Advertisement

Psychiatric Aspects of Perioperative Pain

  • Teofilo E. Matos SantanaEmail author
Chapter

Abstract

Postoperative pain, defined as the acute pain experienced after a surgical procedure, is nearly universal after surgery. When not managed well, it contributes to delayed functional recovery and increased risk of postsurgical complications such as poor wound healing. Preoperative education about pain management, expectations, and available treatments has been shown to reduce postoperative anxiety, opioid requirement, sedative dose, and length of stay after surgery.

Multimodal approaches to managing postoperative pain are the standard of care and yield the best clinical outcomes. They involve a combination of opioid and non-opioid pharmacotherapy along with non-pharmacological interventions including behavioral, psychological, and physical therapies. Monitoring of postoperative pain should include prompt identification of surgical or medical complications in the postoperative period, verification of the half-life, dose and scheduling of analgesic medications, and assessment for physiological dependence or a comorbid substance use disorder. Adequate and safe management of pain after discharge are essential. Prolonged postoperative use of opioids can lead to chronic pain, which is a known adverse outcome of surgery and is costly in terms of suffering, morbidity, and disability.

Keywords

Pain Postoperative Physiology Surgery Management Pharmacotherapy opioids NSAIDs Psychotherapy Addiction Recovery 

References

  1. 1.
    Merskey H. Descriptions of chronic pain syndromes and definition of pain terms. In: Classification of chronic pain. International Association for the Study of Pain (IASP). 1994. p. 41–42.Google Scholar
  2. 2.
    Apfelbaum JL, et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40, table of contents.CrossRefGoogle Scholar
  3. 3.
    Gan TJ, et al. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149–60.CrossRefGoogle Scholar
  4. 4.
    Warfield CA, Kahn CH. Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology. 1995;83(5):1090–4.CrossRefGoogle Scholar
  5. 5.
    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.CrossRefGoogle Scholar
  6. 6.
    Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11–25.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Hunt SP, Mantyh PW. The molecular dynamics of pain control. Nat Rev Neurosci. 2001;2(2):83–91.CrossRefGoogle Scholar
  8. 8.
    Loeser JD, Melzack R. Pain: an overview. Lancet. 1999;353(9164):1607–9.CrossRefGoogle Scholar
  9. 9.
    Carr DB, Goudas LC. Acute pain. Lancet. 1999;353(9169):2051–8.CrossRefGoogle Scholar
  10. 10.
    Boland RJ, Yohanan MV, Goldberg RJ. Acute pain management and psychopharmacology in the medically ill. In: Fogel BS, Greenberg DB. Psychiatric care of the medical patient. 3rd ed. Oxford University Press.  https://doi.org/10.1093/med/9780199731855.001.0001.
  11. 11.
    Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1–32.CrossRefGoogle Scholar
  12. 12.
    Pace MC, et al. Neurobiology of pain. J Cell Physiol. 2006;209(1):8–12.CrossRefGoogle Scholar
  13. 13.
    Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth. 2001;48(10):1000–10.CrossRefGoogle Scholar
  14. 14.
    Clark MR, Treisman GJ. Neurobiology of pain. Adv Psychosom Med. 2004;25:78–88.CrossRefGoogle Scholar
  15. 15.
    Besson JM. The neurobiology of pain. Lancet. 1999;353(9164):1610–5.CrossRefGoogle Scholar
  16. 16.
    Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.CrossRefGoogle Scholar
  17. 17.
    Hanks GW. Towards a new pharmacotherapy of pain. In Bas-Baum AI, Besson JM, editors. Chichester: John wiley & Sons; 1991, vii + 457 pp. ISBN 0–471–92854–2. £65. Human psychopharmacology: clinical and experimental; 1992. 7(1): p. 77–7.Google Scholar
  18. 18.
    Chou R, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.CrossRefGoogle Scholar
  19. 19.
    Anderson EA. Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute postoperative hypertension. J Consult Clin Psychol. 1987;55(4):513–20.CrossRefGoogle Scholar
  20. 20.
    Egbert LD, et al. Reduction of postoperative pain by encouragement and instruction of patients. N Engl J Med. 1964;270(16):825–7.CrossRefGoogle Scholar
  21. 21.
    Arthur HM, et al. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery: a randomized, controlled trial. Ann Intern Med. 2000;133(4):253–62.CrossRefGoogle Scholar
  22. 22.
    Carmichael JC, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 2017;60(8):761–84.CrossRefGoogle Scholar
  23. 23.
    Steinberg AC, et al. Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines. Am J Obstet Gynecol. 2017;217(3):303–13. e6CrossRefGoogle Scholar
  24. 24.
    Patanwala AE, et al. Comparison of opioid requirements and analgesic response in opioid-tolerant versus opioid-Naïve patients after Total knee arthroplasty. Pharmacotherapy. 2008;28(12):1453–60.CrossRefGoogle Scholar
  25. 25.
    Herr K, et al. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230–50.CrossRefGoogle Scholar
  26. 26.
    American Society of Anesthesiologists Task Force on Acute Pain, M. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248–73.CrossRefGoogle Scholar
  27. 27.
    Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005;103(6):1296–304.CrossRefGoogle Scholar
  28. 28.
    Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26(3):191–6.CrossRefGoogle Scholar
  29. 29.
    Ruetzler K, et al. A randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery. J Anesth. 2014;28(4):580–6.CrossRefGoogle Scholar
  30. 30.
    Aubrun F, et al. Randomised, placebo-controlled study of the postoperative analgesic effects of ketoprofen after spinal fusion surgery. Acta Anaesthesiol Scand. 2000;44(8):934–9.CrossRefGoogle Scholar
  31. 31.
    Gimbel JS, et al. Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults. Clin Ther. 2001;23(2):228–41.CrossRefGoogle Scholar
  32. 32.
    Ong CK, et al. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170–9.PubMedGoogle Scholar
  33. 33.
    Mattia C, Coluzzi F. COX-2 inhibitors: pharmacological data and adverse effects. Minerva Anestesiol. 2005;71(7–8):461–70.PubMedGoogle Scholar
  34. 34.
    Haywood A, et al. Corticosteroids for the management of cancer-related pain in adults. Cochrane Database Syst Rev. 2015;4:CD010756.Google Scholar
  35. 35.
    Agarwal A, et al. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 2008;101(5):700–4.CrossRefGoogle Scholar
  36. 36.
    Ittichaikulthol W, et al. Effects of pregabalin on post operative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: a randomized, double-blind trial. J Med Assoc Thail. 2009;92(10):1318–23.Google Scholar
  37. 37.
    Wiffen PJ, et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;4:CD005451.Google Scholar
  38. 38.
    Porter SB, et al. Perioperative ketamine for acute postoperative analgesia: the Mayo Clinic-Florida experience. J Perianesth Nurs. 2015;30(3):189–95.CrossRefGoogle Scholar
  39. 39.
    Lee M, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–61.PubMedGoogle Scholar
  40. 40.
    Seidel S, et al. Antipsychotics for acute and chronic pain in adults. Cochrane Database Syst Rev. 2013;8:CD004844.Google Scholar
  41. 41.
    Scott LJ. Fentanyl Iontophoretic transdermal system: a review in acute postoperative pain. Clin Drug Investig. 2016;36(4):321–30.CrossRefGoogle Scholar
  42. 42.
    Benedetti FMD, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg. 63(3):773–6.CrossRefGoogle Scholar
  43. 43.
    Bjordal JM, Johnson MI, Ljunggreen AE. Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain. Eur J Pain. 2003;7(2):181–8.CrossRefGoogle Scholar
  44. 44.
    Antall GF, Kresevic D. The use of guided imagery to manage pain in an elderly orthopaedic population. Orthop Nurs. 2004;23(5):335–40.CrossRefGoogle Scholar
  45. 45.
    Fernandez E. Psychology, pain and anaesthesia. Behav Res Ther. 1995;33(3):357.CrossRefGoogle Scholar
  46. 46.
    Park E, Oh H, Kim T. The effects of relaxation breathing on procedural pain and anxiety during burn care. Burns. 2013;39(6):1101–6.CrossRefGoogle Scholar
  47. 47.
    Hirsh AT, et al. The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. J Pain. 2015;16(6):558–68.CrossRefGoogle Scholar
  48. 48.
    Ballantyne JC, Sullivan MD, Kolodny A. Opioid dependence vs addiction: a distinction without a difference? Arch Intern Med. 2012;172(17):1342–3.CrossRefGoogle Scholar
  49. 49.
    von Zastrow M, et al. Regulated endocytosis of opioid receptors: cellular mechanisms and proposed roles in physiological adaptation to opiate drugs. Curr Opin Neurobiol. 2003;13(3):348–53.CrossRefGoogle Scholar
  50. 50.
    Weissman DE. Is it pain or addiction? #68. J Palliat Med. 2005;8(6):1282–3.CrossRefGoogle Scholar
  51. 51.
    Wolfert MZ, et al. Opioid analgesics for pain control: Wisconsin physicians' knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11(3):425–34.CrossRefGoogle Scholar
  52. 52.
    Guntz E, et al. Opioid-induced hyperalgesia. Eur J Anaesthesiol. 2007;24(2):205–7.PubMedGoogle Scholar
  53. 53.
    Pasero C, McCaffery M. Opioid-induced hyperalgesia. J Perianesth Nurs. 2012;27(1):46–50.CrossRefGoogle Scholar
  54. 54.
    Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991–1004.CrossRefGoogle Scholar
  55. 55.
    Weissman DE, Haddox JD. Opioid pseudoaddiction--an iatrogenic syndrome. Pain. 1989;36(3):363–6.CrossRefGoogle Scholar
  56. 56.
    Huang AR, et al. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging. 2012;29(5):359–76.CrossRefGoogle Scholar
  57. 57.
    Newshan G. Pain management in the addicted patient: practical considerations. Nurs Outlook. 2000;48(2):81–5.CrossRefGoogle Scholar
  58. 58.
    BenDebba M, Torgerson WS, Long DM. Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain. 1997;72(1–2):115–25.CrossRefGoogle Scholar
  59. 59.
    Dunn LK, et al. Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. J Neurosurg Spine. 2018;28(1):119–26.CrossRefGoogle Scholar
  60. 60.
    Khan RS, et al. Catastrophizing: a predictive factor for postoperative pain. Am J Surg. 2011;201(1):122–31.CrossRefGoogle Scholar
  61. 61.
    Poppe C, et al. Personality traits in chronic pain patients are associated with low acceptance and catastrophizing about pain. Acta Clin Belg. 2011;66(3):209–15.PubMedGoogle Scholar
  62. 62.
    Katz J, et al. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.CrossRefGoogle Scholar
  63. 63.
    Mudumbai SC, et al. Time-to-cessation of postoperative opioids: a population-level analysis of the veterans affairs health care system. Pain Med. 2016;17(9):1732–43.CrossRefGoogle Scholar
  64. 64.
    Thomazeau J, et al. Acute pain factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement. Eur J Pain. 2016;20(5):822–32.CrossRefGoogle Scholar
  65. 65.
    Clarke H, et al. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251.CrossRefGoogle Scholar
  66. 66.
    Sun EC, et al. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286–93.CrossRefGoogle Scholar
  67. 67.
    Perkins FM, Kehlet H. Chronic pain as an outcome of surgery - a review of predictive factors. Anesthesiology. 2000;93(4):1123–33.CrossRefGoogle Scholar
  68. 68.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA. 2016;315(15):1624–45.CrossRefGoogle Scholar
  69. 69.
    Ruhm CJ. Drug poisoning deaths in the United States, 1999–2012: a statistical adjustment analysis. Popul Health Metrics. 2016;14:2.CrossRefGoogle Scholar
  70. 70.
    Bicket MC, et al. Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017;152(11):1066–71.CrossRefGoogle Scholar
  71. 71.
    Hoffmann DE, Tarzian AJ. Achieving the right balance in oversight of physician opioid prescribing for pain: the role of state medical boards. J Law Med Ethics. 2003;31(1):21–40.CrossRefGoogle Scholar
  72. 72.
    Reifler LM, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Med. 2012;13(3):434–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychiatryYale UniversityNew HavenUSA

Personalised recommendations