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Keywords:

  • Attention;
  • Postoperative Pain;
  • Psychological Predictor

Abstract

Objective.  Attentional avoidance of negative stimuli and preference for positive stimuli (assessed prior to surgery) have been found to be predictive of postoperative pain. However, findings so far were mainly obtained in young patients with benign diagnoses. The aim of the present study was to test whether this relationship holds for aged patients with poorer prognosis.

Design.  Preoperatively assessed psychological predictors, including attentional measures for emotionally loaded stimuli, among others, were used to predict acute postoperative pain as indicated by rating and consumption of analgesics.

Patients.  Fifty-eight patients scheduled for surgery due to cancer (80%) with a mean age of 60.5 years participated in the study.

Outcome Measures.  As predictors attentional biases for pain-related, social threat, and positive stimuli were assessed in a dot-probe task. Further predictors were self-reported pain vigilance, pain anxiety, pain catastrophizing, general anxiety, depression, and somatization, as well as pressure pain thresholds. As criteria of prediction, numerical scale ratings of acute postoperative pain and the amount of analgesics (patient-controlled intravenous analgesia [PCIA]) requested after surgery were used.

Results.  Only the dot-probe task parameters provided significant explanation of acute postoperative pain. A significant 23% of variance of the PCIA use was accounted for by the dot-probe task parameters. Here, it was mainly the avoidance of social threat words which contributed to significant prediction and did not appear to be related to the other psychological predictors. Seventy-seven percent of the patients with frequent PCIA use could be classified correctly by this variable.

Conclusions.  Attentional avoidance of emotionally negative stimuli prior to surgery proved to be a powerful predictor of acute postoperative pain reflected by the consumption of analgesics; this time in a sample of aged patients with various but mainly malign diagnoses. This measure outperformed traditional predictors like depression, anxiety, as well as pain catastrophizing, and deserves further attention.