Preoperative pain catastrophisation predicts higher pain and analgesia use during primary hip arthroplasty

Abstract

Introduction: Postoperative pain in orthopaedic operations is associated with reduced patient satisfaction, delayed discharge and increased costs. This study investigates the short-term association between psychological disorders and pain-related beliefs (pain catastrophising [PC], depression and anxiety) and postoperative pain. Method(s): Prospective level II cohort study compared 90 patients undergoing a primary THA for osteoarthritis, mean age 64y (49-77). Patients completed the Pain Catastrophising Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Verbal Rating Scale (VRS) and Oxford Hip Score (OHS) preoperatively and at 48 hours postoperatively. PC patients had significantly poorer hip function and lower OHS (mean 18.5 versus 27.2 in non-PC patients, p<0.05). Result(s): PC patients required significantly greater analgesia postoperatively. In the adjusted multiple regression analysis, postoperative pain intensity was predicted by a higher level of preoperative pain intensity (dichotomized above median; b = 2.15, 95% CI: 0.37-3.92) and a higher score on the preoperative PCS (b = 1.79, 95% CI: 0.67-3.13). Anxiety, depression, and PCS was not significantly different perioperatively. Conclusion(s): Pain catastrophisation is an important independent predictor of postoperative pain intensity in patients undergoing hip arthroplasties. This knowledge can help the multi-disciplinary-team to significantly improve perioperative pain management. It can also be used to re-shape care protocols, e.g. Enhanced Recovery Programme.