Study Links Patients' Optimism with Degree of Pain Experienced

In a first-of-its-kind study published in the November 2008 Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society (www.aofas.org), the expectation of orthopedic post-operative pain was directly correlated with the actual incidence of pain following foot and ankle surgery.

According to the study, orthopedic procedures have been reported to have the highest incidence of pain compared to other types of operations. The study's lead author, AOFAS member Loretta B. Chou, M.D., an orthopedic foot and ankle surgeon in the Department of Orthopaedic Surgery at Stanford University Medical Center, conducted, along with her associates, a prospective study of 98 patients undergoing orthopedic foot and ankle operations at the same hospital. The goal of the research was to evaluate each patient's pain experience both preoperatively and postoperatively.

Surgeries were a mixture of inpatient and outpatient procedures, on both male and female patients, with the average age being 46.5 years. The patients were given a Short-Form McGill Pain Questionnaire (SF-MPQ) before and after surgery to evaluate their levels of pain at both times. The SF-MPQ is is a patient questionnaire with three questions concerning pain. It consists of 15 pain descriptors, the Present Pain Intensity index, and a visual analogue scale for pain. The study suggests that the expectation of pain going into surgery may contribute to its subsequent occurrence.

"Our hypothesis that anticipated pain would predict postoperative pain experience was based on preliminary studies that show that expectation of pain modulates changes in the brain," Chou said. "This may be the brain sending projections to the spinal cord that increases pain signals. To make a long story short, we found that believing there will be pain after surgery leads to just that, pain."

Results showed that pain severity was highest following foot and ankle surgery at the 3-Day Post-Operative Pain assessment whereas, six weeks after surgery, the majority of patients felt little or no pain. The early pain was even greater than that anticipated by the patients, and the severity of preoperative pain was highly predictive of the group's anticipated postoperative pain as well as their level of pain at 6-weeks after surgery, the study found. It was also important that both preoperative pain and anticipated pain predicted higher immediate postoperative pain following foot and ankle operations. Similar research, published in the July 2008 issue of the Journal of Pain and Symptom Management, found that cancer patients who had a more optimistic outlook experienced less severe pain.

"While we cannot isolate the exact cause, optimistic patients suffered much less postoperative pain than their pessimistic counterparts," Chou said. "This result may demonstrate that patients are good at predicting pain, or that their expectation of greater pain may contribute to its subsequent occurrence." Chou noted that a criticism of the findings is that all types of foot and ankle procedures were included in the study but added that future studies are already underway, one focusing solely on ankle fractures and the other on the removal of hardware from the foot and ankle.

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