Advertisement

Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders

  • 14 Accesses

Abstract

Purpose of Review

This review summarizes selected recent evidence on issues important for preoperative pain evaluation.

Recent Findings

Opioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.

Summary

Preoperative pain and psychological factors can affect postoperative pain outcomes. More work is needed in the future to develop practical interventions in the preoperative period to address these factors.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Rachel H. Postoperative pain control. In: Kramer J, editor. . Treasure Island: StatPearls; 2019.

  2. 2.

    Philip BK, Reese PR, Burch SP. The economic impact of opioids on postoperative pain management. J Clin Anesth. 2002;14(5):354–64.

  3. 3.

    Peden CJ, Mythen MG, Vetter TR. Population health management and perioperative medicine: the expanding role of the anesthesiologist. Anesth Analg. 2018;126(2):397–9. https://doi.org/10.1213/ANE.0000000000002750.

  4. 4.

    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–69. https://doi.org/10.1377/hlthaff.27.3.759.

  5. 5.

    Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol. 2017;56(2):295–300. https://doi.org/10.1080/0284186X.2016.1268268.

  6. 6.

    Minkowitz HS, Gruschkus SK, Shah M, Raju A. Adverse drug events among patients receiving postsurgical opioids in a large health system: risk factors and outcomes. Am J Health Syst Pharm. 2014;71(18):1556–65. https://doi.org/10.2146/ajhp130031.

  7. 7.

    Shafi S, Collinsworth AW, Copeland LA, Ogola GO, Qiu T, Kouznetsova M, et al. Association of Opioid-Related Adverse Drug Events with Clinical and Cost Outcomes among Surgical Patients in a large integrated health care delivery system. JAMA Surg. 2018;153(8):757–63. https://doi.org/10.1001/jamasurg.2018.1039.

  8. 8.

    Urman RD, Seger DL, Fiskio JM, Neville BA, Harry EM, Weiner SG, et al. The burden of opioid-related adverse drug events on hospitalized previously opioid-free surgical patients. J Patient Saf. 2019. https://doi.org/10.1097/PTS.0000000000000566.

  9. 9.

    Morris BJ, Sciascia AD, Jacobs CA, Edwards TB. Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty. J Shoulder Elb Surg. 2016;25(4):619–23. https://doi.org/10.1016/j.jse.2015.09.017.

  10. 10.

    Sing DC, Barry JJ, Cheah JW, Vail TP, Hansen EN. Long-acting opioid use independently predicts perioperative complication in Total joint Arthroplasty. J Arthroplast. 2016;31(9 Suppl):170–4 e1. https://doi.org/10.1016/j.arth.2016.02.068.

  11. 11.

    Faour M, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, et al. Neck pain, preoperative opioids, and functionality after cervical fusion. Orthopedics. 2017;40(1):25–32. https://doi.org/10.3928/01477447-20161013-02.

  12. 12.

    Waljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM. Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery. Ann Surg. 2017;265(4):715–21. https://doi.org/10.1097/SLA.0000000000002117.

  13. 13.

    Cron DC, Englesbe MJ, Bolton CJ, Joseph MT, Carrier KL, Moser SE, et al. Preoperative opioid use is independently associated with increased costs and worse outcomes after major abdominal surgery. Ann Surg. 2017;265(4):695–701. https://doi.org/10.1097/SLA.0000000000001901.

  14. 14.

    Hilliard PE, Waljee J, Moser S, Metz L, Mathis M, Goesling J, et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery. JAMA Surg. 2018. https://doi.org/10.1001/jamasurg.2018.2102.

  15. 15.

    Weick J, Bawa H, Dirschl DR, Luu HH. Preoperative opioid use is associated with higher readmission and revision rates in Total knee and Total hip Arthroplasty. J Bone Joint Surg Am. 2018;100(14):1171–6. https://doi.org/10.2106/JBJS.17.01414.

  16. 16.

    Blevins Peratikos M, Weeks HL, Pisansky AJB, Yong RJ, Stringer EA. Effect of preoperative opioid use on adverse outcomes, medical spending, and persistent opioid use following elective Total joint Arthroplasty in the United States: a large retrospective cohort study of administrative claims data. Pain Med. 2019. https://doi.org/10.1093/pm/pnz083.

  17. 17.

    Ben-Ari A, Chansky H, Rozet I. Preoperative opioid use is associated with early revision after Total knee Arthroplasty: a study of male patients treated in the veterans affairs system. J Bone Joint Surg Am. 2017;99(1):1–9. https://doi.org/10.2106/JBJS.16.00167.

  18. 18.

    Dasinger EA, Graham LA, Wahl TS, Richman JS, Baker SJ, Hawn MT, et al. Preoperative opioid use and postoperative pain associated with surgical readmissions. Am J Surg. 2019. https://doi.org/10.1016/j.amjsurg.2019.02.033.

  19. 19.

    Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. https://doi.org/10.1001/jamasurg.2017.0504.

  20. 20.

    • Sun EC, Darnall BD, Baker LC, Mackey S. 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. https://doi.org/10.1001/jamainternmed.2016.3298This retrospective study characterized incidence and risk factors for persistent opioid use after surgery.

  21. 21.

    Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149–60. https://doi.org/10.1185/03007995.2013.860019.

  22. 22.

    Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–44. https://doi.org/10.1097/ALN.0b013e31828866b3.

  23. 23.

    Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–45. https://doi.org/10.1097/ALN.0000000000000108.

  24. 24.

    Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain. 2003;105(3):415–23. https://doi.org/10.1016/s0304-3959(03)00252-5.

  25. 25.

    Tighe PJ, Le-Wendling LT, Patel A, Zou B, Fillingim RB. Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery. Pain. 2015;156(4):609–17. https://doi.org/10.1097/01.j.pain.0000460352.07836.0d.

  26. 26.

    Hah JM, Cramer E, Hilmoe H, Schmidt P, McCue R, Trafton J, et al. Factors associated with acute pain estimation, postoperative pain resolution, opioid cessation, and recovery: secondary analysis of a randomized clinical trial. JAMA Netw Open. 2019;2(3):e190168. https://doi.org/10.1001/jamanetworkopen.2019.0168.

  27. 27.

    Patanwala AE, Jarzyna DL, Miller MD, Erstad BL. Comparison of opioid requirements and analgesic response in opioid-tolerant versus opioid-naive patients after total knee arthroplasty. Pharmacotherapy. 2008;28(12):1453–60. https://doi.org/10.1592/phco.28.12.1453.

  28. 28.

    Chapman CR, Davis J, Donaldson GW, Naylor J, Winchester D. Postoperative pain trajectories in chronic pain patients undergoing surgery: the effects of chronic opioid pharmacotherapy on acute pain. J Pain. 2011;12(12):1240–6. https://doi.org/10.1016/j.jpain.2011.07.005.

  29. 29.

    Aasvang EK, Lunn TH, Hansen TB, Kristensen PW, Solgaard S, Kehlet H. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty. Acta Anaesthesiol Scand. 2016;60(4):529–36. https://doi.org/10.1111/aas.12667.

  30. 30.

    Dunn LK, Durieux ME, Fernandez LG, Tsang S, Smith-Straesser EE, Jhaveri HF, 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. https://doi.org/10.3171/2017.5.SPINE1734.

  31. 31.

    Schreiber KL, Zinboonyahgoon N, Xu X, Spivey T, King T, Dominici L, et al. Preoperative psychosocial and psychophysical phenotypes as predictors of acute pain outcomes after breast surgery. J Pain. 2019;20(5):540–56. https://doi.org/10.1016/j.jpain.2018.11.004.

  32. 32.

    Sipila RM, Haasio L, Meretoja TJ, Ripatti S, Estlander AM, Kalso EA. Does expecting more pain make it more intense? Factors associated with the first week pain trajectories after breast cancer surgery. Pain. 2017;158(5):922–30. https://doi.org/10.1097/j.pain.0000000000000859.

  33. 33.

    Bayman EO, Parekh KR, Keech J, Larson N, Vander Weg M, Brennan TJ. Preoperative patient expectations of postoperative pain are associated with moderate to severe acute pain after VATS. Pain Med. 2019;20(3):543–54. https://doi.org/10.1093/pm/pny096.

  34. 34.

    Simanski CJ, Althaus A, Hoederath S, Kreutz KW, Hoederath P, Lefering R, et al. Incidence of chronic postsurgical pain (CPSP) after general surgery. Pain Med. 2014;15(7):1222–9. https://doi.org/10.1111/pme.12434.

  35. 35.

    Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol. 2015;32(10):725–34. https://doi.org/10.1097/EJA.0000000000000319.

  36. 36.

    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25. https://doi.org/10.1016/S0140-6736(06)68700-X.

  37. 37.

    Chidambaran V, Gang Y, Pilipenko V, Ashton M, Ding L. Systematic review and meta-analysis of genetic risk of developing chronic postsurgical pain. J Pain. 2019. https://doi.org/10.1016/j.jpain.2019.05.008.

  38. 38.

    Althaus A, Hinrichs-Rocker A, Chapman R, Arranz Becker O, Lefering R, Simanski C, et al. Development of a risk index for the prediction of chronic post-surgical pain. Eur J Pain. 2012;16(6):901–10. https://doi.org/10.1002/j.1532-2149.2011.00090.x.

  39. 39.

    Masselin-Dubois A, Attal N, Fletcher D, Jayr C, Albi A, Fermanian J, et al. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain. 2013;14(8):854–64. https://doi.org/10.1016/j.jpain.2013.02.013.

  40. 40.

    Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2015;114(4):551–61. https://doi.org/10.1093/bja/aeu441.

  41. 41.

    Rasouli MR, Menendez ME, Sayadipour A, Purtill JJ, Parvizi J. Direct cost and complications associated with Total joint Arthroplasty in patients with preoperative anxiety and depression. J Arthroplast. 2016;31(2):533–6. https://doi.org/10.1016/j.arth.2015.09.015.

  42. 42.

    Menendez ME, Neuhaus V, Bot AG, Ring D, Cha TD. Psychiatric disorders and major spine surgery: epidemiology and perioperative outcomes. Spine (Phila Pa 1976). 2014;39(2):E111–22. https://doi.org/10.1097/BRS.0000000000000064.

  43. 43.

    Zemła AJ, Nowicka-Sauer K, Jarmoszewicz K, Wera K, Batkiewicz S, Pietrzykowska M. Measures of preoperative anxiety. Anaesthesiol Intensive Ther. 2019;51(1):64–9. https://doi.org/10.5603/AIT.2019.0013.

  44. 44.

    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

  45. 45.

    Sullivan M. The Pain Catastrophizing Scale. User manual. Montreal: McGill University; 2009.

  46. 46.

    Darnall BD, Sturgeon JA, Cook KF, Taub CJ, Roy A, Burns JW, et al. Development and validation of a daily Pain Catastrophizing Scale. J Pain. 2017;18(9):1139–49. https://doi.org/10.1016/j.jpain.2017.05.003.

  47. 47.

    Webster LR. Risk factors for opioid-use disorder and overdose. Anesth Analg. 2017;125(5):1741–8. https://doi.org/10.1213/ANE.0000000000002496.

  48. 48.

    Akbik H, Butler SF, Budman SH, Fernandez K, Katz NP, Jamison RN. Validation and clinical application of the screener and opioid assessment for patients with pain (SOAPP). J Pain Symptom Manag. 2006;32(3):287–93. https://doi.org/10.1016/j.jpainsymman.2006.03.010.

  49. 49.

    Stessel B, Fiddelers AA, Marcus MA, van Kuijk SM, Joosten EA, Peters ML, et al. External validation and modification of a predictive model for acute postsurgical pain at home after day surgery. Clin J Pain. 2017;33(5):405–13. https://doi.org/10.1097/AJP.0000000000000413.

  50. 50.

    Tighe PJ, Harle CA, Hurley RW, Aytug H, Boezaart AP, Fillingim RB. Teaching a machine to feel postoperative pain: combining high-dimensional clinical data with machine learning algorithms to forecast acute postoperative pain. Pain Med. 2015;16(7):1386–401. https://doi.org/10.1111/pme.12713.

  51. 51.

    Powell R, Scott NW, Manyande A, Bruce J, Vogele C, Byrne-Davis LM, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;5:CD008646. https://doi.org/10.1002/14651858.CD008646.pub2.

  52. 52.

    Rolving N, Nielsen CV, Christensen FB, Holm R, Bunger CE, Oestergaard LG. Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients. BMC Musculoskelet Disord. 2016;17:217. https://doi.org/10.1186/s12891-016-1078-8.

  53. 53.

    Yi JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS, et al. The impact of preoperative mindfulness-based stress reduction on postoperative patient-reported pain, disability, quality of life, and prescription opioid use in lumbar spine degenerative disease: a pilot study. World Neurosurg. 2018. https://doi.org/10.1016/j.wneu.2018.09.223.

  54. 54.

    Aronson S, Westover J, Guinn N, Setji T, Wischmeyer P, Gulur P, et al. A perioperative medicine model for population health: an integrated approach for an evolving clinical science. Anesth Analg. 2018;126(2):682–90. https://doi.org/10.1213/ANE.0000000000002606.

  55. 55.

    Bair E, Ohrbach R, Fillingim RB, Greenspan JD, Dubner R, Diatchenko L, et al. Multivariable modeling of phenotypic risk factors for first-onset TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T102–15. https://doi.org/10.1016/j.jpain.2013.09.003.

  56. 56.

    •• Edwards DA, Hedrick TL, Jayaram J, Argoff C, Gulur P, Holubar SD, 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(2):553–66. https://doi.org/10.1213/ANE.0000000000004018American Society for Enhanced Recovery and Perioperative Quality Initiative publication on perioperative management of patients on preoperative opioids.

  57. 57.

    Nguyen LC, Sing DC, Bozic KJ. Preoperative reduction of opioid use before Total joint Arthroplasty. J Arthroplast. 2016;31(9 Suppl):282–7. https://doi.org/10.1016/j.arth.2016.01.068.

  58. 58.

    Ward EN, Quaye AN, Wilens TE. Opioid use disorders: perioperative Management of a Special Population. Anesth Analg. 2018;127(2):539–47. https://doi.org/10.1213/ANE.0000000000003477.

  59. 59.

    Curatolo C, Trinh M. Challenges in the perioperative management of the patient receiving extended-release naltrexone. A A Case Rep. 2014;3(11):142–4. https://doi.org/10.1213/XAA.0000000000000069.

  60. 60.

    Israel JS, Poore SO. The clinical conundrum of perioperative pain management in patients with opioid dependence: lessons from two cases. Plast Reconstr Surg. 2013;131(4):657e–8e. https://doi.org/10.1097/PRS.0b013e31828277bd.

  61. 61.

    Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To stop or not, that is the question: acute pain Management for the Patient on chronic buprenorphine. Anesthesiology. 2017;126(6):1180–6. https://doi.org/10.1097/ALN.0000000000001633.

  62. 62.

    Lembke A, Ottestad E, Schmiesing C. Patients maintained on buprenorphine for opioid use disorder should continue buprenorphine through the perioperative period. Pain Med. 2019;20(3):425–8. https://doi.org/10.1093/pm/pny019.

  63. 63.

    •• Goel A, Azargive S, Weissman JS, Shanthanna H, Hanlon JG, Samman B, et al. Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process. Br J Anaesth. 2019;123(2):e333–e42. https://doi.org/10.1016/j.bja.2019.03.044The most recent advisory on perioperative management of buprenorphine.

  64. 64.

    Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019;66(2):201–17. https://doi.org/10.1007/s12630-018-1255-3.

Download references

Author information

Correspondence to Jeanna Blitz.

Ethics declarations

Conflict of Interest

Lisa V. Doan and Jeanna Blitz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Preoperative Evaluation.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Doan, L.V., Blitz, J. Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders. Curr Anesthesiol Rep (2020). https://doi.org/10.1007/s40140-020-00367-9

Download citation

Keywords

  • Opioids
  • Catastrophizing
  • Anxiety
  • Postoperative pain