Catastrophic thinking about pain increases discomfort during internal atrial cardioversion.
OBJECTIVE
This study investigated whether pain catastrophizing is associated with distress and perceived disability in patients with atrial fibrillation, whether pain catastrophizing predicts pain and fear during a medical procedure of atrial cardioversion, and whether pain catastrophizing influences the effects of an opioid analgesic during internal cardioversion.


METHODS
A secondary analysis is performed upon data from a double-blind placebo-controlled trial during which the effect of intranasal butorphanol tartrate (INB) was evaluated in patients with atrial fibrillation using a step-up internal atrial cardioversion protocol. Before the procedure, patients completed measures of pain catastrophizing, mood, distress and perceived disability. After each shock, patients completed measures of pain and fear.


RESULTS
We found that pain catastrophizing predicted the affective pain rating of the first shock, and the fear increase during subsequent shocks. There was no effect of INB. However, when controlling for the differences in pain catastrophizing, INB significantly reduced fear as compared to placebo. This suggests that the effects of INB during atrial cardioversion were overshadowed by the effects of pain catastrophizing.


CONCLUSIONS
It is recommended that in future atrial cardioversion trials, stratification based on pain catastrophizing be performed. Reducing catastrophizing thinking about pain through cognitive-behavioral techniques are likely to reduce levels of fear during internal atrial cardioversion and may increase the effectiveness of concomitant analgesics.
Vlaeyen
Johan W S
JW
Department of Cardiology, Hospital Maastricht, PO Box 5800, Maastricht, The Netherlands. j.vlaeyen@dep.unimass.nl
Timmermans
Carl
C
Rodriguez
Luz-Maria
LM
Crombez
Geert
G
van Horne
Wendy
W
Ayers
Gregory M
GM
Albert
Adelin
A
Wellens
Hein J J
HJ
D000328:Adult; D001281:Atrial Fibrillation / Q000628:therapy*; D001294:Attitude to Health; D004185:Disability Evaluation; D004311:Double-Blind Method; D004554:Electric Countershock / Q000295:instrumentation*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000523:psychology*; D011594:Psychometrics; D012803:Sick Role; D011795:Surveys and Questionnaires; D013850:Thinking