Correlation Between Anticipation Of Pain Pre-Surgery And Actual Occurrence Post-Surgery

Main Category: Bones / Orthopedics
Also Included In: Pain / Anesthetics;  Psychology / Psychiatry
Article Date: 30 Jan 2009 - 2:00 PDT

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In a first-of-its-kind study published in the November 2008 Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS), the expectation of orthopaedic post-operative pain was directly correlated with the actual incidence of pain following foot and ankle surgery. The lead author, AOFAS member Loretta B. Chou, MD, is an orthopaedic foot and ankle surgeon in the Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, so she is very familiar with the pain complaints of orthopaedic patients.

Orthopaedic procedures have been reported to have the highest incidence of pain compared to other types of operations. Dr. Chou and associates conducted a prospective study of 98 patients undergoing orthopaedic foot and ankle operations at the same hospital. The goal of the study was to evaluate each patient's pain experience both preoperatively and postoperatively. Surgeries were a mixture of inpatient and outpatient procedures, on both male and female patients, with the average age being 46.5 years. The patients were given a Short-Form McGill Pain Questionnaire (SF-MPQ) before and after surgery to evaluate their levels of pain at both times. The SF-MPQ is a patient questionnaire with three questions concerning pain. It consists of 15 pain descriptors, the Present Pain Intensity (PPI) index, and a visual analogue scale for pain (VAS). Their study suggests that the expectation of pain going into surgery may contribute to its subsequent occurrence.

"Our hypothesis that anticipated pain would predict postoperative pain experience was based on preliminary studies that show that expectation of pain modulates changes in the brain," said Dr. Chou. "This may be the brain sending projections to the spinal cord that increases pain signals. To make a long story short, we found that believing there will be pain after surgery leads to just that, pain."

Results showed that pain severity was highest following foot and ankle surgery at the 3-Day Post-Operative Pain assessment whereas, six weeks out after surgery, the majority of patients felt little or no pain. This early pain was even greater than that anticipated by the patients. The severity of preoperative pain was highly predictive of the group's anticipated postoperative pain as well as their level of pain at 6-weeks after surgery. It was also important that both preoperative pain and anticipated pain predicted higher immediate postoperative pain following foot and ankle operations.

A similar study, which was published in the July 2008 issue of the Journal of Pain and Symptom Management, found that cancer patients who had a more optimistic outlook experienced less severe pain.

"While we cannot isolate the exact cause, optimistic patients suffered much less postoperative pain than their pessimistic counterparts," continued Dr. Chou. "This result may demonstrate that patients are good at predicting pain, or that their expectation of greater pain may contribute to its subsequent occurrence."

This is the first study evaluating preoperative and postoperative pain experienced by patients undergoing orthopaedic foot and ankle surgery. This study may help surgeon's choice of treatment of acute pain following surgery to prevent increased illness associated with poorly-controlled pain after orthopaedic foot and ankle operations.

"Future studies have already commenced. These will address some of the limitations of the initial study, such as inclusion of the use of pain medication and limiting the types of operations to two. A criticism of this publication is that all types of foot and ankle procedures were included. In the follow up studies, one study focuses on ankle fractures and the other, removal of painful hardware from the foot and ankle," said Dr. Chou.

Dr. Chou is a member of the American Orthopaedic Foot & Ankle Society. Members of the American Orthopaedic Foot & Ankle Society are orthopaedic surgeons (MD or DO) who have extensive training in the diagnosis, non-surgical care and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves with a special interest in the foot and ankle.

About AOFAS

The AOFAS promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. It creates public awareness for the prevention and treatment of foot and ankle disorders, provides leadership, and serves as a resource for government, industry and the national and international health care community.

To find an AOFAS orthopaedic foot and ankle surgeon in your area, go to http://www.aofas.org.

About Orthopaedic Foot and Ankle Surgeons

Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who specialize in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle. This includes the bones, joints, ligaments, muscles, tendons, nerves, and skin. Orthopaedic foot and ankle surgeons use medical, physical, and rehabilitative methods as well as surgery to treat patients of all ages. They perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle.

Orthopaedic foot and ankle surgeons work with physicians of many other specialties, including internal medicine, pediatrics, vascular surgery, endocrinology, radiology, anesthesiology, and others. Medical school curriculum and post-graduate training provides the solid clinical background necessary to recognize medical problems, admit patients to a hospital when necessary, and contribute significantly to the coordination of care appropriate for each patient.

Education - AOFAS members have the following credentials:

--  Completed four years of medical school. The curriculum covers basic and clinical sciences, surgery, internal medicine, pediatrics, family medicine and all other medical specialties.

--  Completed five years of accredited graduate medical education (residency training) in orthopaedic surgery.

--  Many orthopaedic foot and ankle surgeons also complete advanced fellowship training in foot and ankle surgery.

--  Satisfactory completion of the national medical licensing examination.

--  Continuing medical education credits over a specific time period.

--  Board certification: Certified by or eligible for examination and certification by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery.

--  Each member must hold membership in the American Academy of Orthopaedic Surgeons (AAOS).

When selecting a medical provider to care for your feet and ankles,be sure to ask him/her about:

--  Medical school education
--  Accredited residency training
--  Areas of practice specialization
--  Experience in your prescribed treatment (surgical and/or non-surgical)

AOFAS

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