Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis

Due to the frequency of surgeries, acute postsurgical pain (APSP) is a common problem. However, the role of psychological factors in the experience of this kind of pain has not been well established. In this review, we focused on presurgical psychological factors associated with the experience of APSP. A systematic search of articles was performed using PsycARTICLES, PsycINFO, PubMed, MEDLINE, Scopus, Cochrane and DARE. For each study, we assessed the risk of bias, the level of evidence, the corresponding score points and the degree of association with APSP. Separate meta-analyses were performed for the selected variables. Fifty-three relevant publications were selected. Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety (state and trait), negative affect and depression were classified as likely associated with APSP. Only one of the analysed psychological variables - locus of control - was recognized as shown unlikely association with APSP. Results of meta-analyses suggested that pain catastrophizing was most strongly linked with APSP. Results of the studies reviewed suggest that patients who do not exaggerate the negative aspects of the situation and who have positive expectation of the future before undergoing surgery report lower levels of APSP than patients who catastrophize pain and expect negative events in the future. An increasing interest in preoperative positive psychological variables has been observed over the last few years in studies of surgical patients. What does this review add? Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety (state and trait), negative affect and depression were classified as likely associated with acute postsurgical pain, and locus of control was classified as unlikely associated with acute postsurgical pain. Anxiety was the psychological variable most frequently measured before surgery. Pain catastrophizing was most strongly linked with acute postsurgical pain.