Calming Nerves

Anxious patients going under the knife may develop more pain and experience a worse quality of life.

Anxiety before surgery is associated with increased pain after three months as well as lower quality of life, increased reported feelings of pain sensitivity, and specific genetic configurations, according to research presented at the American Society of Anesthesiologists Annual Meeting.

The study was led by Craig T. Hartrick, MD and his team at the Anesthesiology Research Department, Beaumont Hospitals, Royal Oak, Michigan.

According to the team, chronic pain that is experienced beyond the usual and expected period of healing is a common and frustration for both surgical patients and their healthcare providers.

Hartrick followed 129 minimally invasive arthroscopic shoulder surgery patients to assess their pain status for three months after their procedures. Patients with a known genetic predisposition toward low sensitivity to pain were matched with patients with genetic predispositions toward high tolerance for pain and were controlled for sex, ethnicity, anxiety, symptom duration, age, and sensitivity and pain at the time of surgery.

The found that the low pain sensitivity patients were actually associated with high pain levels three months after surgery.

“While it was not unexpected that we found that anxiety at the time of surgery was associated with greater pain and disability after surgery, the low pain sensitivity patients would have been expected to be associated with a reduction in the incidence of persistent pain, not an increase," Hartrick said, in a press release.

The study could not confirm whether the chronic pain experienced by the high-pain-tolerant patients was due to anxiety, a predisposition to the development of chronic pain, or other factors, but it does add strong evidence that future pain studies which fail to control for anxiety could risk misinterpreting their results, Hartrick said.

“Our findings highlight the importance of examining multiple factors when researching genetics and pain — especially those that may be inter-related or share common genetic features (anxiety, for example) – when designing outcome studies to predict the development of persistence pain conditions.”

The American Society of Anesthesiologists was founded in 1905. It is an educational, research, and scientific association with 44,000 members that is organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. The Annual Meeting presented new data in the quest to develop tailor-made pain management strategies based upon a patient’s genetic predisposition and other important factors.

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