The Effects Of Psychological Factors On Post-Surgical Pain Outcomes

Post-surgical pain is the most common symptom after surgery.Severe acute post-surgical pain may hamper recovery,delay discharge,increase medical costs and even decrease the satisfaction of treatment.Chronic post-surgical pain lasting two months or longer after surgery can have negative implications for quality of life and well-being.Although numerous longitudinal studies have examined relations between pre-surgery psychological factors and post-surgical pain,results have been inconsistent.Therefore,a meta-analysis was performed to evaluate overall strengths of relation between positive beliefs(self-efficacy and optimism)and post-surgical pain outcomes(pain intensity,functional impairment and quality of life)in surgery patients as well as potential moderators that help to explain variable results in this literature.In addition,due to the lack of domestic research on Chinese surgery samples,we also explored the impact of pre-surgery psychological influences on post-surgical outcomes of Chinese surgery patients.In Study 1,a meta-analysis was performed to evaluate overall strengths of relation between positive pre-surgery beliefs(optimism and self-efficacy)and post-surgical outcomes(pain intensity,functional impairment,quality of life)in surgery patient samples,as well as potential moderating effects of demographic characteristics and methodological factors on these associations.In sum,42studies(N = 9308)fulfilled selection criteria for analysis.Analyses of overall effect sizes indicated positive beliefs had significant negative overall correlations with post-surgical pain intensity and functional impairment and a positive overall correlation with quality of life.Each average effect size was small or medium in magnitude.Considerable heterogeneity was also observed for all effect sizes.Moderator analyses for post-surgery pain intensity levels indicated overall effect sizes were not affected by positive belief subtypes(self-efficacy versus optimism),follow-up duration,type of surgery or statistical control of baseline responses on outcomes.Age was the only significant moderator,as effect sizes were smaller in older than younger sample.Moderator analyses for post-surgical functional impairment identified impairment measure subtype as the only significant influence of effect size heterogeneity.Positive pre-surgery beliefs had a stronger association with self-report rather than behavior performance measures of functional impairment.Finally,no moderating influences were found in analyses of positive beliefs-quality of life relations.Study 2 examined the impact of demographics,surgery-related factors and pre-surgery psychological variables on acute post-surgical pain intensity as well as the presence of chronic post-surgical pain and interference among women undergoing hysterectomies.A consecutive sample of 102 women was assessed 24 hours before surgery(T1)with post-surgery follow-ups48-72 hours(T2),and four months after surgery(T3),respectively,among 99 and 79 of these women.The multiple regression analysis for acute pain intensity indicated(1)higher education levels and higher pre-surgery pain intensity levels predicted more intense acute post-surgical pain;(2)Patients who reported chronic post-surgical pain had significantly higher levels of pre-surgical relative pain and more intense acute post-surgical pain as well as lower pre-surgery pain self-efficacy levels.However,pre-surgical relative pain had the only unique impact in the associated logistic regression analysis;(3)Higher pre-surgical relative pain levels were also the only factor that predicted interference from pain at four-month follow-up.In sum,meta-analysis results underscored modest though significant overall effects of positive pre-surgery beliefs related to self-efficacy and optimism on post-surgery outcomes.Although pain self-efficacy also predicted the presence or absence of chronic post-surgical pain among Chinese hysterectomy surgery patients four months after surgery,effects of relative pre-surgery pain levels were more robust in multivariate analyses.Together,these results suggest that patients with lower pre-surgery pain self-efficacy levels may be more susceptible to negative surgery outcomes but pain intensity levels before surgery and during acute recovery also warrant consideration in understanding post-operative pain.