Determinants of the postoperative pain experience

Abstract

The purpose of this study was to discover the determinants of the personal pain experience following surgery. The basic hypothesis was that the postoperative pain experience is complex and multidetermined and comparatively unrelated to the size or location of the incision. A variety of demographic, medical, trait, and coping characteristics was assessed in 98 patients about to undergo abdominal operations. The recently designed Somatizer Identification Questionnaire was included to assess denial with displacement to pain. Postoperatively, daily pain, mood, and opiate intake levels were recorded for three successive days. Univariate tests of association were performed between the pre- and postoperative variables and significant outcomes submitted to multivariate analysis.;Results confirmed the basic hypothesis. Postoperative pain was positively related to prior pain experience, whether chronic or state, and to the number of current prehospital medications. A regression analysis upheld pain states and current medications as predictors. Better mood was directly associated with better postoperative mood and with female gender, black race, and unmarried status, and inversely related to the number of previous operations. Of these, black race and unmarried status were upheld as positive predictors and the high-anxious coping style was identified also as a negative predictor. Opiate consumption was positively correlated with prehospital medications and the somatizing trait. These were both upheld by the regression analysis.;Nonsignificant trends in comparative pain, mood, and opiate intake among coping groups over Days 1 to 3 revealed that: Trait anxiety greatly influences the postoperative pain experience indirectly, via its interaction with the defensiveness trait; that postoperative recovery rates differ according to coping style; and that the identification of coping style can predict idiosyncratic postoperative needs for opiate medication.;This investigation demonstrated the importance of prior pain and psychological states and traits in determining postoperative pain and of demographics and prior mood states in mediating mood following surgery. Also, opiate use was shown to be related to factors other than and in addition to pain. Methods for the identification of coping style and the somatizing trait were validated as modes of individualizing opiate prescription for subgroups of patients.