Skip main navigation

Psychological risk factors

We discuss the psychological risk factors associated with the development of CPSP and how this relates to PPOU

In this step, Dr Kelley Corcoran, Consultant Clinical Psychologist and Clinical Lead for the UCLH Complex Pain Team, discusses the psychological risk factors associated with the development of chronic post-surgical pain (CPSP) and how this relates to persistent post-operative opioid use (PPOU).

Preoperative anxiety and catastrophising are important risk factors for the development of CPSP and PPOU.

There is some evidence that addressing preoperative anxiety and catastrophising through psychological approaches such as acceptance and commitment therapy (ACT) may be of value in reducing CPSP and PPOU [1].

The role of techniques such a mindfulness-based meditation, which have been shown to be valid adjuncts in the management of chronic pain, have been studied less well in acute pain, and the studies which do exist are of low quality, but do demonstrate some promise in reducing analgesic requirement, pain intensity and anxiety [2].


1. Dindo L, Zimmerman MB, Hadlandsmyth K, et al. Acceptance and Commitment Therapy for Prevention of Chronic Postsurgical Pain and Opioid Use in At-Risk Veterans: A Pilot Randomized Controlled Study. J Pain 2018;19:1211–21.

2. Edwards DA, Hedrick TL, Jayaram J, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy. Anesth Analg 2019;129:553–66.

This article is from the free online

Opioids and Surgery

Created by
FutureLearn - Learning For Life

Reach your personal and professional goals

Unlock access to hundreds of expert online courses and degrees from top universities and educators to gain accredited qualifications and professional CV-building certificates.

Join over 18 million learners to launch, switch or build upon your career, all at your own pace, across a wide range of topic areas.

Start Learning now