Catastrophizing: a predictive factor for postoperative pain

doi:10.1016/j.amjsurg.2010.02.007

The American Journal of Surgery

Volume 201, Issue 1, January 2011, Pages 122-131

https://doi.org/10.1016/j.amjsurg.2010.02.007 Get rights and content

Abstract

Background

Postsurgical pain is a major cause of delayed recovery and discharge after surgery. A significant proportion of patients develop chronic postsurgical pain, which affects their quality of life. Cognitive and psychological factors are reported to play a significant role in the severity of reported postsurgical pain. High levels of catastrophizing are associated with a heightened pain experience and appear to contribute to the development of chronic pain. This article describes the concept of pain catastrophizing, its association with postsurgical pain, and its potential role in the management of postsurgical pain and postsurgical quality of life.

Methods

Data for this review were identified from MEDLINE, EMBASE, and PsycINFO. Reference lists of selected articles were cross-searched for additional literature.

Results

High catastrophizing levels were found to be associated with increased pain severity, increased incidence of development of chronic pain, and poorer quality of life after surgery. There was no consensus on the relation between catastrophizing and analgesia consumption.

Conclusions

Identifying and reducing catastrophizing levels can help to optimize pain management in surgical patients.

Section snippets

The concept of pain catastrophizing

Catastrophizing is thought to be a multidimensional cognitive construct with 3 components: magnification (“I am afraid that something serious will happen”), rumination (“I cannot stop thinking about how much it hurts”), and helplessness (“There is nothing I can do to reduce the intensity of the pain”).³⁶ Catastrophizing is considered to have a continuous distribution in the population without a clear cut-off level to distinguish between high and low catastrophizers.³⁹ Individual differences in

Measurement of catastrophizing

The tools used to measure catastrophizing should contain subscales that can assess rumination, helplessness, and magnification. Two scales have been described in the literature: the Coping Strategies Questionnaire (CSQ) and the Pain Catastrophizing Scale (PCS).36, 38

Clinical implications of catastrophizing

Studies have been performed to assess the use of catastrophizing in a clinical context. A correlation between high levels of catastrophizing and increased pain perception has been reported in studies involving healthy adults undergoing aversive diagnostic procedures, those with chronic pain conditions, those with whiplash injuries, and those undergoing dental procedures.28, 36, 44, 45, 46, 47, 48, 49, 50

Catastrophizing in the context of postsurgical pain has gathered interest over the past

Treatment options for perioperative catastrophizing

Identification of catastrophizers, through various validated measuring tools, can help optimize patient care. This can help health care teams to better tailor analgesia to individuals. Reducing levels of catastrophizing has numerous benefits and some of the strategies by which this can be achieved also are discussed later.

As discussed, catastrophizing has been shown to be predictive of the severity of postsurgical pain.58, 59, 60 Measuring a patient's tendency to catastrophize (using scales

Conclusions

Postsurgical pain is a prevalent and challenging condition that can affect a patient's physical and emotional functioning adversely. A significant proportion of postsurgical patients go on to develop CPSP, which can impair quality of life. Although the pain experience is influenced by multiple factors, PC is becoming recognized as a key predictor of the severity of APSP and its progression to CPSP. Through an appropriate measuring scale, the patients with a tendency to catastrophize can be

Acknowledgments

Nick Sevdalis is a member of the Imperial Centre for Patient Safety and Service Quality, which is funded by the National Institute for Health Research.

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NCT03758170 (first registration 29-11-2018).

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ReviewCatastrophizing: a predictive factor for postoperative pain

Abstract

Background

Methods

Results

Conclusions

Section snippets

The concept of pain catastrophizing

Measurement of catastrophizing

Clinical implications of catastrophizing

Treatment options for perioperative catastrophizing

Conclusions

Acknowledgments

Behav Res Ther

Pain

Br J Anaesth

Reg Anesth Pain Med

Br J Anaesth

Pain

Pain

Eur J Pain

Eur J Pain

Pain

Br J Anaesth

Br J Anaesth

Br J Anaesth

Pain

Pain

J Psychosom Res

Pain

Pain

Pain

Pain

Pain

Pain

Pain

Pain

Pain

J Pain

Pain

Br J Anaesth

J Pain

J Pain

Pain

Pain

Pain

Pain

Pain

J Urol

J Pain

Pain

Pain

Pain

Recovery pattern and home-readiness after ambulatory surgery

Anesth Analg

Acute pain service–another in-hospital specialty?

Ugeskr Laeger

Classification of Chronic PainDescriptions of Chronic Pain Syndromes and Definitions of Pain Terms

Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention

Ann Surg

Improving pain management: breaking down the invisible barrier

Br J Nurs

The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials

Anesth Analg

Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors

Can J Anesth

Psychological influences on surgical recoveryPerspectives from psychoneuroimmunology

Am Psychol

Outcome of patients with severe chronic pain following repair of groin hernia

Br J Surg

Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community

Clin J Pain

Review
Catastrophizing: a predictive factor for postoperative pain