The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations

Abstract

Aim: Breast cancer is the most common cancer in women and is the second most cause of cancer associated death. After diagnosis is made, emotional distress, anxiety and depression occurs in 35-38% of women. High anxiety levels prior to operation increases the sensitivity and expectation of the patients towrads pain, influencing the severity of postoperative pain. The aim of the present study was to evaluate the effect of preoperative anxiety on postoperative pain expectation, postoperative pain and opioid consumption in patients undergoing modified radical mastectomy. Material and Method: 60 female patients between the ages of 18-65 were included in the present study. Preoperative anxiety was evaluated using State Trait Anxiety Inventory (STAI) and postoperative pain expectation using Visual Analog Scale (VAS). STAI1 test was administered at preoperative visit, preoperatively and postoperative 6th hour while STAI2 was administered at preoeprative visit. Demographic characteristics were questioned. Postoperative pain levels and overall morphine consumption were recorded. Results: Postoperative STAI1 values were significantly lower than preoperative visit and preoperative STAI1 values (p=0.002-p=0.004). Weak but statistically significant correlation was shown between preoperative visit STAI1 and STAI2 values. A statistically significant but weak positive relation was found betwen STAI1 preoperative and STAI1 postoperative 6th hour values and postoperative VAS (p=0.030; rho=0.280; p=0.003; rho=0.378). Median postperative pain expectation was found to be 6.0 (min=3.0; max=10.0). Conclusion: In the present study, it was demonstrated that high preoparetive anxiety scores are associated with increased postoperative pain level anxiety stimulations may potentiate pain, by exerting pain like effect via psychological system. It is our suggestion that, in special patient groups in which anxiety levels are high, such as breast cancer patients, planning postoeprative pain management after determining preoperative anxiety level and other risk factors will increase patient satsisfaction and the efficacy of analgesia.

The Relationship Between Fear of Surgery and Affecting Factors in Surgical Patients

“…It is also argued that these factors may affect the course of acute and chronic disease and the recovery and survival of patients (16,17). In addition, it is stated in the literature that preoperative anxiety and fear increase the intensity of postoperative pain and cause the individual to need more analgesics and have di culty controlling pain (7,(18)(19)(20)(21)(22).…”

Predictors of postoperative pain six months after breast surgery

“…First, some studies only assessed pain severity retrospectively 13 – 15 , which may not capture the full extent of the pain experience. Second, some of the previous studies used small sample sizes 16 , which limits the generalizability of the findings. Third, previous studies have not investigated the potential role of loneliness as a risk factor for postoperative pain in breast cancer patients specifically.…”