The Association Between Preoperative Pain Catastrophizing and Postoperative Pain Intensity in Cardiac Surgery Patients

OBJECTIVE: Postoperative pain is associated with delayed discharged and recovery, reduced patient satisfaction, and increased costs. The aim of this study was to investigate the short-term association between preoperative psychological variables (pain catastrophizing, anxiety, and depression) and postoperative pain in a sample of cardiac surgery patients. DESIGN: This is a prospective epidemiological study. SETTING: This study was carried out at two Imperial College Healthcare National Health Service Trust Hospitals (St. Mary's Hospital and Hammersmith Hospital, London, UK). SUBJECTS: Sixty-four cardiac surgery patients completed the "pain catastrophizing scale (PCS)," the "hospital anxiety and depression scale," and the "verbal rating scale" (VRS) for pain intensity preoperatively and at 48 hours postoperatively. Analgesia consumption was recorded. Data on demographic, operative, and clinical characteristics were obtained from medical records. OUTCOME MEASURES: Pain intensity at 48 hours postoperatively. RESULTS: Scores on the anxiety, depression, and PCSs were not significantly different between the pre- and postoperative period. In contrast, patients reported a higher level of pain intensity postoperatively (P < 0.001). In the fully adjusted multiple regression analysis, postoperative pain intensity was predicted by a higher level of preoperative pain intensity (dichotomized above median; β = 2.00, 95% confidence interval CI: 0.28-3.72) and a higher score on the preoperative PCS (dichotomized above median; β = 1.87, 95% CI: 0.53-3.21). CONCLUSIONS: Pain catastrophizing can predict postoperative pain intensity in cardiac surgery patients, independently of the presence of anxiety, depression, or preoperative level of pain. Future studies should aim to establish the role of pain catastrophizing in longer-term outcomes in cardiac surgery.