RESEARCH ARTICLE


The Role of Pain Catastrophizing in the Prediction of Acute and Chronic Postoperative Pain



Ran Kremer1, Michal Granot2, *, David Yarnitsky3, Yonathan Crispel3, Shiri Fadel3, Lael Anson Best1, Rony-Reuven Nir3
1 Department of General Thoracic Surgery, Rambam Health Care Campus, and Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
2 Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
3 Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel


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Creative Commons License
© 2013 Kremer et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; Tel: + 972 4 828 8006; Fax: + 972 4 828 8017; E-mail: granot@research.haifa.ac.il


Abstract

Background and Objectives:

Despite the established association between greater pain catastrophizing and enhanced postoperative pain, it is still unclear: (i) what is the relative contribution of each of the pain catastrophizing scale (PCS) dimensions in the prediction of acute and chronic postoperative pain; and (ii) whether PCS scores mediate the association between acute and chronic postoperative pain intensity.

Methods:

The current prospective, observational study was conducted at Rambam Health Care Campus, Haifa, Israel. PCS was obtained in 48 pain-free patients a day before an elective thoracotomy in response to tonic heat pain. Acute postthoracotomy pain (APTP) was assessed during rest, including general pain (Restgeneral), and incision-related pain (Restincision), and in response to provoked physical activity, including hand elevation (Provokedhand) and cough (Provokedcough). Chronic postthoracotomy pain (CPTP) was assessed after 4.5±2.3 months.

Results:

Of the PCS subscales, only rumination: (i) was correlated with Restgeneral scores (r=0.337, P=0.027); and (ii) predicted chronic postthoracotomy pain in a regression analysis (P=0.001). General PCS and its subscales mediated the correlation between Restgeneral and chronic postthoracotomy pain intensity (Ps<0.006).

Conclusions:

Findings may elucidate the unique role of the rumination subscale in reflecting an individual's postopertive acute and chronic pain responsiveness. The transition from acute to chronic postoperative pain seems to be facilitated by enhanced pain catastrophizing.

Keywords: Pain Catastrophizing, Postoperative Pain, Acute Postoperative Pain, Chronic Postoperative Pain, Mediation Analysis.