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Anticipated Pain, Perceived Analgesic Needs and Psychological Traits Predict Pain and Analgesic Usage Following Cesarean Delivery
Abstract Number: F-08
Abstract Type: Original Research
Introduction: Fear and anxiety are associated with postoperative pain.(1) This study aimed to determine if preoperative tests for anxiety, fear of pain, pain catastrophizing and/or simplified anticipated pain and analgesic rating scores could reliably predict pain intensity and analgesic usage following cesarean delivery (CD).
Methods: 50 healthy women undergoing scheduled CD comprised the study population for this prospective, IRB-approved study. Patients received spinal anesthesia with intrathecal morphine and multimodal analgesia. Preoperative predictors included 3 validated psychological questionnaires [Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale (PCS)]; and 3 simple ratings: 1. Anticipated postoperative pain (How much pain 0-10 do you expect to experience after your surgery?), 2. Analgesic threshold (At what point on a pain scale of 0 - 10 would you likely request post-operative pain relief?), and 3. Perceived analgesic needs (What do you expect your analgesic requirements will be after surgery? 0=no analgesia, 10=highest possible amount). Postoperative response outcome measures included post-CD pain (combined rest and movement scores) and opioid use for the 48-h study period. Bivariate (Spearman) correlations of predictors and outcomes followed by forward-backward multiple regression modeling were utilized.
Results: Bivariate correlations between preoperative predictive tests and post-CD outcomes are outlined in Table 1. Significant correlations were found with anticipated pain and opioid use (r=0.35), analgesic threshold and post-CD pain (r=-0.35), analgesic needs and post-CD pain (r=0.31). Multiple linear regression analysis found that anticipated postoperative pain and analgesic needs contributed to post-CD pain prediction modeling (R2=0.44, p<0.0001); and anticipated postoperative pain, ASI and FPQ were associated with opioid use (R2=0.42, p<0.0001).
Conclusion: Simple questions rating women’s anticipated pain, analgesic threshold and analgesic needs correlated with post-CD pain and analgesic usage. Results suggest that asking patients their anticipated pain and analgesic needs is useful in predicting and planning pain management post-CD (2). Although ASI and FPQ contributed to opioid use predictive modeling, these time-consuming questionnaires appear less useful than simple rating questions in post-CD pain prediction.
1. Anesthesiology 2009; 111: 657-677
2. Anesthesiology 2013; 118:1170-9