Role of Psychological Factors in Postoperative Pain Control and Recovery with Patient-Controlled Analgesia

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Abstract
Objective: We examined the extent to which preoperative state and trait anxiety, general need to control, need to control analgesia, expectations regarding postoperative pain, and demographic variables predict the severity of postoperative pain, discomfort, anxiety, duration of recovery, and patient-controlled analgesia (PCA) behaviors. Design: Preoperative and outcome variables were analyzed using Pearson product-moment correlations and forward stepwise multiple linear regression. Setting: This study was conducted at a university hospital in preoperative and postoperative settings. Patients: Ninety-nine consecutively consenting ASA physical status I-II women (age 46 ± 11 years, 70% Caucasian, 28% Afro-American, 2% Hispanic) undergoing simple hysterectomy procedures with no known cancer were included in the study. Interventions: Standardized general anesthesia, surgery, and PCA therapy was conducted. Outcome Measures: The McGill Pain Questionnaire (MPQ), patient requests and delivered analgesic medication, visual analog scales (VAS) for pain and anxiety, time to oral medications and hospital discharge, and Likert scale measurements of overall pain and discomfort were utilized. Results: Older patients generally reported less pain, but used the same amount of analgesic medication as younger patients. Preoperative trait anxiety correlated with increased PCA requests, but not with postoperative pain. In contrast, preoperative state anxiety correlated positively with postoperative pain and with shorter time to hospital discharge. The patients' need for control was positively correlated with the Present Plan Index scale of the MPQ, with morphine requirement, and with PCA requests. Conclusions: Psychological factors do influence postoperative recovery and pain control in women receiving PCA therapy after abdominal hysterectomy, and attention to individual patient differences may lead to improved postoperative outcomes.

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