Pre-Surgical Screening Tools and Risk Factors for Chronic Post-Surgical Pain

This report provides an overview of evidence regarding evidence-based risk factors and pre-surgical screening tools or assessments that may help identify individuals at risk for developing chronic post-surgical pain. This is not a systematic review and a formal critical appraisal was not performed. Our review identified 19 evidence-based risk factors for chronic post-surgical pain from published systematic reviews. The most commonly reported chronic post-surgical pain risk factors were anxiety (7 studies), catastrophizing (pain or general) (catastrophizing is the tendency to exaggerate a situation in a negative manner [e.g., imagine the worst possible outcome]) (6 studies); depression (5 studies); and psychological distress (non-specific symptoms of depression, anxiety, and stress), kinesiophobia (fear of movement), and age (3 studies each). These risk factors were reported among various surgical procedures (e.g., mixed surgery types, total knee and hip replacements, spine surgery) and age populations (adult, pediatric, adult plus pediatric). Definitive conclusions cannot be made regarding particular risk factors and their association with chronic post-surgical pain. The evidence was either mixed and/or associated with limitations in the methodology of the study and unclear whether the results may apply in groups other than those included in the studies. Our review identified 11 pre-surgical screening tools or assessments that were studied for their ability to predict chronic post-surgical pain. These included various quantitative sensory testing measures (e.g., mechanical, heat or cold, electrical), validated scales of other conditions, and screening tools. Four of the identified screening tools or assessments were found to predict chronic post-surgical pain but their it is unknown whether they can be applied to broader clinical practice (i.e., various surgery types among different age groups). These were only investigated in 1 study among specific populations. These 4 tools or assessments included a pain threshold evaluation performed with a sphygmomanometer (blood pressure monitor comprised of an inflatable cuff) in adults who underwent total knee replacement; the modified Tampa Scale of Kinesiophobia with 13-items (i.e., only the positively scored items) in pediatric patients who underwent orthopedic or general surgery; the Presurgical Psychological Screening algorithm in adults who underwent spine surgery; and the Pediatric Pain Screening tool in pediatric patients who underwent major musculoskeletal surgery. The remaining screening tools or assessments that were identified reported either mixed findings or no association with chronic post-surgical pain in various surgical populations. Definitive conclusions cannot be made for the use of pre-surgical screening tools or assessments to identify risk of developing chronic post-surgical pain.