Patient's Attitude Toward Pain Indicates Severity of Postoperative Pain

A new study has found that the expectation of orthopedic postoperative pain was directly correlated with the actual incidence of pain following foot and ankle surgery.

Researchers at Stanford University Medical Center (CA, USA) conducted a prospective study of 98 patients (average age 46.5 years) undergoing orthopedic foot and ankle operations at the same hospital, and evaluated each patient's pain experience both preoperatively and postoperatively; the surgeries performed were a mixture of inpatient and outpatient procedures. The patients were given a Short-Form McGill Pain Questionnaire (SF-MPQ) before and after surgery to evaluate their levels of pain at both times.

The results of the study showed that pain severity was highest following foot and ankle surgery at the 3-day post-operative pain assessment whereas, six weeks out after surgery, the majority of patients felt little or no pain. This early pain was even greater than that anticipated by the patients. The severity of preoperative pain was highly predictive of the group's anticipated postoperative pain, as well as their level of pain at 6-weeks after surgery. Both preoperative pain and anticipated pain predicted higher immediate postoperative pain following foot and ankle operations. The researchers concluded that the study suggests that the expectation of pain going into surgery may contribute to its subsequent occurrence. The study was published in the November 2008 issue of Foot & Ankle International.

"While we cannot isolate the exact cause, optimistic patients suffered much less postoperative pain than their pessimistic counterparts; this result may demonstrate that patients are good at predicting pain, or that their expectation of greater pain may contribute to its subsequent occurrence,” said lead author Loretta Chou, M.D., an orthopedic foot and ankle surgeon in the department of orthopedic surgery. "This may be the brain sending projections to the spinal cord that increases pain signals. To make a long story short, we found that believing there will be pain after surgery leads to just that, pain.”

The SF-MPQ is a patient questionnaire with three questions concerning pain. It consists of 15 pain descriptors, the Present Pain Intensity (PPI) index, and a visual analogue scale for pain (VAS).

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Stanford University Medical Center