Post-Surgery Chronic Pain More Common In Patients Who ‘Catastrophize’

Patients who engage in a type of irrational thinking, or cognitive distortion, known as catastrophizing are more likely to experience chronic pain following a surgery, according to new research from the Rush University Medical Center in Chicago.

There are two main variations of catastrophizing, which is frequently a symptom of generalized anxiety disorder (GAD). The first kind of catastrophizing involves excessive worries about a mistake you made or some other negative situation and assuming that the worst case scenario will happen. The other variation of catastrophizing is similar, but involves imagining future events and assuming they will result in catastrophic results.

Common examples of catastrophizing might be making a mistake at work and assuming you are going to lose your job, or receiving a poor grade on a test and assuming you are going to fail the class and never graduate. People who deal with chronic catastrophizing regularly believe that disaster is going to be the outcome of any mistake or unlucky incident, and can deal with nearly constant anxiety or even panic as a result.

Psychology Can Influence Post-Operative Pain

This new study suggests that, in certain circumstances, catastrophizing may create a self-fulfilling prophecy. Previous research has suggested that chronic post-surgical pain can be influenced by a patient’s psychology, and this study suggests that a belief in negative surgery outcomes may make patients more likely to encounter chronic pain.

The Rush University researchers conducted a meta analysis of seven studies involving a total of 661 patients who had undergone a surgical operation. They found higher overall pain scores among patients who were frequent catastrophizers. However, the studies included in this meta analysis did not include such factors as additional psychological conditions and levels of pre-surgical pain.

Therefore, the Rush University team conducted its own follow-up study to test the conclusions of its analysis. This study involved 62 patients who had all undergone a total knee replacement. This type of surgery is considered to have a moderate incidence of chronic pain following the procedure, with between 10 percent and 20 percent of total knee replacement patients encountering chronic pain during the post-surgical recovery process.

The study confirmed that patients identified as frequent catastrophizers reported higher overall pain scores during their post-surgery evaluations. Post-operative chronic pain was more common among these patients even after the researchers adjusted for the baseline pain levels the patients reported before their operations, and considered the possible influence of other psychological factors and conditions.

New Strategies for Treating Chronic Post-Surgical Pain

The results of this new study were reported at the Anesthesiology 2014 annual meeting. Anesthesiology is all about the management of pain, and post-surgical pain is an ongoing challenge because it can be difficult to predict. Studies such as these suggest new possibilities for preventing or treating post-operative pain that do not involve using drugs for pain management.

Preemptively treating psychological factors such as depression or anxiety that includes pain catastrophizing could help to prevent patients from developing chronic pain following a surgical procedure.

Of course, these conditions are serious and potentially debilitating illnesses in their own right, and require treatment for reasons that go well beyond avoiding pain following an operation. However, in the event that such a condition has not been previously identified or addressed, a forthcoming surgery could be an excellent opportunity to screen patients for mental illness. In addition to helping patients to receive needed attention for these illnesses, it could also help them avoid struggles with chronic pain.

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