completed preoperatively, and acute postoperative pain was recorded until 4 days after the operation.
All patients received follow-up questionnaires at 6 months to assess pain, functional limitations, global perceived recovery, and quality of life.
The research team used multivariable logistic regression analyses to estimate relative risk of poor outcome in terms of pain, functional limitations, and global recovery.
Multivariable linear regression analysis was used to assess associations with quality of life at 6 months.
The team found that the most important somatic predictors of unfavorable outcome were duration of the operation, and high levels of acute postoperative pain.
Patients reporting high levels of pain 4 days after the operation, and undergoing an operation of longer than 3 hours were at risk for increased pain.
The team noted that patients with increased functional limitations, and poor global recovery reported lower levels of quality of life 6 months after the operation.
The researchers observed that psychologic variables that influenced long-term outcome were preoperative fear of surgery and optimism.
Fear of the long-term consequences of the operation was associated with more pain, poor global recovery, and worse quality of life 6 months later.
However, the team noted that optimism was associated with better recovery and higher quality of life.
Dr Madelon's team concluded, “This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain, functional limitations, and quality of life 6 months after surgical interventions.”
“We replicated previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome.”
“We also identified additional risk factors, namely, long duration of the operation, American Society of Anesthesiologists' status, and preoperative fear of surgery.”