The Influence of Preoperative Mood and Treatment Expectations on Early Postsurgical Acute Pain After a Total Knee Replacement

Abstract

BackgroundReducing postoperative pain immediately after surgery is crucial because severe postoperative pain reduces quality of life and increases the likelihood that patients develop chronic pain. Even though postoperative pain has been widely studied and there are national guidelines for pain management, the postoperative course is differently from one patient to the next. Different postoperative courses could be explained by factors related to the treatment context and the patients. Preoperative emotional states and treatment expectations are significant predictors of postoperative pain. However, the interaction between emotional states and preoperative treatment expectations and their effect on postoperative pain have not yet been studied. The aim of our study was to identify the interaction between emotional states, treatment expectation and early postsurgical acute pain.MethodsIn this prospective clinical trial, we enrolled patients who had received a TKR at a German hospital between October 2015 and March 2019. Patients rated their preoperative pain on a numeric rating scale (NRS) 0–10 (0 = no pain and 10 = worst pain imaginable), their emotional states preoperatively on the Pain and State of Health Inventory (PHI), their preoperative treatment expectations on the Stanford Expectation of Treatment Scale (SETS), and their postoperative level of pain on a NRS 0–10.FindingsThe questionnaires were completed by 122 patients (57% female). Emotional states predict negative treatment expectation F(6, 108) = 8.32, p < 0.001, with an excellent goodness-of-fit, R2 = 0.31. Furthermore, a mediator analysis revealed that the indirect effects and therefore relationship between the emotional states sad (ab = 0.06, 95% CI[0.01, 0.14]), anxious (ab = 0.13, 95% CI[0.04, 0.22]), and irritable (ab = 0.09, 95% CI[0.03, 0.17]) and postoperative pain is fully mediated by negative treatment expectations. Whereas the emotional states tired (ab = 0.09, 95% CI[0.03, 0.17]), dizzy/numb (ab = 0.07, 95% CI[0.01, 0.20]), weak (ab = 0.08, 95% CI[0.03, 0.16] are partially mediated by negative treatment expectations.ConclusionThe relationship between emotional states and postoperative pain is mediated by negative treatment expectations. Therefore, innovative treatment strategies to reduce postoperative pain should focus on eliminating negative treatment expectation through establishing a differentiated preoperative expectation management program that also focuses on emotional states.

Psychological predictors of acute postoperative pain after total knee and hip arthroplasty: A systematic review

“…After reviewing the identified articles, 18 studies met all inclusion criteria. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] The reasons for the exclusion of the remaining studies are specified in Figure 1.…”

“…Ten studies evaluated pain after TKA, 26,[28][29][30][31][32][39][40][41][42] two studies after THA, 33,34 and four studies after both TKA and THA. 27,36,37,43 Of the studies evaluating both TKA and THA patients, only one study 37 presented the results independently.…”

“…The most commonly evaluated psychological aspects were anxiety (13 studies), [26][27][28][29][30][31][32][33][34]36,37,39,42 depression (13 studies), [26][27][28][29][30][31][32][33][34]36,37,39,42 and pain catastrophizing (nine studies). 26,27,31,32,36,37,39,40,43 Other aspects included pain self-efficacy (one study), 27 somatization (one study), 26 illness perception (three studies), 29,30,37 type D personality (one study), 34 optimism (two studies), 36,37 mood (two studies), 27,40 emotional state (one study), 41 surgical fear (two studies), 36,37 and treatment expectations (one study). 41 T...…”

“…26,27,31,32,36,37,39,40,43 Other aspects included pain self-efficacy (one study), 27 somatization (one study), 26 illness perception (three studies), 29,30,37 type D personality (one study), 34 optimism (two studies), 36,37 mood (two studies), 27,40 emotional state (one study), 41 surgical fear (two studies), 36,37 and treatment expectations (one study). 41 The specific scales used for each psychological aspect are provided in Table 1.…”

“…All studies had pain assessment time points within 48 h, with followup ranging from 24 h to 30 days. Pain was rated in most studies using an 11-or 21-point numerical rating scale (NRS) [26][27][28][29][30][31]33,34,36,37,39,41,42 or 10 cm visual analog scale (VAS), 32,43 with three studies using the brief pain inventory (BPI) or brief pain inventory short form (BPI-SF) instrument. 27,36,37 One study rated pain using the short-form…”