Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data

Abstract

ObjectivesSurgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological risk and resilience factors of postoperative pain and validated the German version of the Surgical Fear Questionnaire (SFQ).SettingUniversity Hospital of Marburg, Germany.DesignSingle-centre observational study and cross-sectional validation study.ParticipantsData for validating the SFQ were obtained from a cross-sectional observational study (N=198, mean age 43.6 years, 58.8% female) with persons undergoing different kinds of elective surgery. A sample of N=196 (mean age 43.0 years, 45.4% female) undergoing elective (orthopaedic) surgery was analysed to investigate somatic and psychological predictors of relevant acute postsurgical pain (APSP).Outcome measuresParticipants completed preoperative and postoperative assessments at postoperative days 1, 2 and 7. Presurgical pain, age, gender, pain expectation, surgical setting, physical status, anaesthesia, surgical fear, pain catastrophising, depression, optimism and self-efficacy were examined as predictors.ResultsConfirmatory factor analysis confirmed the original two-factor structure of the SFQ. Correlation analyses indicated good convergent and divergent validity. Internal consistency (Cronbach’s α) was between 0.85 and 0.89. Blockwise logistic regression analyses for the risk of APSP revealed outpatient setting, higher preoperative pain, younger age, more surgical fear and low dispositional optimism as significant predictors.ConclusionsThe German SFQ is a valid, reliable and economical instrument with which the important psychological predictor surgical fear can be assessed. Modifiable factors that increase the risk of postoperative pain were higher pain intensity before surgery and being fearful about negative consequences of the surgery whereas positive expectations seem to buffer against postsurgical pain.Trial registration numbersDRKS00021764 and DRKS00021766.

Measures of preoperative anxiety: Part two

“…The detailed requirements for calculating the SFQ scores undoubtedly constitute its advantage, as they ensure high reliability of the data obtained. The discussed questionnaire has satisfactory psychometric properties, allowing for its use both in clinical practice and scientific research [28][29][30][31][32][33].…”

Perioperative pain management in dermatosurgery – current practice in Germany: Data analysis of a Germany‐wide online survey among dermatosurgeons

“…Negative affective states also influence the perception of pain. 4 Pain management is therefore a central task in the patient care, since sufficient pain relief, ideally freedom from pain, is to be regarded as an essential principle of modern medicine and can also be defined as an individual patient right in accordance with Article 1 and 2 of the German Basic Law (Grundgesetz) as "… every person shall have the right to life and physical integrity". 5 In dermatology, most studies and recommendations on pain management focus on the treatment of acute and chronic pain in skin diseases, e.g.…”

“…However, if the pain persists, this protective mechanism loses its warning character, and what was initially a reasonable avoidance behavior becomes, over time, an impairment of physical functioning. Negative affective states also influence the perception of pain 4 . Pain management is therefore a central task in the patient care, since sufficient pain relief, ideally freedom from pain, is to be regarded as an essential principle of modern medicine and can also be defined as an individual patient right in accordance with Article 1 and 2 of the German Basic Law (Grundgesetz) as “… every person shall have the right to life and physical integrity” 5…”

Perioperative Schmerztherapie bei dermatochirurgischen Eingriffen – aktuelle Praxis in Deutschland: Datenauswertung einer deutschlandweiten Online‐Umfrage unter Dermatochirurgen

“…Auch negative Gefühle beeinflussen dabei die Schmerzwahrnehmung. 4 Die Schmerzbehandlung stellt somit eine zentrale Aufgabe in der Versorgung kranker Menschen dar, da eine ausreichende Schmerzlinderung, im Idealfall die Schmerzfreiheit, als eine wesentliche Handlungsmaxime der modernen Medizin anzusehen ist und auch als individuelles Patientenrecht gemäß Artikel 1 und 2 des Grundgesetzes als "… Grundrecht auf körperliche Unversehrtheit" definiert werden kann. 5 In der Dermatologie konzentrieren sich die meisten Untersuchungen und Empfehlungen zur Schmerztherapie auf die Behandlung akuter und chronischer Schmerzen bei Hauterkrankungen, zum Beispiel der (Post-)Zoster-Neuralgie, jedoch nur sehr selten auf das therapeutische Management (post-)operativer Schmerzen.…”

“…Bei anhaltenden Schmerzen verliert dieser Protektionsmechanismus jedoch seinen Warncharakter und aus einem initial sinnvollen Vermeidungsverhalten entsteht über die Zeit eine Beeinträchtigung der körperlichen Funktionsfähigkeit. Auch negative Gefühle beeinflussen dabei die Schmerzwahrnehmung 4 . Die Schmerzbehandlung stellt somit eine zentrale Aufgabe in der Versorgung kranker Menschen dar, da eine ausreichende Schmerzlinderung, im Idealfall die Schmerzfreiheit, als eine wesentliche Handlungsmaxime der modernen Medizin anzusehen ist und auch als individuelles Patientenrecht gemäß Artikel 1 und 2 des Grundgesetzes als „… Grundrecht auf körperliche Unversehrtheit“ definiert werden kann 5…”