Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

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OBJECTIVE

Perception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.

METHODS

Patients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.

RESULTS

One hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).

CONCLUSIONS

Catastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

ABBREVIATIONS ASA = American Society of Anesthesiologists; CBT = cognitive behavioral therapy; HADS = Hospital Anxiety and Depression Scale; ICU = intensive care unit; LMM = linear mixed effects model; ODI = Oswestry Disability Index; PACU = post-anesthesia care unit; PCA = patient-controlled analgesia; PCS = Pain Catastrophizing Scale; QoR40 = 40-item quality of recovery questionnaire; VRS = verbal rating scale.

Article Information

Correspondence Bhiken I. Naik, Department of Anesthesiology, University of Virginia, Box 800710, Charlottesville, VA 22911. email: bin4n@virginia.edu.

INCLUDE WHEN CITING Published online November 10, 2017; DOI: 10.3171/2017.5.SPINE1734.

Disclosures The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References

  • 1

    Abbott ADTyni-Lenné RHedlund R: The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy 96:2132212010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Abbott ADTyni-Lenné RHedlund R: Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery. Eur Spine J 20:162616342011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bates DMächler MBolker BWalker S: Fitting linear mixed-effects models using lme4. J Stat Softw 67:i012015

  • 4

    Boutin RDWilliamson MR: Magnetic resonance imaging of musculoskeletal tumors. West J Med 156:2951992

  • 5

    Caumo WNazare Furtado da Cunha MCamey SMaris de Jezus Castro STorres ILCadore Stefani L: Development, psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain. Br J Anaesth 117:6426492016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Fairbank JCPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000

  • 7

    Farag EGhobrial MSessler DIDalton JELiu JLee JH: Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. Anesthesiology 119:9329402013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Haythornthwaite JABenrud-Larson LM: Psychological aspects of neuropathic pain. Clin J Pain 16 (2 Suppl):S101S1052000

  • 9

    Jacobsen PBButler RW: Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. J Behav Med 19:17291996

  • 10

    Keefe FJRumble MEScipio CDGiordano LAPerri LM: Psychological aspects of persistent pain: current state of the science. J Pain 5:1952112004

  • 11

    Khan RSAhmed KBlakeway ESkapinakis PNihoyannopoulos LMacleod K: Catastrophizing: a predictive factor for postoperative pain. Am J Surg 201:1221312011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kim HJCho CHKang KTChang BSLee CKYeom JS: The significance of pain catastrophizing in clinical manifestations of patients with lumbar spinal stenosis: mediation analysis with bootstrapping. Spine J 15:2382462015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kim HJKim SCKang KTChang BSLee CKYeom JS: Influence of educational attainment on pain intensity and disability in patients with lumbar spinal stenosis: mediation effect of pain catastrophizing. Spine (Phila Pa 1976) 39:E637E6442014

    • Search Google Scholar
    • Export Citation
  • 14

    Kovacs FMSeco JRoyuela APeña AMuriel A: The correlation between pain, catastrophizing, and disability in subacute and chronic low back pain: a study in the routine clinical practice of the Spanish National Health Service. Spine (Phila Pa 1976) 36:3393452011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Loftus RWYeager MPClark JABrown JRAbdu WASengupta DK: Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology 113:6396462010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Lohman CMTallroth KKettunen JALindgren KA: Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine (Phila Pa 1976) 31:183418402006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Myles PSWeitkamp BJones KMelick JHensen S: Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84:11152000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Naik BINemergut ECKazemi AFernández LCederholm SKMcMurry TL: The effect of dexmedetomidine on postoperative opioid consumption and pain after major spine surgery. Anesth Analg 122:164616532016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Papaioannou MSkapinakis PDamigos DMavreas VBroumas GPalgimesi A: The role of catastrophizing in the prediction of postoperative pain. Pain Med 10:145214592009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Pavlin DJSullivan MJFreund PRRoesen K: Catastrophizing: a risk factor for postsurgical pain. Clin J Pain 21:83902005

  • 21

    Phillips FMSlosar PJYoussef JAAndersson GPapatheofanis F: Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976) 38:E409E4222013

    • Search Google Scholar
    • Export Citation
  • 22

    Picavet HSVlaeyen JWSchouten JS: Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156:102810342002

  • 23

    Rahim-Williams FBRiley JL IIIHerrera DCampbell CMHastie BAFillingim RB: Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics. Pain 129:1771842007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Rodrigues-De-Souza DPFernández-De-Las-Peñas CMartín-Vallejo FJBlanco-Blanco JFMoro-Gutiérrez LAlburquerque-Sendín F: Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain. Braz J Phys Ther 20:4124212016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Ruscheweyh RNees FMarziniak MEvers SFlor HKnecht S: Pain catastrophizing and pain-related emotions: influence of age and type of pain. Clin J Pain 27:5785862011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Schreiber KLCampbell CMartel MOGreenbaum SWasan ADBorsook D: Distraction analgesia in chronic pain patients: the impact of catastrophizing. Anesthesiology 121:129213012014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Sirvanci MBhatia MGaniyusufoglu KADuran CTezer MOzturk C: Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 17:6796852008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Snaith RP: The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes 1:292003

  • 29

    Sommer MGeurts JWStessel BKessels AGPeters MLPatijn J: Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg 135:1241302009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Sullivan MJLBishop SRPivik J: The Pain Catastrophizing scale: development and validation. Psychol Assess 7:5245321995

  • 31

    Sullivan MJD’Eon JL: Relation between catastrophizing and depression in chronic pain patients. J Abnorm Psychol 99:2602631990

  • 32

    Sullivan MJLynch MEClark AJ: Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain 113:3103152005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Sullivan MJThorn BHaythornthwaite JAKeefe FMartin MBradley LA: Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 17:52642001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Tripp DAStanish WDReardon GCoady CSullivan MJ: Comparing postoperative pain experiences of the adolescent and adult athlete after anterior cruciate ligament surgery. J Athl Train 38:1541572003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Turner JAJensen MPWarms CACardenas DD: Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain 98:1271342002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    van Tulder MWOstelo RVlaeyen JWLinton SJMorley SJAssendelft WJ: Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine (Phila Pa 1976) 25:268826992000

    • Crossref
    • Search Google Scholar
    • Export Citation

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