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Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery

https://doi.org/10.1016/j.jpsychores.2004.07.007Get rights and content

Abstract

Objectives

The aim of the present study was to predict postoperative pain and morphine consumption based on preoperative psychosocial factors.

Methods

One hundred and twenty-two women completed measures of distress and coping 1 week before major abdominal gynecological surgery by laparotomy. Forty-eight hours after surgery, measures of pain and negative affect (NA) were completed, and morphine consumption was recorded from a patient-controlled analgesia pump. Four weeks after surgery, measures of pain and NA were completed.

Results

Multivariate analyses revealed that preoperative self-distraction coping (P=.039) positively predicted postoperative pain levels in the hospital, after accounting for the effects of age, concurrent NA, and morphine consumption. Emotional support (P=.031) and religious-based coping (P=.036) positively predicted morphine consumption in the hospital, after accounting for the effects of age, concurrent NA, and pain levels. Preoperative distress (P<.04 to .008) and behavioral disengagement (P=.034), emotional support (P=.049), and religious-based coping (P=.001) positively predicted pain levels 4 weeks after surgery, after accounting for the effects of age and concurrent NA.

Conclusion

The results suggest that preoperative psychosocial factors are associated with postoperative pain and morphine consumption.

Introduction

Until recently, the role of presurgical psychosocial factors in predicting adjustment to the acute outcomes after surgery has been limited to the investigation of anxiety and related states. The results of these studies are equivocal. For example, in some studies, state-based factors, such as anxiety and anticipatory stress, have been found to be positively associated with physical complaints [1] and postoperative pain and/or analgesic consumption [2], [3], [4], [5], [6], [7], [8]. In other studies, however, no association has been found between preoperative anxiety and pain or analgesic consumption [3], [9], [10], [11], [12], [13], [14], [15].

Part of the difficulty in accurately determining the nature of the relationship between preoperative anxiety and postoperative pain arises because studies have failed to assess other important variables in the postoperative period that are known to influence pain and analgesic consumption. For example, the preoperative anxiety that may be associated with postoperative pain could reflect a dispositional characteristic of the individual that is associated with a generalized increased reactive state to stressful situations, which may include increased pain levels. Alternatively, postoperative anxiety may lead to increased pain reporting, independent of the dispositional anxiety level.

There has been considerably less research examining presurgical coping behaviors as predictors of postoperative adjustment. It has been suggested that avoidant coping (e.g., not thinking about the upcoming surgery) is associated with less preoperative anxiety and better short-term recovery than is vigilant-style coping [16], [17]. However, in most studies, the effects of coping style have not been disentangled from their association with anxiety in predicting postoperative recovery measures.

The main aim of the present study was to determine whether presurgical psychosocial factors were associated with postoperative pain reports and analgesic consumption after adjusting for the effects of other medical factors and concurrent variables. We hypothesized that presurgical measures of distress and general coping behaviors would be associated with postoperative pain and analgesic consumption, after adjusting for the concurrent factors. We were particularly interested in determining the extent to which the endorsement of specific coping strategies would predict postoperative pain and analgesic consumption after controlling for the effects of the distress measures before surgery and negative affect (NA) at the time pain was assessed. Factors that are amenable to change were of particular interest because knowledge of modifiable psychological and behavioral characteristics associated with adjustment could aid in the design of more effective, targeted preoperative intervention programs.

Section snippets

Participants

The present study was conducted in the context of a randomized, double-blind, placebo-controlled trial examining the benefits of preincisional epidural anesthesia for women undergoing major abdominal surgery. Patients scheduled for major gynecological surgical procedures by laparotomy were eligible for recruitment into the study. Inclusion criteria were ASA physical status I–II, age between 19 and 75 years, weight between 45 and 90 kg, height between 150 and 175 cm, body mass index less than or

Descriptive analyses

One hundred and twenty-two women provided baseline data and completed at least one of the follow-up measures 48 h after surgery. For the Pearson correlation analyses examining the association of the preoperative measures with the postoperative pain level and morphine consumption, the number of patients in the analyses ranged from 113 to 122 for the 48-h postoperative time point and from 77 to 83 patients for the 4-week follow-up assessment. The hierarchical regression analyses used only data on

Discussion

One of the most important findings from the present study was the ability of certain preoperative factors to predict postoperative pain levels and analgesic consumption while in the hospital and 4 weeks later, even after accounting for the effects of age and the concurrent factors that were associated with the outcome measures. The results of the present study indicate that preoperative distress and coping predict postoperative morphine consumption and pain level, as measured by the MPQ. The

Acknowledgments

Supported by Grants MT-12052 and MOP-37845 from the Canadian Institutes of Health Research (CIHR), Ontario, Canada; Grant NS35480 from the National Institute of Neurolgical Disorders and Stroke, Bethesda, MD; and a CIHR Investigator Award to Dr. Katz. We thank Beth Notzon, from the Department of Scientific Publications, The University of Texas M.D. Anderson Cancer Center, for her helpful editorial comments on this article.

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