Psychological risk factors

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].

References

_{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.}